Ashdowne Care Centre

Ashdowne Care Centre is a care home, registered to provide accommodation with nursing or personal care, for up to 60 people. There were 57 people using the service on the first day of our inspection.

The service is in the town of Tiverton. It comprises of two detached, two storey buildings linked by a corridor. The home is divided into two units, one in each building, Ashdowne unit and Pinnexmoor unit. The Ashdowne unit is primarily used for older people with physical disability and the Pinnexmoor unit is for older people with dementia or a mental health need. Each of these units has its own staff team, communal spaces and secure outside garden for people to use as they choose.

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

People told us on the Ashdowne unit they did not feel there were always enough staff on duty to meet their needs. Comments included, “We do have to wait at times for help”, “They are too busy to spend the time” and “They were short of staff sometimes". We found that the staff levels across the home were not consistent.

On the Pinnexmoor unit, we observed people’s needs being met promptly and appropriately by a full staff team. However, on the Ashdowne unit we observed they were short of staff which meant people’s care needs were not always met promptly.

We have made a recommendation to the provider to monitor the deployment of staff across the home to minimise the impact on people.

Improvements were needed to ensure staff recruited at the service had all of the required checks. A revised recruitment checklist was put in place after the inspection and all recruitment files were checked to ensure they contained the required information.

The provider had processes in place to monitor the risks to people. However, we identified not all people able to use a call bell had access to one, pressure mattress checks had not identified that one had been turned off and it was not clear if one person had an adequate fluid intake. We were assured that action was taken regarding these concerns.

Environmental risks were on the whole, managed well. This included fire checks and drills and regular testing of fire and electrical equipment, and maintenance issues being dealt with effectively. Radiators which were identified as a possible risk on the first day of our visit were covered the following day to ensure people were not at risk of burns.

People generally received their medicines safely. However, it was not clear if people who had been prescribed supplements as they were at risk of weight loss, had received them. The manager took action and improved the recording of people’s supplements and monitoring.

On arrival at the home we found some areas which were not clean and bed bumpers which were ripped and therefore not able to be cleaned, which posed a risk to people. Action was taken by the manager and these areas were clean and bed bumpers were replaced on the day of the inspection.

People were supported by staff who had received safeguarding training and were aware of the different types of abuse. People said they felt safe living at the service. Comments included, “Yes I feel safe with staff...They (staff) are very careful”; “The staff are very good and helpful…I am well looked after.” And “Yes, quite safe. It’s just sort of natural the way they look after me...”

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.

Accidents and incidents were, on the whole, managed appropriately. Each accident or incident was reviewed by the manager to ensure staff had taken appropriate action. After a discussion they said they would be looking at potential trends to be identify and minimise the risk of future incidents.

Since the last inspection a new manager had been appointed. They were supported by the provider, operations manager and unit leads. They were committed to working with staff to provide people with a good quality person-centred service. They worked alongside staff to pass on their ethos and ways of working. Staff were complimentary about the new manager and were hopeful the changes they were making would be embedded.

The provider had a program of audits they required managers to undertake. These had been completed and actions were being undertaken when areas of concern were identified. At the inspection we highlighted areas of concern which had not been identified by the program of audits. When we raised these concerns the management team reviewed the quality of their audits process. They gave us reassurances this would ensure the risk of future concerns would not be missed. We recognise these changes have been made and we will expect to see an improvement at our next inspection. We have made a recommendation that they continue to monitor their auditing process to ensure it is effectively highlighting areas which might need to be addressed.

People’s and relatives’ views were sought through surveys and meeting with the manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 August 2021)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashdowne Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashdowne Care Centre is registered to provide accommodation with nursing or personal care, for up to 60 people. There were 58 people using the service on the first day of our inspection.

The service is in the town of Tiverton. It comprises of two detached, two storey buildings linked by a corridor. The home is divided into two units, one in each building, Ashdowne and Pinnexmoor. The Ashdowne unit is primarily used for older people with physical disability and the Pinnexmoor unit is for older people with dementia or a mental health need. Each of these units has its own staff team, communal spaces and secure outside garden for people to use as they choose.

