Ashcroft Nursing Home

Ashcroft Nursing Home is a residential care home providing personal care for up to 40 people. At the time of our inspection there were 31 people using the service. The service provides support to people with a range of needs, including those living with dementia. The service no longer provided nursing care at the time of our inspection.

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

People received safe care because staff knew their individual risks and how to support them. Staffing levels had improved since the last inspection; there were enough staff available, so people did not have to wait for support. Staff training had been completed to enable staff to provide safe, person-centred care. People received safe support for medicines. The home had undergone refurbishment and there were improvements to décor, fixtures and fittings.

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 consulted and informed about their care.

Care staff were very kind and caring and they worked in person-centred ways so that each person was supported in ways they preferred. Care records were being developed to include more person-centred detail. We made a recommendation for the provider to consider how they can make care records more accessible to people, their families and all staff involved in people’s care and support. Activities and interaction with people had significantly improved and there were high levels of meaningful engagement. People’s relatives said they thought care was safe and there were good levels of trust for the staff and management team.

There had been significant improvement in the way staff, people and their relatives were involved and informed. Communication had improved throughout the service. Without exception, relatives’ feedback was highly positive and recognised the achievements and improvements since the last inspection. The service worked well with partners. Everyone felt they were able to feedback their views to the management team.

There were marked improvements in the leadership and management of the service. There was clearer oversight of the service delivery and the quality of care being provided. Systems and processes had been established to ensure more robust auditing and the registered manager was continuously considering ways to improve their processes to ensure quality checks were rigorous. We made a recommendation for the registered manager to consider ensuring further detail and clarity of recording where quality checks were made.

Rating at last inspection and update

The last rating for this service was inadequate (report published 23 September 2022) and breaches of regulation were identified.

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.

This service has been in Special Measures since 22 September 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to good based on the findings of this inspection.

Follow up

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

Ashcroft Nursing Home is a residential care home providing personal care for up to 40 people. At the time of our inspection there were 28 people using the service. The service provides support to people with a range of needs, including those living with dementia. The service had stopped providing nursing care at the time of our inspection.

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

People did not always receive safe care because risks were not properly assessed or mitigated. There were not enough staff deployed to meet people’s needs in a timely way and staff did not have up to date training to support people safely and in person-centred ways. The home was in the process of being refurbished, but some aspects of the building, furniture and equipment were not safe. People were not safely supported with their medicines.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not fully support this practice. We made a recommendation for staff to consistently involve and include people in decision making, in line with the principles of the MCA.

Care staff worked hard to try to meet people’s needs and they were kind and caring in their approach. Activities were not offered in ways which were meaningful to people and some people were not appropriately stimulated. Records of people’s care and support were not always completed or known by staff, to ensure the care people received met their needs. People’s relatives said they thought their loved ones were safe and well cared for overall. They trusted the staff, although expressed concerns about staffing levels.

People, families and staff were not always involved and informed about their care, or what took place in the home. We received mixed views about the quality of the communication in the service. Some relatives reported no concerns at all, whilst others said they thought there had been a recent decline in the standards and quality of care management and communication from the manager. We made a recommendation the provider seeks and acts on feedback and uses this information to improve the service.

There were significant weaknesses in the leadership and management of the service. There was poor internal communication and oversight of risk. Quality checks lacked rigour, and there was no robust or consistent oversight of the service delivery.

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 the service was Good, (published on 1 March 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was prompted in part due to concerns received about the environment and the quality and safety of the care provided. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the safe management and quality of people’s care, so we widened the scope of the inspection to become a comprehensive inspection which included all the key questions.

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.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people’s care, safety, staffing issues and how the service is managed.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

•Ashcroft nursing home is a care home that was providing personal and nursing care to 38 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

•Action had been taken to reduce risks since the last inspection.

•Staff were recruited safely and there were sufficient numbers of staff on duty to meet people’s needs. New staff received induction and there was an on-going programme of training and supervision for existing staff.

•Records were personalised, were updated at regular intervals and were stored securely.

•The management of people’s medicines was safe.

•The home was clean and suitably maintained.

•Staff were kind and caring. They respected people’s right to privacy and maintained their dignity.

•Complaints were acted upon and the registered provider and registered manager were pro-active in seeking feedback from people, their relatives, other visitors to the home and staff. Staff understood their roles and responsibilities. It was evident the management team and staff were committed to ensuring people received high level of care and support.

•The service met the characteristics for a rating of "good" in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was "good".

Rating at last inspection:

•Requires Improvement (published February 2018). This service has been rated ‘Requires Improvement’ at the last three inspections.

Why we inspected:

•This was a planned inspection based on the rating at the last inspection.

Follow up:

•We will continue to monitor the service to ensure that people receive safe, compassionate, high

quality care. Further inspections will be planned for future dates.

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

Ashcroft is registered to provide nursing and residential care for up to 40 people. When we inspected, 34 people were using the service. It consists of one building with three floors accessed by two passenger lifts. The majority of rooms are single with ensuite facilities. In one part of the ground floor there is a communal lounge and dining area within a large conservatory which has access to an outdoor paved seating area. A separate unit for up to six people living with dementia called Terrace Way is also located on the ground floor; this has an enclosed garden area with seating.

Ashcroft is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection we rated the home as ‘Requires Improvement’ in four of the five key questions and overall, and as ‘Inadequate’ in the key question of well-led. We identified breaches of the regulations relating dignity and respect, staffing, consent, safe care and treatment, and good governance. As a result, we served the registered provider with three warning notices and two requirement notices.

