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.