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

People felt safe living at the service and relatives felt confident people were safely cared for. Staff had received safeguarding training and demonstrated an understanding and awareness of the different types of abuse. Risks to people’s health and safety had been identified.

Improvements had continued to ensure there were enough staff on duty at all times. Staff sickness had improved but continued to have an impact which put pressure on other staff. The registered manager had recruited a full care staff team and was working to improve staff sickness further.

Staff had been safely recruited. Staff new to the service completed a period of induction and the providers induction pack.

Fire safety was well managed. Regular checks of the environment and servicing and maintenance of equipment was carried out to identify and minimise environmental risks.

Staff had received training and were following up to date guidance in infection prevention and control, to minimise risks to people. Staff used personal protective equipment (PPE) correctly and in accordance with current guidance to minimise cross infection risks to people.

The provider was facilitating visits for people living in the home in accordance with the current guidance. Although some people and relatives were not always clear about the government’s guidance and the visiting arrangements at the home.

Medicines were safely managed. All staff that were administering medicines had received training around the safe use of medicines and their competency had been assessed. A recent pharmacy report had raised no significant concerns.

People's physical and mental healthcare needs were being well-monitored to recognise any signs of deteriorating health so action could be taken. Staff had the skills and knowledge to deliver care effectively.

People and relatives mostly told us the food at the service was good and they were offered choices. Improvements were needed to make sure the mealtime experience was a pleasant social occasion for all people at the home. This was being addressed by the management team.

The provider had continued to develop and extend the service and had a programme of refurbishment to redecorate and upgrade.

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 service was well-led by a registered manager who had a dual registration with CQC and managed two services for the provider. They were supported by the provider’s operations manager, two-unit leads, nurses and team leaders. They had made improvements since starting at the home but were facing additional pressures due to the pandemic and staff sickness. Staff spoke highly of the registered manager, however some staff felt they needed to be at the home more and could improve their communication. The registered manager was very responsive to this feedback and said they would work to improve their communication.

Quality assurance and monitoring systems were in place to help drive improvements at the service.

Why we inspected

We received concerns in relation to staffing levels, staff training and the management style and culture. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed following this focused inspection and remains good.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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

The service is in the town of Tiverton. It comprises of two detached, two storey buildings linked by a corridor. The home is divided into two units, one in each building, Ashdowne and Pinnexmoor. The Ashdowne unit is primarily used for people with physical disability and the Pinnexmoor unit is for people with dementia or a mental health need. Each of these units has its own staff team, communal spaces and secure outside garden for people to use as they choose.

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

The service has had a new registered manager since our last inspection. They have a dual registration with one of the providers other homes. They had a good understanding of the provider’s processes and systems and were working well with the provider to implement changes at the home. Quality assurance processes remained in place which included regular audits undertaken by the management team and the provider’s operations manager. Where concerns were identified action was taken to try and resolve.

Staff spoke positively about the new registered manager and said they felt supported. Two staff members comments reflected all spoken with. One said “I trust our manager; he is very approachable. He is one of best managers I've ever had. I feel confident that he will take appropriate actions and make sure that every possible issue that may arise, will be dealt with professionally and in a timely manner.” The other said, “He has changed so much since he has been here. If we need something done, he will sort it… he is trying to change bad habits.”

Improvements had been made and action was being taken to ensure there were enough staff on duty at all times to keep people safe and meet their needs. Staff sickness levels had improved since our last inspection and action was being taken by the registered manager to improve it further as there were still shortfalls. The provider had put in place an additional role of team leaders on the Ashdowne unit to ensure a good skill mix was deployed on each shift. The recruitment process at the service continued to be robust.

Medicines continued to be safely managed and the environment and equipment continued to be safe and well maintained.

The registered manager understood their responsibilities and had made appropriate referrals to the local authority safeguarding team and followed their guidance.

