The inspection took place on 24 November 2016 and was unannounced.

Ashton Lodge Care Home provides accommodation and nursing care for up to 92 older people. There is a garden to the rear of the premises. A large car park area is located at the front. The service is located close to Brent Cross shopping centre and public transport facilities.

The current registered manager had been in post for six month. 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 told us they felt safe at the home. Each care file included a dependency tool to calculate the level of need for each individual. This was used to inform staffing levels to ensure there were sufficient staff deployed on each shift. There were sufficient staff deployed on the day of the inspection. The recruitment process was robust to help ensure suitable staff were employed at the service.

Appropriate policies were in place with regard to safeguarding and whistle blowing. Staff had received training in safeguarding and those we spoke with were aware of the issues and confident of the reporting procedure.

Medication systems were robust and medicines were managed safely at the service. Individual and general risk assessments were in place.

Equipment was fit for purpose and was regularly serviced and maintained to ensure it was in good working order.

The induction programme helped ensure new employees were equipped with the skills, knowledge and competence to work at the home. Training was on-going and mandatory training was refreshed regularly.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA). Deprivation of Liberty Safeguards (DoLS) authorisations were in place where required and staff were aware of the implications of these.

People's nutritional and hydration needs were assessed and recorded appropriately. Special diets were adhered to by the chef and people were given choice with regard to meals.

People we spoke with felt the care was good and staff were kind and caring. We observed good interactions between staff and people who used the service throughout the day. People who used the service and their families were involved in discussions about the delivery of their care. Staff respected people's dignity and privacy.

People who were nearing the end of their lives were cared for, as far as possible, in accordance with their wishes. Staff had undertaken appropriate training in end of life care and people's end of life care plans were thorough and comprehensive.

Care files we looked at evidenced that care was delivered in a person centred way, taking into account people's preferences, likes and dislikes. People we spoke with said staff responded quickly to call alarms.

There was a programme of activities at the home and people were encouraged to participate if they were able to. One to one interaction was undertaken with people who were unable to participate in group activities.

There was an appropriate complaints policy and this was displayed throughout the home. Concerns were responded to in a timely and appropriate manner and the service had received a number of compliments and thank you cards.

People told us the staff and management were approachable. Staff felt the registered manager was supportive towards them. Regular team meetings were held, and staff were given supervisions on a regular basis. Residents' and relatives' meetings were also in the process to be arranged for the beginning of December 2016.

We saw evidence of regular checks and audits that took place at the service to help ensure continuous improvement with regard to care delivery.

We carried out an unannounced comprehensive inspection of this service on 23rd and 31st October 2014. A breach of Regulation 13 Management of medicines of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 was found.

We undertook this focused inspection on 26 March 2015 to check and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashton Lodge Care Home on our website at www.cqc.org.uk.

Ashton Lodge Care home is registered to provide accommodation and nursing care for up to 92 older people, people with dementia and people with physical disabilities. Medicines were administered by registered nurses or trained senior support workers.

During our focused inspection on 26 March 2015 we found that the provider had taken the necessary steps to ensure that medicines were recorded, stored and administered safely.

Ashton Lodge Care Home provides accommodation for up to 92 people who require nursing, personal care and support. The home is able to support people with physical disabilities, sensory impairments, and dementia. The home specialises in care for people over 65 years of age. At the time of our inspection 84 people were using the service.

People who used the service and their relatives were happy with the service received. Staff treated people kindly and with compassion. Staff were aware of people’s likes, interests and preferences, and their care and support needs. The relatives we spoke with told us staff kept them informed of people’s progress and any changes in their health.

Staff felt well supported by their manager. The team worked together and colleagues supported each other. Staff felt the manager was accessible, approachable and provided good leadership.

A manager had been recently appointed. They had submitted an application to become the service’s registered manager and it was in the process of being reviewed at the time of drafting this report.

In general, people felt safe at the service. Staff were knowledgeable in recognising signs of potential abuse and concerns were appropriately reported. We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards.

Risk assessments and care plans were in place. However, we found that many of them lacked detail and there were some inaccuracies in the information recorded in people’s care records, particularly around pressure ulcer care, continence care and monitoring of food and fluid intake. This meant we could not be assured that care was always tailored to people’s individual needs and that preventative measures were put in place to protect people’s welfare and safety.

There was a lack of stimulation and activities on offer at the service. The activities that were on offer were not always tailored to people’s interests and there was a risk that people may become socially isolated. Activities were mainly task based and there was little interaction between staff and people who used the service outside of this. We found at times people were not treated with dignity and respect, during mealtimes and toileting.

Systems were in place to monitor and assess the quality of service provision. However, we were unable to evidence that appropriate action was taken in response to areas identified as requiring improvement through these systems.

The problems we found breached health and social care regulations and you can see what action we told the provider to take at the back of the full version of the report.

