The inspection took place on 31 October 2017 and was unannounced. Ashley House is registered to provide residential care for older people, people with a physical disability or a sensory impairment. Ashley House specialises in the provision of dementia care for people. At the time of the inspection there were 36 people living at the service.

Rating at last inspection

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good.

Processes were in place to ensure people’s medicines were managed safely. People were safeguarded from the risk of abuse. Risks to people had been assessed and were managed safely. Sufficient staff were deployed in order to meet people’s needs.

Staff were provided with an effective induction, training, supervisions and annual appraisal to enable them to support people effectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were provided with a range of nutritious foods and drinks that met their needs. Staff ensured peoples’ healthcare needs were identified and met.

People experienced positive and caring relationships with staff. People were provided with information in a manner in which they could understand so they could make decisions. Staff ensured peoples’ privacy and dignity was upheld in the provision of their care.

The service continued to be outstandingly responsive in the innovative manner in which the needs of people living with dementia were met. Processes were in place to enable people to make a complaint or provide their feedback and this was used to improve the service.

People’s care was provided by staff who understood and applied the provider’s values of care in their work. There was good, clear leadership of the service. Processes were in place to monitor and improve the service provided.

Further information is in the detailed findings below.

When we visited there were 36 people using the service. We spoke with the registered manager, 3 members of staff and 10 people who use the service, or their relatives.

People were treated with respect and kindness by staff. If necessary, they were supported with their meals and there were a range of activities on offer both the in the home and in the wider community.

People’s needs were assessed and care was delivered to support people’s safety and welfare. Staff had a good understanding of people’s needs, and any changes were discussed at staff handovers. People’s care was reviewed and updated regularly. Positive feedback was received from people. One person said “The care here is marvellous.”

We found that staff were well supported with opportunities for training, development and review. Staff reported that they felt valued working at the service and they were familiar with the safeguarding procedures to keep people safe.

A relatives and residents survey was carried out annually. As a result of the last survey changes had been implemented such as including more salad on the menus and organising more day trips.

During our visit we spoke with five people who use the service, three relatives and a visiting healthcare professional.

All the people we spoke with said they enjoyed living at Ashley House. They all said they liked the staff as they were very helpful and kind.

One relative said “I just think it is excellent, the way staff talk to the residents. People are given care and respect.”

Another relative told us that the registered manager had come to meet her mother at her home prior to moving to Ashley House. The meeting had been used to assess her needs and had involved her mother discussing what care and support she wanted and what she liked or disliked.

All the people we spoke with said they felt the home was kept clean. One relative described the home as “spotless.”

People told us that staff responded promptly to their needs and in a manner which respected their dignity.

People told us that the food at the home was good and that there was a choice of menu.

Generally, those we spoke to were happy with the environment in which they lived, however one person told us that at times there was an unplesent odour in the home.

People told us they felt safe at the home and they told us that the care provided at the home was good. They said that they were happy living at the home and that the staff looked after them well.

Relatives informed us that staff kept them up to date in respect of their relatives’ care and any changes required. They told us that the staff were polite, attentive, kind and caring. However they did, say that at times, communication between staff on a shift to shift basis could be better.

We were told by people that they believed there were enough staff working at the home and that staff had the skills to provide the care and support they required.

The inspection took place on 12 and 14 October 2015 and was unannounced. Ashley House is registered to provide residential care for older people many of whom experience dementia, people with a physical disability or a sensory impairment. At the time of the inspection there were 33 people living at the service.

The service had a registered manager. 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’s medicines were stored safely. Staff had worked with professionals to ensure people only took medicines they required and had followed national guidance to ensure medicines were not used to control people’s behaviours. However, there had been an incident where procedures in relation to the administration and recording of medicines controlled under the Misuse of Drugs Act 1971 had not been followed to ensure people’s safety. The registered manager had also accepted evidence from a new staff member of their previous medicines training rather than ensuring that they had completed and passed the provider’s approved medicines training before administering people’s medicines. The failure to follow medicines procedures had placed people at risk of not receiving their medicines correctly.