Accident and incident reporting continued to be thorough. Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted as part of our Thematic Review of infection control and prevention in care homes. We found that staff were following up to date infection prevention and control guidance to help people to stay safe.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires improvement. (report published July 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as requires improvement overall.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in July 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to ensure there were enough staff deployed to meet people’s needs. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashdowne Care Centre on our website at www.cqc.org.uk.

Ashdowne Care Centre is registered to provide accommodation with nursing or personal care, for up to 60 people. There were 53 people using the service on the first day of our inspection. The service is in the town of Tiverton. It comprises of two detached, two storey buildings linked by a corridor. The home is divided into two units, one in each building, Ashdowne and Pinnexmoor. The Ashdowne unit is primarily used for people with physical disability and the Pinnexmoor unit is for people with dementia or a mental health need. Each of these units has its own staff team, communal spaces and secure outside garden for people to use as they choose

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

There were not always enough staff on duty to meet people’s needs on the Ashdowne unit at the home.

The provider had checks and audits in place to assess the safety of the service. They had produced a Service Development Plan which identified and reviewed concerns and the actions being taken. The provider was working with the local authority quality assurance and improvement team (QAIT), health and social care community services team and Eastern Care services regarding further and ongoing development.

We observed that improvements had been made by the new manager and operations manager, but these systems need time to embed to ensure they lead to improvements in people’s care and support.

Staff completed individual risk assessments promptly when people came to the home and put in measures to reduce risks as much as possible. A new call bell system had been put into place on the Ashdowne unit and people in communal areas had access to call bells. The provider had appropriate checks and maintenance systems in place to ensure the home and equipment was safe for people.

People, relatives and staff spoke positively about the new manager who started work at the home in January 2019. They said they felt able to raise concerns and were confident that these would be addressed. Improvements had been made to the management of complaints which were being dealt with in line with the provider’s policy.

Staff said they felt well supported in their roles. The manager had a supervision schedule in place to ensure staff received regular supervisions and appraisals. Where there were gaps these had been scheduled. The manager and provider’s operations manager had identified that not all staff had completed all the mandatory staff training and were working with staff to complete the required training. All staff completed the provider’s induction when they started work at the home.

People said they felt safe at the home. Staff continued to be aware of the signs of abuse and reported concerns internally. There was good communication amongst the staff to ensure key information was shared. Staff knew their responsibilities for reporting accidents, incidents or concerns. The management team were committed to driving improvement and learning from accidents and incidents.

Medicines were safely managed. There were appropriate control of infection processes in place which meant people lived in a home which was clean.

People were very positive about the staff and told us that they were treated with dignity and respect and their visitors could visit at any time. They said staff were caring and hardworking. People’s care plans included information for staff about the support they required to meet their needs.

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 were positive about the food they received. Comments included, “I never feel hungry here, I get plenty to eat here.” There were opportunities for people to engage in activities.

We identified a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to deploying sufficient staff to meet people’s needs. Details of action we have asked the provider to take can be found at the end of this report.

More information is in the full report.

Rating at last inspection and update: The last rating for this service was requires improvement (published 24 October 2018) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. Following this inspection, the ratings for the service remains unchanged.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashdowne Care Centre 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.

Ashdowne Care Centre is registered to provide accommodation with nursing or personal care, for up to 60 people. There were 45 people using the service on the first day of our inspection. The service is located in the town of Tiverton. It comprises of two detached, two storey buildings linked by a corridor. The home is divided into two units, one in each building, Ashdowne and Pinnexmoor. The Ashdowne unit is primarily used for people with physical disability and the Pinnexmoor unit is for people with dementia or a mental health need. Each of these units has its own staff team, communal spaces and secure outside garden for people to use as they choose.

At our last comprehensive inspection in April 2016 the service was rated good overall and in all domains except effective. We issued the provider with a requirement because they had not ensured people were supported by staff who had the appropriate training and supervision necessary to enable them to carry out the duties they are employed to perform. Following the inspection the provider sent us an action plan telling us the improvements they would make. We returned and undertook a focused inspection in May 2017 and checked to see whether the requirement had been met and found it had been addressed.

