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Inspection carried out on 4 September 2018

During a routine inspection

The inspection took place on 4 September 2018 and was unannounced. Our last inspection was in July 2017 where we identified one breach of the legal requirements in relation to medicines and infection control. At this inspection, the provider had taken action to meet the legal requirements of the regulations.

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

Ashton Manor Nursing Home provides care to up to 39 people in one adapted building. They provide support to older people, people with physical disabilities and long term medical conditions. They also provided support to people living with dementia. At the time of our visit, there were 32 people living at the home.

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.

Risks to people were assessed and actions were identified and implemented to keep people safe. Staff understood people’s clinical needs and appropriate support was provided to meet them. People had regular access to healthcare professionals and staff worked collaboratively with them. People’s medicines were managed and administered in line with best practice and staff had received medicines training and their competency had been assessed. Nursing staff had support to maintain their competencies and the provider had checked that nurses were registered with the Nursing & Midwifery Council (NMC).

There were sufficient numbers of staff to meet people’s needs safely and the provider had carried out checks on staff to ensure they were suitable for their roles. Staff underwent training before working with people and this had been regularly refreshed. Staff had regular one to one supervision meetings and there was an appraisal and competency framework in place to allow staff to develop themselves. Staff felt supported by management and there were systems in place to enable communication between staff.

Staff understood their roles in safeguarding people from abuse and records showed staff responded appropriately to incidents. The provider monitored incidents and clinical risks such as weight loss and infections. There were a variety of checks and audits undertaken at the service to identify and respond to any issues. People were regularly asked for their feedback and regular meetings took place to involve people in the running of the home. There was a complaints policy in place and records showed complaints were responded to in line with this policy.

People’s care was planned in a person centred way and staff knew what was important to people. We observed that staff were kind and caring and got on well with people. Staff offered people choices and involved them in their care. People were encouraged to maintain skills and independence and staff provided support in a way that was respectful of people’s privacy and dignity. End of life care was planned sensitively and delivered in a personalised way, by trained staff.

Staff supported people to eat food that matched their preferences and met their dietary needs. There was a wide variety of activities taking place at the home which covered a range of interests. People lived in a clean home environment that had been adapted for their needs. Relatives told us they were made to feel welcome and staff knew what was important to people.

Inspection carried out on 25 July 2017

During a routine inspection

The inspection took place on 25 July 2017 and was unannounced.

Ashton Manor Nursing Home is a nursing home that provides nursing and personal care to up to 39 adults. People living at the home had physical disabilities and long term health conditions. The majority of people at the home were living with dementia. At the time of our inspection there were 33 people living at the home.

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.

At this inspection, we identified a breach of Regulation 12 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.

People’s care was not always delivered safely. We identified potentially hazardous substances not being stored securely. Some equipment was shared between people without actions in place to reduce the risk of infection spreading. We also observed unsafe practice by staff when administering medicines. Following the inspection the provider had addressed these individual concerns. However, we will require action taken to ensure future risks are identified and managed more proactively.

People were cared for by sufficient numbers of staff. We did identify that staff appeared stretched at busy times. The provider was already taking steps to address this at the time of inspection. Appropriate checks were carried out when recruiting staff to ensure that they were suitable for their roles.

Risks to people’s safety were assessed and managed. Measures were in place to keep people safe, whilst still promoting people’s independence. Staff had a good understanding of how to support people to be more independent. People’s care plans were person-centred and reflected what was important to them, as well as their needs and goals. Regular reviews were undertaken and where people’s needs changed, measures were put in place to address this. The provider took steps to ensure that people were kept safe in the event of an emergency.

People were supported by kind and caring staff who knew them well. Relatives told us that staff encouraged visits from them and maintained good communication with them. Staff communicated with people in a way that demonstrated understanding of their needs. We did note one instance in which staff did not communicate with one person effectively. We recommended that the provider reviews their systems for ensuring staff communicate with people with more complex needs.

Apart from the unsafe practice observed from one staff member when administering medicine to one person, people’s medicines were managed safely. Important information about people’s healthcare needs and medicines were recorded in their care plans. Staff worked alongside healthcare professionals to meet people’s health needs. Where any accidents, incidents or infections occurred, staff took appropriate action in response to them. People told us that staff were respectful and staff understood how to promote people’s privacy and dignity when providing care.

