The inspection took place on the 10 November 2017 and was unannounced. A second day of inspection took place on 11 December 2017, this visit was announced.

Ashurst Residential and Care Home is situated in the centre of Scarborough and provides personal care and accommodation for up to 19 people. The service provides care for older and working age people, some of whom may be living with dementia and some of whom may have a mental health diagnosis. There were 17 people using the service when we visited.

At the last inspection in January 2016, the service was rated Good. At this inspection, we found the service remained Good. There was a manager in post who had registered with CQC. The registered manager and deputy manager assisted throughout the inspection. 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.

Risks to people were monitored and people were protected. The risk of cross infection was reduced through the use of personal protective equipment and improvements made to the laundry facilities and storage of clean linen. Staff had received safeguarding training and demonstrated a good understanding of the processes required to safeguard adults who may be vulnerable from abuse. They were able to explain to us what they would do if they had concerns.

Comprehensive risk assessments were in place which detailed how to reduce the risk of harm to people. Medicines were managed safely. Staff were recruited in a safe manner and there were enough staff on duty to support people safely.

The provider ensured that all staff working at the service were well trained and had the skills necessary to perform their role. Training was up to date and new staff completed a comprehensive induction when they joined the service. Staff were given the opportunity to expand their knowledge in specialist areas such as end of life care and mental health. Staff attended regular supervision meetings with the registered or deputy manager and this monitored their performance.

People were consulted about their care and treatment and we found verbal and signed consent was sought prior to care being delivered. People we spoke with confirmed they felt valued and included and said their opinions mattered. People told us they were asked their views of the service and when changes were suggested these were actioned by the management team.

The management and staff within the service worked within the principles of the Mental Capacity Act 2005. People were empowered to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service support this practice.

People consistently told us the staff and the managers were very caring. We saw people's needs were met with dignity and compassion and it was evident that people who used the service had positive relationships with the staff who supported them. Where needed, people were supported to maintain a balanced diet. Community health professionals were involved in devising nutrition and hydration plans for those deemed to be at risk.

Care records were person-centred and contained all relevant information to enable staff to provide personalised care and support. People were involved in the assessment of their needs and were regularly consulted about the care they received. Quality assurance processes were in place and conducted on a regular basis to enable the service to continuously improve.

Further information is contained in the detailed findings below.

This inspection took place on 23 December 2016 and was announced at 48 hours' notice.

Ashurst Residential and Care Home is located in the town of Scarborough in North Yorkshire. It provides care to up to nineteen people older or younger people who may have mental health needs. Bedrooms are shared or single occupancy. There is a passenger lift to all three floors of the property. The house, built in a residential area of Scarborough, has access to local transport and car parking is on the street outside the property. On the day of inspection the service was caring for nineteen people.

The service had a registered manager in place. 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.

We carried out an unannounced comprehensive inspection of this service on 20 January 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan 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 Ashurst Residential and Care Home on our website at www.cqc.org.uk

We found that action had been carried out to improve the safety of care at the service. Bathrooms. toilets and the laundry room had been refurbished so that the living environment minimised the risk of cross infection. Risks to people's health and wellbeing were well managed to protect people while ensuring their freedom was maximised.

We could not improve the rating for safe from Requires Improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

The home has a registered manager in place. 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.

Staff were able to tell us what they would do to ensure people were safe and people told us they felt safe at the home. The home has sufficient suitable staff to care for people safely. Staff received regular supervision and they were safely recruited. People were protected because staff handled medicines safely. The home was regularly cleaned and staff were trained in infection control. However, bathrooms and toilets were in need of refurbishment in order to prevent the risk of cross infection. This was a breach of Regulation 12(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made a recommendation about the way in which clean laundry was stored to reduce the risk of cross infection. You can see what action we have told the provider to take at the back of the full version of this report.

Staff had received training to ensure that people received care appropriate for their needs. Staff were able to tell us about effective care practice and people had access to the health care professional support they needed. Not all training had been recorded.

Staff had received up to date training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff ensured that people were supported to make decisions about their care. People were cared for in line with current legislation and they were consulted about choices.

People’s needs in relation to food and drink were met. People enjoyed the meals and their suggestions had been incorporated into menus. We observed that the dining experience was pleasant and that people had choice and variety in their diet.

Health and social care professionals told us that the management team communicated with them very well and were quick to ask and act on advice. People had access to health care services when they needed them.

People were treated with kindness and compassion. We saw staff had a good rapport with people whilst treating them with dignity and respect. Staff had a good knowledge and understanding of people’s needs and worked together as a team. Care plans provided information about people’s individual needs and preferences.

People were supported to live their lives the way they chose to. We saw people smiling and chatting with staff. They told us they were consulted about their care. Staff responded quickly to people’s changing needs. Needs were regularly monitored through staff updates and regular meetings.

People told us their complaints and concerns were handled quickly and courteously.

The registered manager worked with the team, monitoring and supporting the staff to ensure people received the care and support they needed. People told us they liked the registered manager and that they were approachable and listened to them.

The registered manager and staff told us that quality assurance systems were used to make improvements to the service. We sampled a range of safety audits and care plan audits which were used to plan improvements to the service.

One inspector carried out this inspection. During the inspection, the inspector focussed on answering five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we looked at records for four people who used the service. We spoke with the manager. We spoke with three people who lived in the home. We also spoke with two care staff. We reviewed records relating to the management of the home.

