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

Ashtonleigh provides accommodation and personal care for up to 54 older people with varied care needs. Some people were living with dementia, whilst others required support with physical illness or disability. There were 49 people using the service at the time of inspection. There were single and double occupancy rooms available. Some people had bathrooms attached to their bedrooms and there were communal facilities for those that did not. There were numerous communal areas for people to relax in, including a large, well maintained garden.

At our last inspection in October 2017, the service was rated 'Requires Improvement' with one breach to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection, we found significant improvements had been made and the provider is now meeting the regulations.

The service had two registered managers. 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 and that staff knew them and any risks to their wellbeing. There were risk assessments for people and for the building, with relevant safety checks completed by the management team each month. Staff were recruited safely and there were suitable numbers so people’s needs were consistently met. Staff had a good understanding of how to recognise potential signs of abuse and what actions to take with any concerns. Medicines were given in a safe, consistent way, by staff who were competent to do so. Any accidents or incidents were analysed and actions taken immediately to prevent their reoccurrence.

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 practise.

Staff had the skills and knowledge to support people and meet all their needs. They spoke highly of the training offered. Their induction was in depth and gave them opportunities to get to know people, their routines and preferences. Further support was provided in supervisions, appraisals and team meetings.

People’s nutritional needs were met and they were positive about the quality and choice available of food. People had continuous input from a variety of health and social care professionals to improve their wellbeing. People’s health conditions were managed well and staff valued and followed feedback or guidance given by professionals.

Feedback from people, their relatives and a professional was consistent, in that staff were kind, caring and attentive to people’s needs. People's dignity, independence and privacy was promoted and encouraged. Staff knew people, their preferences and support needs well and celebrated special events with them. They took an interest in people’s wishes and did everything possible to make these happen.

Care plans were tailored to individual's and detailed support needs, preferences, people’s life stories and routines. Staff were knowledgeable of people’s communication support needs and used a variety of tools to support them with this. People told us they always felt listened to. There was a clear complaints process and any concerns received had been responded to promptly and professionally. People had choice and control over the activities they wanted to participate in each day. These were tailor-made to people's likes and dislikes and used to support them to reminisce about their past.

People, their relati

Ashtonleigh is a care home without nursing, providing accommodation and personal care for up to 54 People. We inspected the service on 24 and 26 October 2017. On the days of our visits 49 people were living at the service. People living at the service are older people. The service offers care to people living with or without dementia as a primary diagnosis; Some people may also be living with physical illness or disability.

At the last inspection on 5 and 8 May 2015 the service was rated as good in all areas apart from safe, where it was rated as requires improvement. The overall rating was good. At this inspection in October 2017 we found improvements made following the last inspection had been sustained. However we identified some additional areas where improvements were needed. We have rated the service as requires improvement.

Some management or governance systems were not effective in identifying improvements needed at the service. As a result, people did not always receive safe care in an environment where risks had been assessed and addressed. We identified some furnishings that were not stable, and the water supply to some rooms was erratic in temperature. The laundry was cluttered and did not provide an environment that could be kept clean. We did not identify people had suffered harm as a result of these concerns, and the provider took immediate action to address these areas during the inspection.

People received their medicines safely, but some clarification was needed on staff training and accountability in relation to the administration of insulin. As Ashtonleigh is a care home without nursing, the administration of insulin would normally be done by a community nurse if the person was not able to do so safely themselves. The community nurse may decide to delegate the responsibility for this to care staff at the home, if they have assured themselves they are competent to do this. However the accountability would need to remain with the community nurse. At Ashtonleigh the accountability was not clear. Following the inspection we received evidence to show action had been taken.

There were sufficient staff on duty to support people and meet their needs.

Incidents were analysed to identify trends and learning took place to prevent a re-occurrence. Following an incident where a fire had taken place at the service due to building works occurring, the provider had been asked by the fire service to share their experience with other providers in the area. Staff had managed the incident well and no-one had been harmed as a result. The provider had taken steps to provide a sprinkler system in most areas of the home to protect people further.

Effective systems for staff training and support were in place. We saw staff working well with people and they had a clear understanding of people’s need and wishes regarding their care. The registered manager ensured staff received appropriate supervision with observation of their practice. The registered provider also regularly monitored staff interactions to ensure they reflected positive outcomes for people.

People received a well-balanced and nutritious diet. People told us the food was very good, and we saw people enjoying a choice of meals. The cook had worked at the home for many years and was a well-respected member of the care team. They understood about safe textures of meals to support people with swallowing difficulties and special medical diets. We have made a recommendation over ensuring staff have access to information to help them assess risks from poor hydration.