People were provided with food that matched their preferences and ensured any dietary needs were met. Staff routinely offered people choices and involved them in their care. People’s legal rights were protected because staff worked in accordance with the Mental Capacity Act (2005). People had access to a range of activities that suited their needs and their interests.

The provider created a positive culture by giving staff lead roles and delegating to senior staff appropriately. Staff felt valued and supported and there were a variety of systems and schemes in place to ensure this. Staff received training appropriate to their roles and the provider’s values. Staff benefitted from regular supervision and appraisals.

Regular audits and checks were carried out to ensure the quality of the care that people received. Apart from where we found safety concerns, audits were regular and robust. We did recommend that the provider reviews their systems for auditing medicines storage. The provider routinely involved people, relatives and staff in decisions about the home. People knew how to raise a complaint and where complaints were raised, they were responded to appropriately.

Inspection carried out on 15 August 2016

During a routine inspection

We undertook this unannounced inspection of Ashton Manor on 15 August 2016. The last Care Quality Commission (CQC) inspection of the home was carried out on 17 September 2013, where we found the service was meeting all the regulations we looked at.

Ashton Manor provides nursing, personal care and support for up to 39 adults. The service specialises in supporting older people living with dementia. At the time of our inspection there were 34 people living at the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People and their relatives told us they were happy with the standard of care and support provided at Ashton Manor. We saw staff looked after people in a way which was kind and caring. Feedback we received from people supported this. Staff spoke with people and their guests in a warm and respectful way and ensured information they wanted to communicate to people was done in a way that people could understand.

People felt safe at the home. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage these risks in order to keep people safe. The service managed accidents and incidents appropriately and suitable arrangements were in place to deal with emergencies. We saw the premises and garden were wheelchair accessible and had been suitably adapted with grab rails, a passenger lift and ramps to enable people to move freely around the home. The provider ensured regular maintenance and service checks were carried out at the home to ensure the building was safe.

Electronic versions of care plans had been developed for each person who lived at the home, which reflected their specific needs and preferences for how they were cared for and supported. These plans and associated risk assessments were reviewed regularly and kept up to date. This gave staff clear guidance and instructions about how they should care for and support people to ensure their needs were met.

People were supported to keep healthy and well. Staff ensured people were able to access community health and social care services quickly when they needed them. Managers and staff worked closely with other health and social care professionals to ensure that people were supported to receive the health care that they needed. People received their medicines as prescribed and staff knew how to manage medicines safely.

There was a choice of meals, snacks and drinks. People were encouraged to drink and eat sufficient amounts to reduce the risk to them of malnutrition and dehydration.

We discussed the lack of clear signage in the home with the managers and activities coordinator who agreed to improve signage throughout the building to help people orientate themselves and identify important rooms, such as their bedroom, toilets and communal areas.

There were sufficient staff to meet people’s needs, and staffing levels were flexible to provide people with the support they required. People told us there were always staff around and if they needed any assistance a staff member came to support them promptly. We observed staff spending time with people in communal areas.

Staff were clear about their roles and responsibilities. People received care from staff who received effective training and support from the management team. This provided them with the knowledge, skills and confidence to meet people's needs in a person centred way. There was a proactive approach to the personal development of staff and the acquiring of new skills and qualifications.

People were encouraged to maintain relationships with people who were important to them. There were no restrictions on visiting times and we saw guests were welcomed by staff. Staff encouraged people to participate in meaningful social, leisure and recreational activities that interested them. We saw staff actively encouraged and supported people to be as independent as they could and wanted to be.

Staff supported people to make choices about day-to-day decisions. Consent to care was sought by staff prior to any support being provided. People were involved in making decisions about the level of care and support they needed and how they wanted this to be provided.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005. Managers understood when a Deprivation of Liberty Safeguards (DoLS) authorisation application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

The service had an open and transparent culture. Managers proactively sought the views of people, relatives, visitors, staff and other healthcare professionals about how the care and support people received could be improved. People felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. Although there were few complaints and concerns raised the provider had a positive approach to using them to improve the quality of the service.

The management structure showed clear lines of responsibility and leadership and managers understood their roles. The provider had developed effective governance systems and there was a strong emphasis placed on continuous improvement of the service. Where the need for improvement was identified, the provider took appropriate action to make the necessary changes. Managers used learning from near misses, incidents and inspections to make improvements that positively enhanced people’s lives.