People and relatives told us the service was safe. Staff had undergone relevant training and understood their role in relation to safeguarding people and the actions they should take to keep people safe from the risk of abuse.

There were processes in place to ensure risks to people had been assessed and action had been taken to manage any identified risks. Staff had been allocated to people, in order to check upon their welfare across the course of the day. Where incidents occurred they were documented, reported, investigated and reviewed to identify if any further action was required to keep people safe. Relevant checks were undertaken in relation to the environment to ensure people’s safety.

The registered manager aimed to provide a good level of staffing to meet people’s needs. Four staff had left the service in August 2015 when the army left the area. This had resulted in a reduction in staffing levels on some shifts, especially at weekends. There had still been sufficient staff deployed to meet peoples’ care needs. The registered manager had taken swift action to replace these staff and to enable them to staff the service at the usual staffing level. Recruitment checks had been completed to ensure staff were suitable for their role.

Staff underwent the industry standard induction when they commenced work for the provider. Staff had been required to undertake a range of training and underwent additional face to face dementia care training to ensure they had the skills to support people effectively. Staff had been encouraged to undertake professional qualifications. Staff told us they adequately supported in their role. People’s care was provided by staff who had the required skills to support people effectively.

Where people lacked the mental capacity to make specific decisions, staff were guided by the principles of the Mental Capacity Act 2005. This ensured any decisions made were in the person’s best interests. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLs applications had been submitted for people where required. People’s liberty was only restricted where this was legally authorised.

Risks to people from malnutrition were managed effectively. People’s weight was monitored. A range of nutritious foods was available to them across the course of the day. People were supported by staff to have positive mealtime experiences and were enabled to make choices about their meals. Staff rosters were organised to ensure staff were available to support people with their meals.

People were supported by staff to access a range of health care professionals as required in response to their identified health care needs. Staff had good working relationships with external health care professionals.

People told us they found the staff to be caring towards them. Staff treated people with dignity and respect when they provided their care. Staff had developed positive and caring relationships with people and interacted with them in a kindly, unrushed manner. People were continually offered choices about their care and supported by staff to express themselves. Staff ensured people were able to exercise their independence.

People’s care needs were assessed prior to them being admitted to the service. People and their relatives were involved in on-going reviews of their care.

The service was outstanding in their flexibility and responsiveness to the individual needs and preferences of people living with dementia, finding creative ways to enable people to live as full a life as possible. In addition to the scheduled range of activities. People had been provided with innovative and varied opportunities to engage in activities which they could initiate for themselves. Throughout the service there were items for people to touch, hold, look at and things for them to do. Staff had ensured the environment was arranged in response to people’s needs for different activities and spaces depending on their mood. People were provided with a range of purposeful activities which stimulated them and enriched their lives.

Staff had formed links with the local community and there was a weekly session so people who were living in the community with dementia and their carers could come in and share a cup of tea and a chat with people. Staff had also worked with a charity to enable people to be involved in their own theatrical production. People were innovatively enabled to engage with the outside world.

The provider had a process in place to enable people to make complaints, none had been received. The registered manager held regular resident’s meetings to seek people’s views on the service. People were consulted on a range of everyday issues such as the quality of the meals. Their views were sought about proposed projects. Changes had been made to the service as a result of people’s feedback from these meetings.

The provider required staff to apply their principles of care in the provision of people’s care. Staff were observed throughout the inspection to apply these in their work and interactions with people.

The registered manager was accessible to people and their relatives. They were sited where they could monitor the culture of the service. The registered manager knew people and their relatives. They were supported in their role by the regional manager and there were plans to further strengthen the management team with the planned appointment of a deputy manager. The service was well led for people.

The provider had processes in place to regularly monitor the quality of the service people received. When areas for improvement had been identified through these processes action had been taken to ensure they were addressed for people.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.