People‘s rights regarding capacity and consent were understood and supported. Where necessary the service had applied for authorisations to deprive people of their liberty. Staff understood about ‘best interest decisions’ and these were recorded in people’s files where needed. Staff also understood that people had the right to make poor choices where they had capacity, and acknowledged this, for exa

We spoke with two of the 24 people who lived at Ashtonleigh Residential Home. They told us they were happy with the way medication was administered to them. They confirmed they received it at times convenient to them and were able to request medication for pain relief when they needed it. One person told us, “I have paracetamol for pain relief. I usually have this in the morning, at midday and in the evening. I do get this medication when I need it.”

We spoke with two members of care staff who were responsible for the administration of medication. They confirmed they had received appropriate training. They also told us what was expected of them to ensure medication had been administered, recorded and stored safely.

We looked at records of medication that had been administered to three people. They had been kept up to date and well maintained and demonstrated that medication had been managed safely.

During our visit we spoke with 15 of the 24 people using the service and one of their relatives. People’s comments included,

“I’m happy with the service I receive. The staff are very good.”

“There’s a nice atmosphere. I never feel rushed. The staff are very helpful”

We also gathered evidence of people’s experiences of the service by indirectly observing the care they received from staff. We saw that staff addressed people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We saw that people were confident in approaching staff and asking for assistance.

We also spoke with two of the home’s owners, the manager and four care staff.

We were concerned that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. For example, we found recording errors which meant it could not be confirmed that medicines had been administered correctly.

People we spoke with told us that they were very happy living in the home; they said that they were well cared for by staff that were friendly and helpful.

One person said, “The people here are looked after extremely well”.

Another person said, “The staff here are always polite, and considerate. They carry out their duties very well.”

This inspection took place on the 5 and 8 May 2015 and was unannounced.

Ashtonleigh is registered to provide accommodation and personal care for up to a 43 people and there were 36 people living there when we inspected. They specialise in providing care for older people some of whom live with dementia. There are 14 bedrooms on the ground floor with en-suite wet rooms. Bedrooms on the first and second floor are accessed via a shaft lift or stair case. There is a dining room and a large conservatory on the ground floor and a small quiet lounge situated on the middle floor. There is level access to the garden at the rear of the property.

The home is managed by 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 were positive about the home and were able to see their friends and families as they wanted. All the visitors we saw told us they were made welcome by management and staff and some referred to Ashtonleigh as being “Home from home”. Everyone we spoke with liked the home cooked food and told us there was a choice of what and where to eat at meal times. One person said “The food’s great” another said “It’s usually pretty good the food and it’s nice to have it cooked for you, I often have a boiled egg for breakfast”.

Staff knew the people they were supporting and were aware of their personal preferences, likes and dislikes. Care plans were in place detailing how people wished to be supported and people and or their representatives were involved in making decisions about their care. Where people lacked the capacity to make specific decisions they were being supported to make decisions in their best interests. They were supported with their healthcare needs and staff liaised with their GP and other health care professionals as required.

People and their visitors described staff as being kind, patient and considerate. One person told us “They are kind the staff”. A relative referred to staff as “Very caring, like family”. We heard staff referring to one person as “Grandma” as she preferred to be called.

It was clear that people enjoyed the group activities on offer and the weekly visit by entertainers. The activity person spent one to one time with people that did not want to join group activities and religious ceremonies were held once a month. A reminiscence area had been initiated in the lounge specifically to help engage and stimulate people living with dementia.

People told us there was enough staff to meet their needs. One person said “I ring the bell for assistance and they come quite quickly. They don’t rush me”. A visiting relative said they felt “There are enough staff and they know what they are doing” However there was no formal system for assessing and reviewing the skill mix and number of staff needed to support people safely. We identified this as an area that required improvement.

Systems for recruiting new staff included security and identity checks and at least one reference from a previous employer. Staff were aware of their responsibility to protect people from harm or abuse. They knew the action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident reporting any concerns to the registered manager or senior member of staff.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs. They felt supported within their roles, describing an ‘open door’ management approach, where the registered manager, deputy managers and company directors, were available to discuss suggestions and address problems or concerns. One member of staff described the registered manager as, “Very supportive to me and all the staff, they are very good”.

Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future. A visitor told us their relative, who lived with dementia, had had several falls since moving in but could never tell them how the fall had happened. They told us the staff always explained “who, what, when where and how.” They said the staff “Have been superb about her falls and how they are going to deal with them.” Risks associated with the environment and equipment had been identified and managed and emergency procedures were in place in the event of fire.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. People, their visitors, health care professionals and staff were all encouraged to express their views and complete satisfaction surveys. Feedback received showed a high level of satisfaction overall. Any areas identified as in need of improvement had been addressed.