We have made a recommendation about staff training on the subject of learning disability and mental health awareness and managing behaviours that challenge in a positive way.

Inspection carried out on 17 September 2013

During a routine inspection

On the day of our visit there were 31 people residing in the home out of total capacity of 39. We were met by the manager and the head of care. The manager explained that she had only been in post two months.

We found that people’s individual preferences were respected and catered for, and that the newly appointed activities co-ordinator was in the process of developing a range of social and community activities.

We found that people’s care was being properly managed and that everyone had a robust care plan in place that was regularly reviewed and updated. We also found that people who used the service and their relatives appeared happy with the level of care offered by the home.

We found that staff were properly trained in safeguarding people from abuse, and were prepared to report any instances of abuse even if this involved close colleagues.

We found that there were appropriate staffing levels in the service and that care staff were qualified to fulfil their roles.

We found that the provider asked for regular feedback from people and relatives on the quality of the service, and had systems in place to conduct regular audits and assessments of the whole service.

During a check to make sure that the improvements required had been made

We did not visit the service as part of this review of compliance. We did not, therefore, speak with people who used the service or with staff.

We carried out this review through the examination of documentary evidence specified by us and sent to us by the registered manager.

We found that people's care was planned and delivered in line with their assessed needs,

People who used the service were involved in the planning of the care they received and were consulted with regard to any changes in their needs.

Plans of care, including assessments of people's needs and notes recorded by staff were accurate and contributed to the care delivered being appropriate to the care needs of the people who used the service.

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

Inspection carried out on 4 October 2012

During a routine inspection

We were told by people who used the service that their right to privacy was maintained at all times and the advice and support they received from the staff were given in a way that maintained their dignity. They said they were involved in the planning of their care.

We found the assessments of people’s needs were not appropriately documented. For example, assessments were documented under observations indicating that people and their families were not involved in the assessment of the person’s care and social needs. Also, people's care needs identified in their care plans were not being carried out as recorded in the progress sheets.

The service was responsive to people’s equality and diversity needs. People told us their religious needs were catered for and met. People told us staff were competent and knowledgeable about the need to keep them safe and that they received their medicines on time.

Inspection carried out on 14 April 2011

During an inspection in response to concerns

People who used the service told us that they had visited the service and spent time at the service before making an informed decision that the service could meet their needs. They told us prior to admission an assessment was undertaken at their home, and another fuller assessment with them and their relatives was again completed when they came into the service. They told us their plan of care needs was based on their individuality, such as religion, likes and dislikes,social, night and day time activities and to maintain relationships with their families.

People told us they knew whom their carers were and that they were able to make and maintained good relationship with them. They said the staff were very good and will inform their relatives of any change in their health care needs, and usually a care worker accompanied them to hospital appointments or to Accident and Emergency department should this become necessary.

People said they felt safe in the service and they knew whom to speak to if they felt uncomfortable with a situation. They told us they would speak with the manager who would act on their behalf. They told us they have been provided with the service's service user,s guide which contained information on keeping people safe, but they have never had to use it.

Inspection carried out on 14 April 2011

During a routine inspection

People who used the service told us they were consulted about their care. That the service recognises and values their diversity, values and human rights such as their religion and their right to practice. People told us they were able to choose whether or not they participated in an activity. People said staff helped them in choosing their daily clothing, but the final decision regarding which outfit they wore was their choice.

People told us staff respected their privacy, dignity and independence. They said staff made sure their personal care was delivered behind locked doors either in their bedrooms or in the bathroom. Staff respected their choice to care for themselves whenever they can.

People told us that their medical care was well looked after as they were registered with the home's General Practitioner (GP) and the GP visited the home regularly and will come out to visit them if they were unwell. They told us the staff were very good and will inform their relatives of any change in their health care needs, and usually a trained nurse accompanied them to hospital appointments or to Accident and Emergency department should this become necessary.

People who used the service told us they felt safe in the service and they knew whom to speak to if they felt uncomfortable with a situation. They told us they had a good relationship with the staff. They told us they have been provided with the service user's guide which tells them how to report unsatisfactory behaviour of staff or visitors, but they have never had to use it.