A new registered manager started working at the service in May 2017 and registered with CQC In February 2018. A registered manager is a person who has registered with CQC to manage the service. Like registered persons, 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 not always protected from risk because people did not always have access to a call bell when in communal areas. People were not protected because risks for each person were not always assessed. Care records contained risk assessments for falls, nutrition monitoring and skin integrity. However these were not always completed in a timely way when people arrived at the service.

There were adequate numbers of staff on duty on the Pinnexmoor unit although concerns were raised regarding the staff levels on the Ashdowne unit. The registered manager explained that there had been staff shortages but staff had undertaken additional duties and staff had come across from the Pinnexmoor unit and the provider’s other service to fill gaps. However they said they had not always been able to cover short notice staff sickness. They had recruited new care staff who were undertaking their induction. This meant that there were staff working on the Ashdowne unit who were learning about the service and developing their experience. They had also increased the staff level because they had two new admissions.

Staff were knowledgeable about recognising the signs of abuse and had a good understanding of how to keep people safe. The registered manager had been working with the local authority safeguarding team regarding safeguarding concerns. During the inspection a person raised a safeguarding concern with CQC. We discussed this with the registered manager and operations manager and they made an alert and took appropriate action.

Recruitment procedures were thorough and all necessary checks were made before new staff commenced employment. New staff had received an induction when they started working at the service. There was a system to ensure staff received training to ensure they had the right skills and knowledge to meet people’s needs. The registered manager had a system to delegate supervisions and appraisals; however these had not been undertaken for all staff. Where concerns had been raised about two staff, no supervisions had been undertaken to discuss and look at the staff’s performance and development needs.

Staff recorded accidents promptly in the accident book and the actions they had taken at the time. However the oversight monitoring of accidents and incidents to look for patterns and trends had lapsed. Therefore it was not possible to ensure that staff were responding appropriately and risks reduced, where possible.

The complaints log contained five complaints during 2018. However it was not evident if the registered manager had followed the provider’s complaints policy. One complaint had not been dealt with in a timely manner and another had not been included in the complaints log.

Most aspects of medicines management were being safely managed. However, time specific medicines were not always being given at the required times and that cream charts were not always completed fully.

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 practice. The registered manager and nurses demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. They understood where people lacked capacity, a mental capacity assessment needed to be completed with best interest decisions made in line with the MCA. They had submitted applications where required to the local authority Deprivation of Liberties Safeguarding team (DoLS) to deprive some people of their liberties.

Staff on the Pinnexmoor unit were friendly and kind to people and provided a good service. However at times on the Ashdowne unit staff were rushed and people’s dignity was not always maintained. People were able to make daily choices about the care they received.

People were supported to have regular appointments with their GP, dentist, optician, chiropodist and other specialists.

There was a staff member designated on both units to undertake activities with people. There were records of activities people had undertaken on the Pinnexmoor unit. Where people could not or chose not to leave their rooms the staff member had spent time with people in their rooms to ensure they undertook meaningful activities and were not at risk of social isolation. However this was not recorded on the Ashdowne unit, only the activities which had taken place. Therefore the registered manager could not demonstrate that people on the Ashdowne unit were not being socially isolated. The staff member on the Ashdowne unit had needed to undertake care shifts to cover staff shortages. This meant there had been limited activities on the Ashdowne unit. The operations manager said they would be increasing the allocated activity hours on Ashdowne to increase the oversight of the lounges and to undertake more activities. People had been asked in an activity review and said they were happy with the activities at the service.

People’s needs were assessed with them before they were admitted to the home. Personalised care plans were developed and these were reviewed on a regular basis and when a change in their needs was identified. Staff had completed individual risk assessments for people to assess how to reduce risks as much as possible. However these were not always completed promptly when new people came to the service. The provider supported people who required end of life care.

People were supported to eat and drink sufficient amounts to maintain their health. People said they liked the food provided. A new summer menu was being implemented following a review with people to ask their views.

The registered manager held regular meetings with staff and actively sought their views. The registered manager said they were required by the provider to hold a residents meeting twice a year. They said nobody attended the last one so they spoke to individuals. They said they would arrange another meeting.