We spoke with ten people who used the service, three relatives, eight members of staff, the clinical lead and the manager. We viewed and assessed six care plans, medication adminstration records and other documents we requested during our inspection.

The people we spoke with told us that they were being well cared for and well looked after. One person said "I like living here. The staff are good and so is the food." Another person said "I join in the activities sometimes but I like watching the television. I like the food and the staff are helpful." Another person told us "The nurses are truly excellent, very caring, kind and a good laugh." Another comment made by a person "I would give the home ten out of ten, it is wonderful here."

One relative told us "We looked at six care homes, before we finally chose Ashton Lodge. The place is a god send, my relative has settled down and the behaviour has improved."

We found that the home was meeting the standards we inspected. People's privacy and dignity were respected. They received care and treatment that met their needs. There was a system for the safe management and administration of medicines and staff had been provided with relevant training and regular supervision so that they were competent in their roles.

There was a system to assess and monitor the quality of service. People's and their relatives' views had been sought, listened to and acted on.

We carried out an unannounced inspection following the compliance action that we had made at the time of our previous inspection that took place on the 19 February 2013. During that inspection we had found that the pre admission assessments lacked information about people’s behaviours and that there was a lack of information about people’s dementia needs.

During this follow up inspection we spoke with three people using the services, two relatives and four members of staff but on this occasion focused on whether the provider had met the compliance action in respect of Outcome 4 Care and welfare of people who use services, Regulation 9 (HSCA 2008 Regulated Activities) Regulations 2010.

We also looked at Outcome 13 Staffing, Regulation 22 (HSCA 2008 Regulated Activities) Regulations 2010 following concerns raised regarding staffing levels and Outcome 14 Supporting workers Regulation 23 (HSCA 2008 Regulated Activities) Regulations 2010 due to a recent change in management at the home.

At this inspection we found that the provider had taken proper steps to ensure that pre admission assessments had information about people’s behaviours. We also found that a dementia assessment had been carried out in respect of four care plans we looked at, which included details of people’s history, interests and social links. We noted that there was a variety of activities and that people were encouraged to participate.

You can see our judgements on the front page of this report.

We spoke with six people who use the service, eleven staff including care workers and nurses, two relatives, a deputy manager and the registered manager.

We viewed three care plan files, various incident and accident records, complaint records and three staffing and recruitment records. Due to the allegations made we focused on the second and third floor of Ashton Lodge, which accommodated people with dementia and people who were more vulnerable due to their physical conditions.

Care workers knew how to respect people’s privacy and dignity and told us that they would never enter a room without knocking first, a practice that we observed. The expert noted that she "observed staff treating people with care in a variety of situations."

One person told the expert, "that care workers take care of feet, hair and eyes and that care workers look after people well."

Relatives spoken with told us that their relative “is safe” at Ashton Lodge and they would talk to the manager if they had any issues. A person using the service made the following comment to the expert when asked what he would do if he had any concerns, "I would see the nurse." The expert observed staff to be busy, but available to sit down with people for a chat and provide reassurance.

We asked relatives if they knew how to make complaints, we were told that they "would complain to the manager."

We saw that people were involved in their treatment or care and staff were seen asking people how they would like to be cared for. Care plans and assessments were formulated together with people using the service and their opinion was obtained and included in the care planning process. People told us, "staff will always ask us first how we would want to be cared for". Relatives and people using the service said they were satisfied with the treatment or care provided. A comment made by a persons' relative summarised this. "I could not care for my relative better".

People using the service told us that they felt safe and protected at Ashton Lodge. Comments made by people using service included "I am safe here" and "staff look after our relative well".

Staff were allocated according to the needs of people using the service and we observed staff attending to peoples' needs and while being busy did not appear to be too rushed. Relatives told us that there was "enough staff available" and "care workers know what they were doing".

Regular health and safety and equipment checks ensured that people using the service and visitors were safe.

People told us; they liked living in the home, they chose their meals, the food was good, they had their health needs met, and staff listened to them. They also informed us they had the opportunity to participate in a range of activities.

People were positive about the care and support they received at the home. People spoke of the staff being ‘good’, ‘friendly’,’ nice’, and approachable. They told us they felt safe living in Ashton Lodge Care Home. People knew who to talk to if they had any worries or concerns, and told us they felt that staff would respond to these in an appropriate manner.

People spoke about being able to make choices about their lives.

People confirmed they attended healthcare appointments and saw a doctor when they needed to. They told us they had contact with a variety of health and social care professionals.

People were positive about the environment of the home and were happy with their bedrooms. Some people told us they had personalised their rooms.

Comments from people included; “I am happy with my room”, “I choose what to do”, “It’s fine here”, “the staff are nice”, “approachable and kind”, staff “ask me want I want”, “I enjoy the food”, “I can choose what to eat”, “we have snacks”, “I have my hair cut”, “I have seen a doctor”, “I have my toenails cut”, “I saw the dentist”, and I am “happy living here”.