Below is a summary of what we found. The summary describes what people who used the service and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found that the provider undertook checks on staff before they commenced employment in the home. This included checks of people’s criminal records and identification as well as employment history and references from previous employers. Staff also underwent an induction training programme which included shadowing experienced members of staff and completion of mandatory training. This ensured that staff were safe to work with vulnerable people. Staffing levels were monitored to ensure they remained safe.

Some people that used the service were able to access the community by themselves and there were procedures in place to ensure that people did that safely.

There was a programme of improvement of the environment being undertaken at the time of our inspection. This helped to ensure that the environment was safe for people using the service.

Is the service effective?

People had an individual care plan. We saw that the care plans contained information about people’s needs and in some cases people themselves had been involved in the development of these. The care plans we looked at didn’t always contain a large amount of information. The risk assessments in the records were sufficient to identify and minimise risks. The service was appropriately assessing risk and providing guidance for staff about to how to manage and minimise these risks.

When we spoke with people who used the service they were very pleased with the support they received from staff. One person told us “I like it here. The staff are approachable and friendly”. When we spoke with staff they told us that they felt they provided good and effective care.

Is the service caring?

All the staff we spoke with were enthusiastic to provide a caring and effective service. We observed during our visit that staff were patient and caring with people when supporting them.

When we spoke with people who used the service they were very complimentary about the quality of support that was provided by staff. One person told us “I feel staff are well trained. They listen to me”. The interactions we observed throughout our visit were good. Staff spoke with people in a friendly and clear manner. When people were assisted to move or complete an activity instructions and support were straightforward and appropriate in nature. Staff knew people well and offered care that was calm, clear and friendly.

Is the service responsive?

There were audit systems in place regarding the environment, delivery of care, medication, documentation and people’s satisfaction with the service they received. This allowed management to monitor the quality of service. The systems in place for highlighting issues and learning from accidents, incidents, surveys and resident meetings, staff feedback and complaints led to improvements in the service.

We spoke with people who used the service about the ways they were able to feedback and how this information was used. One person told us “I would speak to the manager and I think they would do something about it”. Another told us “I know how to complain”.

Is the service well-led?

Many of the staff that worked in the service had done so for some time. There was a low level of sickness and absence and a low level of vacancies within the staff team. The staff we spoke with told us that the manager was approachable and pro-active.

We spent some time with the manager discussing the future of the service and the areas of priority. The manager had clear ideas about how the service could improve and the ways in which this was being actioned at the time of our visit. All the staff that we spoke with felt that the manager was focussed on the service being high quality. One staff member told us “The managers are always about to support”. Another told us “The manager acts if anything is raised”.

People who used the service told us that they hadn’t seen the directors and weren’t familiar with who they were. One of the directors came to carry out audit visits on a regular basis.

We had been informed that there were concerns regarding the care and welfare of people that used the service and that the environment was inadequate in respect of peoples' safety and dignity.

We carried out a responsive inspection to address these concerns. We found that care and welfare of people in respect of the outcomes they experienced were satisfactory. However, we found that people did not have access to a well maintained and comfortable environment because there were areas of the property that had not been maintained or redecorated for many years, the heating system was malfunctioning, there was some damaged furniture and bedding had not been renewed regularly.

We found there were no designated cleaning staff to support care workers to enable care workers to concentrate their time on supporting people that used the service in light of their increased dependence. We found there was only one 'waking' night staff on duty overnight and the needs of some of the people that used the service were more pronounced at night time.

We visited the service in May 2013. At that time we found that maintenance of the premises did not meet the requirements of the regulation on safety and suitability of the premises. We asked the provider to take action with regard to the general décor, and to kitchen, bathrooms and external areas.

We visited the service again on 27 November 2013. We spoke with people who used the service and staff and looked round the premises. We checked documentation within the home. We found the provider had implemented a programme of repair and refurbishment and significant progress had been made in most areas. This included safety aspects highlighted in the previous report to rectify deficiencies in the kitchen and in the grounds.

People who used the service told us they liked their rooms and had been able to contribute their ideas to the new décor. Plans were in place to complete the remaining work needed in the bathroom and laundry. Management systems had been put in place for the provider to be able to take timely action to manage and address environmental issues in future.

We spoke with people that used the service and staff, we viewed the premises and looked at documentation within the home. We found that people gave their consent to care, support and treatment and that their needs were well met by conscientious staff.

People told us, “I sign whatever I have to”, “The staff are helpful but let you make your own decisions”, “I really like it here” and “I don’t have many needs but staff are polite and they let you get on with it.”

We found that medication handling systems and practices were appropriate, suitable and met peoples’ needs. Systems and practice were safe and compliant with the regulation on management of medication.

We found that the maintenance of the premises did not meet the requirement of the regulation on safety and suitability of the premises and so we have asked the provider to take some action with regard to the kitchen, bathrooms and the front of the property.

We found there were sufficient staff on duty to meet peoples’ needs and that there was a simple system for monitoring the quality of care and support provided by the service. The quality monitoring system had room for further development.

We spoke with two people who lived at the home and spent a period of time observing three members of staff interact with people. All staff displayed a good understanding of each person’s family connections and care needs. They were able to speak with people about what was important to them. One person told us, 'I think they are really good here.'

A number of relatives and medical professionals had returned surveys to the home recently. A relative had written, ‘The staff should be congratulated on their professionalism and obvious care demonstrated to residents.’ A medical professional had written, ‘I have always observed the staff be very respectful to residents and taking their best interests into consideration when planning their care.’

People told us that staff gave good care and that they felt safe and secure and the home.