The premises and equipment were managed to keep people safe.

The provider is required by law to send CQC notifications about important events at the service. For example, deaths, serious injuries or safeguarding concerns. We received notifications as required from the provider.

We found three breaches of regulation. You can see what action we told the provider to take at the back of the full version of this report.

This inspection was to follow up if the required improvements had been made following our last inspection in April 2016. At that visit, we gave the service an overall rating of ‘Good’. However we rated the ‘effective’ domain as requires improvement because we found a breach of regulations. This was because the provider had not ensured people were supported by staff who had the appropriate training and supervision necessary. This meant they may not be able to carry out the duties they were employed to perform. We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met legal requirements. At this inspection we found improvements had been made. All staff were receiving the provider’s mandatory training and support through supervisions and appraisals.

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 (Ashdowne care Centre) on our website at www.cqc.org.uk”

Ashdowne Care Centre is registered to provide accommodation with nursing or personal care, for up to 60 people. The service is intended for older people, who may have a dementia or mental health need. The home is divided into two units, Ashdowne and Pinnexmoor. Each of these units has its own staff team. The two units are joined by a linked corridor. There were 50 people living at the home at the time of our visit.

The service had two registered managers, who shared the role and responsibilities. As part of their role they also scheduled to undertake nursing duties. 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.

There were systems in place to ensure staff received regular supervisions and an annual appraisal. Staff received the provider’s mandatory training and updates when required. Therefore staff had received appropriate training to meet people’s needs.

Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

People were protected by the practice in place in relation to decision making. The registered managers and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been appropriately made when needed.

People were supported to eat and drink enough and maintain a balanced diet. People were offered a variety of meals and snacks to ensure good health. People’s weight was monitored and where concerns were identified additional snacks and higher calorie foods were offered. People were positive about the food at the service.

We last visited the service in August 2015 to undertake a focused inspection. This visit was to look at actions taken by the provider to address concerns found at a comprehensive inspection in March 2015. There had been significant improvements to the overall management of the home. All legal requirements had been met.

The service had two registered managers in post who shared the role. The second registered manager had moved from another of the provider’s locations in February 2016. A registered manager is a person who has registered with CQC 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.

There were adequate staffing levels to meet people’s needs. Staff had clear leadership roles at the home with delegated responsibilities.

People were supported by staff who had the required recruitment checks in place. Staff had received an induction and were knowledgeable about the signs of abuse and how to report concerns.

The provider had not ensured all staff had undertaken mandatory training to ensure they had the required knowledge to meet people’s needs. Not all staff had received support with their practice through supervisions and appraisals.

People were involved in making day to day decisions. Staff delivered care that was kind and compassionate. People felt they were treated with dignity and respect.

Measures to manage risk were as least restrictive as possible to protect people’s freedom. Medicines were safely managed on people’s behalf.

Care plans were personalised and recognised people’s health, social and psychological needs. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA.

People were supported to eat and drink enough and maintain a balanced diet. People were positive about the food at the service.

The premises were well managed to keep people safe. A designated maintenance person was employed to undertake repairs and undertake regular checks of the service. There were emergency plans in place to protect people in the event of a fire or emergency.

The provider had a range of quality monitoring systems in place which were used to continually review and improve the service. People were happy they could raise a concern if they needed to and action would be taken.

The provider actively sought the views of people, their relatives and staff through staff and residents meetings and questionnaires to continuously improve the service.

We found a breach of the regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

This was a follow up inspection to look at required improvements which had been made in relation to care and welfare and staffing levels, following our previous inspection in June 2014. Following the inspection the provider sent an action plan to the Care Quality Commission (CQC) detailing the improvements being made.

We found improvements had been made and people living on the Pinnexmoor unit were having their social needs met. The registered manager had ensured there were enough staff on duty with procedures in place to ensure people received safe care from people with the appropriate qualifications, skills and experience required at all times. These areas are now compliant.

