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Inspection carried out on 27 January 2020

During a routine inspection

About the service

Ashtree House is a residential care home providing personal care for a maximum of 27 people, some of whom are living with dementia. At the time of the inspection 26 people were using the service. Accommodation was provided on two floors with a lift to the upper floor containing bedrooms. Communal areas and some bedrooms were located on the ground floor.

People’s experience of using this service and what we found

People were very happy living at the service. One person said, “I am really pleased I am here, I couldn’t wish for anything better.” A relative said, “Staff are fabulous.” People spoke about the helpfulness, kindness and friendliness of staff and told us their privacy and dignity was respected.

People received a safe service where they were protected from avoidable harm and abuse. People felt safe and staff understood their responsibilities in relation to the people they cared for. Risks to people’s health and safety were assessed and actions were taken to reduce these risks. Staffing levels were planned to ensure there were sufficient staff with the right skills and experience to provide safe care that was responsive to people’s individual needs. A person said, “You never wait long for assistance. People’s medicines were managed safely and people told us they received their medicines regularly.

Staff were well trained and knowledgeable about the people they cared for. They liaised well with other professionals and ensured people had access to ongoing healthcare services.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had access to a wide range of activities based on their interests and which encouraged them to be as active as possible to maintain their health and mobility. They had opportunities to engage in the wider community and were supported to maintain relationships with people important to them.

The service benefitted from clear and consistent leadership. Staff were provided with opportunities to develop and progress. The service was active in the local community and had developed good links with local services and voluntary groups. Processes were in place to monitor the quality of the service provided and promote continuous improvement.

Rating at last inspection

The last rating for this service was Good (published 25 October 2017).

Why we inspected

This was a planned inspection based on the previous rating.

For more details, please see the full report which is on the CQC website at

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 30 August 2017

During a routine inspection

Ashtree House is registered to provide accommodation and personal care for up to 27 older people, including people living with dementia. The registered provider also offers day care support in the same building as the care home although this type of service is not regulated by the Care Quality Commission (CQC).

We carried out our inspection on 30 August 2017. The inspection was unannounced. There were 26 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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.

At our last inspection in July 2015 we rated the home as Good. Following this inspection the rating remains as Good.

Action was required to improve the provision of activities and other forms of stimulation and occupation. In all other areas however, the provider was meeting people’s needs effectively.

There was a calm, relaxed atmosphere and staff supported people in a kind and friendly way. Staff knew and respected people as individuals and provided responsive, person-centred care. People were provided with food and drink of good quality that met their individual needs and preferences. The décor and facilities in the home reflected the needs of people living with dementia.

There were sufficient staff to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way. There was a varied training programme in place to provide staff with the knowledge and skills they required to meet people’s needs effectively.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted DoLS authorisations for three people living in the home and was waiting for a further 11 applications to be assessed by the local authority. Staff had an understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Decisions that staff had made as being in people’s best interests were correctly documented.

The registered manager was well-known to everyone connected with the home and had the loyalty and respect of her team. A range of auditing and monitoring systems was in place to monitor the quality and safety of service provision.

Inspection carried out on 16 & 20 July 2015

During a routine inspection

We inspected Ashtree House on 16 and 20 July 2015. This was an unannounced inspection. Our last inspection took place on 18 June 2014. The service provides care and support for up to 27 people. When we undertook our inspection there were 24 people living at the home.

People living at the home were older people. Some people required more assistance either because of physical illnesses or because they were experiencing memory loss. The home also provides end of life care.

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.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of our inspection there were four people subject to such a restriction.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

People had a choice of meals, snacks and drinks. And meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it.

The provider used safe systems when new staff were recruited. All new staff completed training before working in the home. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements.

Inspection carried out on 18 June 2014

During a routine inspection

Our inspection team was made up of one inspector. We considered our evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. Regular checks were undertaken to ensure the environment was safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place.

The service was safe, visibly clean and hygienic. Equipment was well maintained and serviced regularly. Therefore people were not put at unnecessary risk.

The registered manager ensured that staff were trained and supported to do their roles.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans. People said that they had been involved in writing them and they reflected their current needs.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

People told us they could express their views at meetings, on a one to one basis and by completing surveys.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people.

People commented, "Staff are lovely, so patient." and "I love living here."

People, their relatives, friends and other professionals involved with the service attended meetings throughout the year. Where shortfalls or concerns were raised these were addressed. People told us they felt their opinions were valued.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People told us they could speak with staff each day and share their concerns. They told us staff acted quickly. Relatives told us they could speak with staff about their family member's needs, when that person could not make decisions for themselves.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records showed that identified shortfalls were addressed.. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

Inspection carried out on 14 June 2013

During a routine inspection

Care and treatment was planned and delivered in such a way that was intended to ensure people�s safety and welfare. We looked at eight care plans for people who used the service. These were personalised and provided detailed and up to date guidance about how people�s needs should be met.

We were present whilst lunch was taken. We saw appetising food was served. One person told us, �The food is good, we can always ask for things we really like.�

We looked around the home and observed a good overall standard of cleanliness. We observed the interior decoration of the building was good and we were shown many areas that had been totally refurbished, including many people�s rooms. Some carpets had become worn; the manager told us these would be addressed in the coming year.

We observed a member of staff administering medications in one unit of the home. We reviewed the medications administration records (MARs) and found them to be accurate.

We spoke with a unit manager who explained how the staff rotas were set up and how cover for holidays and sickness was arranged from within the team itself.

We found the building had been maintained effectively. We checked the home�s maintenance records and found the electrical safety certificate was valid and oil fired boiler installations had been checked each year. We saw all radiators were covered in order to protect people from harm.

Inspection carried out on 1 March 2013

During an inspection to make sure that the improvements required had been made

We did not speak to people who used the service on this occasion as we were checking records and speaking to staff.

Inspection carried out on 20 November 2012

During a routine inspection

As part of our inspection we spoke with some people who used the service and relatives. We also used the Short Observational Framework for Inspection (SOFI) to determine whether staff were looking after people, especially those with communication difficulties and dementia.

People told us they liked living in the home and confirmed they were supported to make choices and decisions about the care they received. One person told us, "They take care of me well here." A relative told us, "I am more than satisfied with the care xx receives."

People who used the service knew staff kept records on them. All but one person had seen their records. They told us they could talk to any staff, any time and they would be listened to.

They also told us they felt safe. One person said, "I feel safer here than in my own home."

People said the staff knew a lot about them and they could easily answer their questions. One person said, "Staff know the answers to most of my questions and if they don't they quickly find out." They told us they were sent a questionnaire earlier in the year. One person said,"I had nothing but praise for them then and still do."

Inspection carried out on 7 February 2012

During a routine inspection

One person we spoke with told us �I�m well looked after here. I do have everything I want and if I ask for something I know the manager will do her best to get it for me.�

Another person told us �I chose to stay here after a couple of week�s respite. It was a good decision and I�ve been happy ever since.�

A relative we spoke with told us �This was the best place for my relative. I looked at some others but there was no doubt in my mind that this was the right choice.