Comments from staff included “I like working at Ashton Lodge” Care Home, “there is good team work”, “I like caring for older people”, “It’s a nice place to work”, and the “management staff are approachable”.

This inspection took place on 23rd and 31st October 2014 and was unannounced.

During our last inspection, which was carried as part of our Wave 1 pilot on 24 April 2014 we found the registered provider in breach of regulations 9, 10 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. During this inspection, we found that the provider had made the required improvements and is no longer in breach of regulations.

Ashton Lodge Care Home is registered to provide accommodation and nursing care for up to 92 older people and people with physical disabilities who required varying levels of support to manage conditions such as diabetes, the after effects of stroke or accident and other illnesses associated with old age. Some people required support to move around. The premises are a purpose built property with accommodation arranged over three floors. There were a variety of communal areas where people could relax, have meals or take part in activities. Bedrooms were located on all floors and could be accessed via a passenger lift. People with physical disabilities accommodated the ground floor, older people who did not require nursing care the first floor and people with dementia and nursing needs accommodated the second floor. The home had two kitchens, one providing vegetarian food for Asian people and one general kitchen. These were located on the third floor. The home had an outdoor space; however, this was limited due to the urban location.

There was a registered manager at Ashton Lodge Care Home. 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 were protected from the risk of abuse. The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff knew how to safeguard the people they supported.

People told us they felt safe and we saw that people were treated with dignity and respect by staff and management. They said, “I am always treated with respect, they [care workers] always knock on my door and ask me what I want.” “I feel very safe here.”

Risks to people’s safety were identified and managed effectively and there were enough staff on each shift to make sure that people were protected from the risk of harm. Robust recruitment procedures were followed to make sure that only suitable staff were employed to work with people in the home.

People did not always receive their medicines correctly, staff had received training and appropriate systems and storage arrangements were in place. However there were not always risk assessments in place for people who chose to self-administer medicines.

The service was effective because staff had the information they needed to provide personalised care and support. People’s health and care needs were assessed with them, and people were involved in writing their plans of care. People told us they were very happy with the way they were cared for.

Staff received the training, supervision and support they needed to enable them to carry out their roles effectively. This included induction for new staff, key mandatory training and additional training in people’s specialist needs. This meant that staff understood and were able to meet people’s needs.

People told us there were no restrictions on their freedom. The management and staff had training and the home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards so they knew how to protect people’s rights.

People told us they enjoyed their meals and there was always plenty to eat and drink. We saw that meals were home cooked, freshly prepared and well presented, and people were offered variety and choice. Special diets were catered for and people were involved in the assessment of and decisions about their nutrition and hydration needs. Professional advice and support was obtained for people when needed.

People’s health care needs were supported effectively through arrangements for them to see health professionals such as GPs, chiropodists, dentists, nurses and opticians as required. Health professionals we spoke with at the inspection said, “It’s a pleasure to visit this home” and “I wish they were all as good as this”.

The service was caring because people were listened to, valued and treated with kindness and compassion in their day to day lives. There was a calm and relaxed atmosphere in the home. We saw that staff and management knew people well. All the interactions we observed between staff, management and people who lived in the home were respectful and warm. People told us, “They are so kind here.” “They’ll do anything for you.” and “I’m treated very well here.” We also spoke with a visitor. They told us they were very happy with the way their relative was cared for and said, “They’re all very kind.”

Staff who we spoke with knew what people needed help with and what they could do for themselves. They encouraged and supported people to remain as independent as possible.

The service was responsive because people’s individual assessments and care plans were reviewed with the person concerned. These were updated as people’s needs changed to make sure they continued to receive the care and support they needed.

People were provided with the opportunity to take part in a wide range of activities. Outings and entertainments were also arranged as requested by people who lived at Ashton Lodge Care Home. People told us they enjoyed the activities and looked forward to the entertainer.

People told us they knew who to talk to if they had any concerns. They said, “I can’t find fault with anything.” “I’ve never had anything to complain about.” and, “I have no complaints whatsoever”. There was a complaints procedure displayed on the residents’ notice board on all floors and people were provided a copy during their admission.

There was an open and positive culture which focussed on people who used the service. The manager had an open door policy so that people who lived in the home, staff and visitors could speak with her at any time.

Staff told us, “You get great support.” “It’s such a good atmosphere, I enjoy coming to work.” and, “Strong management team, all of them are really approachable”.

People were actively involved in developing the service in a variety of ways, such as meetings, satisfaction surveys, forums and day to day contact with the management team. Suggestions made by people were acted on. This meant that people’s views were taken into account.

Throughout our visit the staff and management team showed us that they were committed to providing a good service. There were effective systems in place to monitor and review the quality of the service. The management team carried out regular audits to make sure that any shortfalls were identified and improvements were made when needed.