At the time of our inspection there were 52 people living at Ashdowne Care Centre. The care centre consists of two units known as Ashdowne House and Pinnexmoor. The Ashdowne unit provides nursing care for older people and the Pinnexmoor unit provides care for older people with dementia. There were 26 people living in the Ashdowne unit and 26 people living in the Pinnexmoor unit. One inspector visited the home and spent approximately five hours there. The focus of the inspection was on the Pinnexmoor unit. This was because at our last inspection June 2014 the concerns we identified had been on this unit.

During our inspection, we spoke with three visitors, the registered manager, the provider's operations manager and nine staff. Due to most people living in the Pinnexmoor unit being unable to comment directly on the care they received we spent time in the communal areas observing people's experiences and how staff interacted with them.

As part of our inspection we looked at the activity records and care files of two people who were receiving support on the unit.

The questions we asked on this visit were:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service safe?

The service was safe because the registered manager had put into place procedures to ensure people were safe by having enough staff on duty with the appropriate qualifications, skills and experience required.

Is the service caring?

The service was caring because we observed staff treating people with kindness and respect.

Visitors told us 'I am very happy with the care here' and 'Very nice, X is well looked after, I have no concerns'.

Is the service effective?

The service was effective because the registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLS). They had made applications to the DoLS team for people with an assessed need in line with Deprivation of Liberty Safeguards legislation.

Is the service responsive?

The service was responsive to people's social needs. We saw people on the unit had a designated activity staff member. We saw people were engaged in meaningful activities. Staff interacted with people living at the home and were not always task orientated.

Documentation we saw showed every person in the unit had been engaged in personalised meaningful activities on a regular basis.

Staff we spoke with told us they had seen improvements. One member of staff told us 'The changes have made it nicer to come to work' another said 'It is much better but there is still room for improvement'.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

At the time of our inspection there were 48 people living at Ashdowne Care Centre. The care centre consists of two units known as Ashdowne House and Pinnexmoor. The Ashdowne unit provides nursing care for older people and the Pinnexmoor unit provides care for older people with dementia. There were 26 people living in the Ashdowne unit and 22 people living in the Pinnexmoor unit.

The inspection took place over two days. On the first day two inspectors visited the home and spent time in each of the two units. On the second day one inspector spent time in the Pinnexmoor unit.

During our inspection, we spoke with 11 people who lived at Ashdowne care centre, 26 staff and one visitor. Due to most people living in the Pinnexmoor unit being unable to comment directly on the care they received. We spent time in the Pinnexmoor communal areas observing people's experiences and how staff interacted with them.

Is the service safe?

The service was safe because people were supported by staff who had received appropriate training in the skills required to perform their roles.

However the registered manager had not ensured there were enough staff on duty with the appropriate qualifications, skills and experience required at all times.

The home had suitable arrangements in place to reduce the risks of people receiving inadequate nutrition or becoming dehydrated.

The service was safe because staff told us there was sufficient equipment to meet people's mobility needs. We saw maintenance schedules for equipment at the home which included the lifts, hoists and emergency lighting.

Arrangements were in place to manage emergencies, such as power failures, where necessary. We saw a list of emergency contact telephone numbers for staff to ring which included the lifts, hoists, sluices and fire equipment.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The registered manager told us they were aware of the judgement made by the supreme court in March 2014 regarding depriving people of their liberties. They were in the process of assessing people living at the service to assess whether they were restricting or depriving people using the service of their liberty. They would then make an application to the DoLS team in line with Deprivation of Liberty Safeguards legislation.

Is the service effective?

We know the service is effective because staff we spoke with knew people well and understood people's care and support needs. We saw comprehensive care plans had identified people's needs and how these needs should be met.

The service had undertaken regular audits and produced action plans which were then acted upon.

Is the service caring?

The service was caring because people were treated with respect and their dignity was maintained by staff. Throughout our visit, we saw that people were treated in a caring and compassionate manner and with dignity and respect. We saw while undertaking tasks staff were engaged in cheerful conversations with people and treated them as individuals.

