We carried out an unannounced comprehensive inspection of Ashlands Manor Care Centre (Ashlands Manor) on 09 and 11 May 2018. Since this inspection we received concerns in relation to staffing levels, and management of end of life care. As a result, we undertook a focused, unannounced inspection to look into those concerns. This report only covers our findings in relation to the key questions of whether the service was safe, responsive and well-led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashlands Manor Care Centre on our website at www.cqc.org.uk

This inspection was carried out on 18 and 19 December 2018. At our last inspection in May 2018, we found the service was meeting the fundamental standards, and we rated it good overall. At this inspection, the service continued to meet the fundamental standards, and the rating remained good overall, and the rating for safe improved from requires improvement to good.

Ashlands Manor is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is a purpose-built home which can accommodate up to 57 people over three floors. All rooms are en-suite and each floor had its own separate facilities. The ground floor supports people requiring support with personal care, the first floor supports people living with dementia and the second floor supports people who need nursing care. There were 55 people living at the home at the time of our inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There had been no change in registered manager since our last inspection.

No-one was receiving end of life care at the time of our inspection. However, we found there were systems and procedures in place to help ensure the service was prepared to provide effective end of life care when needed that followed good practice guidance.

Nurses employed by the home had received training in how to use specialist equipment that might be needed when providing end of life care. At the time of our inspection, staff had not received any general end of life training. However, we found they were aware of good practice and procedures and were aware of where they could seek additional support and advice from, if needed.

The service regularly used agency nurses, and occasional agency care staff. The registered manager had information about their training and qualifications that allowed them to check they had the appropriate skills and experience to meet the needs of people living at the home.

Where possible, the service used the same agency staff to improve consistency. However, at the time of our inspection, the regular agency nurses were on leave, and the nurse on duty on both days of the inspection had not worked at the service before. We spoke with the agency nurses who told us they felt they had received adequate handovers and inductions to the service to allow them to understand their responsibilities and the needs of people living at the home.

We found there were sufficient staff on duty to meet people’s needs. Some staff said they could be ‘pressured’ at certain busy times of the day, which was also our observation on the first-floor household that supported people living with dementia. However, we saw there were no significant delays to people receiving the care and support they needed.

The service used an electronic system to help manage medicines and record the administration of medicines. Staff told us they found the

We completed this inspection on the 9 and 11 May 2018 and the first day was unannounced. This was the first inspection at Ashlands Manor (known as Ashlands) since the service first registered with the Care Quality Commission (CQC) on 28 April 2017.

Ashlands is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ashlands is a purpose built home which can accommodate up to 57 people over three floors. All rooms are en-suite and each floor has its own separate facilities. The ground floor is a residential household, the first floor supports people living with dementia and the second floor supports people who need nursing care. There were 49 people living at the service at the time of our inspection.

There was a manager in place who was registered with the CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives thought they were safe living at Ashlands. The staff said they enjoyed working for the service and felt very well supported by registered manager.

People received their medicines as prescribed. A new electronic medicine administration record (eMAR) system had been introduced which prompted when medication was to be administered. Quantities of stock were checked each week; however we found stock balances on the eMAR system did not always tally with the physical stock held due to an issue with duplicate records in the eMAR system. The training manager was going to work with the dispensing pharmacist and eMAR supplier to identify the cause of the duplicate records.

Senior care staff differed in how they responded to any differences in stock balances found, with one investigating the reason for the discrepancy and one altering the quantity noted in the eMAR system. Additional training was to be provided on the eMAR system so all discrepancies were looked into.

Protocols for when any ‘as required’ medicines were to be administered were not sufficiently detailed. Additional information was added to the system during our inspection. Topical creams were applied by the care staff and recorded on a cream chart. However this chart had not been distributed to the rooms that needed one on the nursing unit in May. Cream charts for previous months had been completed on all floors.

Person centred care plans and risk assessments were in place. These provided guidance and information about people’s support needs, their likes, dislikes and preferences and how to mitigate the identified risks. The guidance for staff to distract people who had behaviours that may challenge the service varied in its detail. Staff we spoke with knew people and their needs well. Care files were reviewed each month. People and their families were involved in these reviews.

People were supported with their health and nutritional needs. Ashlands was part of a scheme where a GP visited the home each day. This meant any minor ailments could be raised with the GP with the aim of preventing them becoming more serious and reducing hospital admissions. Two health professionals we spoke with were complimentary about the support provided to maintain people’s health.

Staff thought there were sufficient staff on duty to meet people’s needs; although they thought a hospitality member of staff would be beneficial on the first floor as well as the ground and second floors. People and relatives we spoke with said they felt additional staff should be on duty. During our inspection we found sufficient staff were on duty and call bells were responded to in a timely manner. Daily ch