People on the Ashdowne unit told us they were happy with the care they received. Comments included 'They (staff) are a good bunch of girls' and 'They look after us very well'.

Is the service responsive?

The service was not fully responsive to people's social needs. We saw people on the Pinnexmoor unit had no activity stimulation. There was little interaction between staff and people living at the home unless it was task related. Documentation we saw showed people were not receiving meaningful activities. We were told there was no program of activities in place.

The home had appropriate systems in place for gathering, recording and evaluating information about the quality and safety of the overall service. Systems were in place to make sure the registered manager and provider learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

The service was responsive because people's needs were risk assessed and their care plans regularly reviewed.

Is the service well led?

We found the service was well led. The registered manager has been in post for a number of years and is currently registered with CQC. We were told by staff and people who used the service and their visitors they had confidence in the registered manager and were able to approach her if they had any concerns.

The provider had an operations manager who visited the service regularly, supported the registered manager and undertook quality assurance checks. This showed the provider worked with the registered and the staff to ensure the standards that people expected at the home were maintained.

The provider undertook an annual survey to find out the views of health professionals and the people living at the service and their relatives.

We were joined on our inspection visit by an expert by experience, provided to CQC though AgeUK. They spoke with people living at the home and visiting relatives about the experiences of people living there.

There were 45 people living at the home. 24 on Ashdowne and 21 on the Pinnex unit. We concentrated our observations on the Ashdowne unit and saw every person living in that unit. However, we also spent some time in Pinnex to and observed lunch and morning activities on that unit.

We met with the registered manager, the provider and the operations manager. We also spoke with a total of thirteen people and five visiting relatives. We met and spoke with nurses on duty, care workers and ancillary support staff. During the inspection we observed the activities coordinator interacting with eight people. We watched interactions between individual staff members and residents, including assistance with moving and handling and assistance given at mealtimes. We observed lunch being taken on both floors of the building.

We found a number of strengths at the home. Records, including care planning and risk assessment were completed very well and tailored to individual need. There were low incidents of falls and people received health care support from community based professionals when they needed this. Every person we spoke with summed the staff up as kind and caring. Food and nutrition appeared well organised and a range of specialised diets were catered for.

Cleaning staff were on duty. They struggled to prevent the development of pockets of malodour in the home in the Ashdowne wing. However, people were clean and well care for. One regular visitor to the home told us they noticed an odour each time they visited.

There was one activity worker, five days a week. On the Ashdowne wing the majority of people were nursed in bed, meaning people were often isolated. People received individual attention but this was often limited because of the demands upon care worker time in providing physical care support for people at the home.

We spoke with a dozen people and with their relatives. Some people were confused as to where they were or why they now lived at the Care Centre. Everyone we spoke with told us how highly they rated the staff saying "I can't fault these people, I would not want you to think it" and "they are nice people". One women told us "yes I like it here, the staff are very good. They're kind, you can talk to them, they listen to you." A relative told us that they had looked at "every home in the district" and said "This is the best, the nurses are prepared to help - not just doing a job, they do appear to care."

We saw that the staff knew everyone well and could anticipate their needs. While we were there one person was celebrating their birthday. They had a family party with lots of visitors. Afterwards the person was tired and one member of staff stayed and supported them, gently chatting about the events of the afternoon.

People's privacy, dignity and independence were respected. Their views and experiences were taken into account in the way the service was provided. One person said "I am very happy here, the staff leave me alone and let me do what I want. I have choices in everything I do. I get up early when I like and I have choices each meal time, and you can change your mind." There were effective systems to monitor the service's quality and manage risks to people, such as from unsuitable premises. A typical comment about the environment was "It's clean and tidy.'

People experienced care that met their needs and protected their rights. For example, before they received care they were asked for their consent and where people did not have the capacity to consent the provider acted in accordance with legal requirements. We found the staff were supported to deliver care safely to an appropriate standard. Comments from people about whether their needs were met included 'Oh yes, they notice if you're a bit peaky' and 'There's always activities for residents.' One relative said 'Very happy here, wonderful care, the staff give all the care they need."