Following the last inspection, we met with the provider to discuss the improvements required at Ashcroft. They provided an action plan to show what they would do and by when to improve all the key questions to at least good.

Ashcroft had a registered manager. At the time of the last inspection in June 2017 she was on extended leave; at this inspection the registered manager was back 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 managed. Hoists were serviced but not subject to ‘thorough examination’ as required by Lifting Operations and Lifting Equipment Regulations 1998. Action to minimise Legionella risk was lacking.

Most feedback from people, their relatives and staff about staffing levels at Ashcroft was positive. Some concerns were raised about the staffing of Terrace Way; we fed these back to the registered manager and she immediately implemented a solution.

Medicines were managed and administered safely. This was an improvement from the last inspection.

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.

Records showed staff access to training and supervision had improved since the last inspection. Staff we spoke with told us they felt supported.

Feedback about food and drinks at Ashcroft was positive. People were given choices at each meal and the cook knew the specific dietary needs of individuals.

A system of communication was in place at the home to facilitate team-working. People were supported to meet their wider health needs. Care and treatment provided was based upon established evidence-based good practice.

People told us staff were caring and respected their privacy and dignity. All interactions we observed during this inspection were polite and supportive. This was an improvement from the last inspection.

People and their relatives were involved in planning and reviewing the care and treatment people received. The service supported people to meet their diverse needs.

Care plans at Ashcroft had been improved. We saw they contained person-centred detail and had been reviewed and updated regularly. People had care plans containing information about their communication needs in line with the Accessible Information Standard.

Care workers were now responsible for providing activities at the home. We saw a range of activities were ongoing during the inspection and feedback from people and staff was positive.

No complaints had been made since the last inspection. People and their relatives told us they felt able to complain if they wanted to.

People had end of life care plans in place. Staff were knowledgeable about end of life care and feedback we saw from relatives of people supported at the end of their lives was positive.

A system of checks and audits was in place to monitor safety and quality at the home. This had led to improvements, although failed to identify gaps in safety checks.

Feedback about the registered manager, nominated individual for the registered provider and other senior staff at the home from people, their relatives and other staff was positive.

People and staff were asked for feedback and ideas on how to improve the service.

The service learned lessons went things went wrong, and sought to improve using good practice and by partnership working.

We found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Ashcroft is a care home registered to provide nursing and residential care for up to 40 people. It consists of one building with three floors accessed by two passenger lifts. The majority of rooms are single with ensuite facilities. There were 33 people living at the home at the time of this inspection.

In one part of the ground floor there is a communal lounge and dining area within a large conservatory which has access to an outdoor paved seating area. A separate unit for up to six people living with dementia is also located on the ground floor; this has an enclosed garden area with seating.

Ashcroft was last inspected in November 2015. At that time it was rated as Requires Improvement overall as it was deemed to be Requires Improvement in all five of the key questions of care: Safe, Effective, Caring, Responsive and Well-led. We asked the registered provider to send us an action plan to tell us how they were going to tackle breaches of regulation relating to consent, safeguarding people and good governance.

The home had a registered manager; at the time of this inspection she had been on a period of extended leave since December 2016 and was due back to work in October 2017. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Not all risks to people had been assessed and managed. For example, people’s care plans did not contain information on how to support them to bathe and shower safely.

Control measures identified as required to reduce risk posed by the building were not in place. Other checks on the building’s utilities and equipment had been completed.

We identified concerns around the way medicines were administered, stored and recorded. Medicine stock levels reconciled with recorded amounts.

Feedback about staffing levels from people, their relatives and staff was mixed. We raised concerns about the dementia unit which was staffed by one senior care worker. Our observations showed people’s needs were met but staff were busy.

People said they felt safe at Ashcroft. Staff could describe the forms of abuse and knew how to report concerns appropriately.

Records showed staff did not have access to regular supervision; records made of supervision sessions were not detailed. The same concerns were raised at the last inspection in November 2015.

The home was not compliant with the Mental Capacity Act 2005 as mental capacity assessments had not been made for some people known to have problems making decisions. This was a breach of regulation at the last inspection in November 2015.

People and relatives gave us positive feedback about the food and drinks served at Ashcroft. We observed the dining experience was pleasant and people were offered choices. One person’s records contained contradictory information about their nutritional needs and their records did not evidence whether they received their prescribed supplements.

Most interactions between care staff and people were kind and caring, although we observed some which were disrespectful.

People were supported to maintain their independence and told us staff respected their privacy and dignity.

It was not possible to tell from people’s records whether they had been involved in planning their own care. People had access to independent support with decision-making if they needed it.

The thank you cards we saw from relatives of people who had received end of life care at Ashcroft were highly complimentary. Care staff could describe the important aspects of good end of life care.

The quality of care plans was variable. Most were detailed and person-centred, although some we saw had not been updated when people’s needs had changed or lacked the information staff would need to provide effective care. This was a concern at the last inspection in November 2015.

Most of the feedback from people about the activities offered at the home was positive. Throughout the inspection we observed people had opportunities to take part in activities. People and relatives told us visitors were welcome at any time.

None of the people or relatives we spoke with had made a complaint about the home since the last inspection, but all said they felt confident to complain if they needed to.

Concerns raised at the last inspection in November 2015 had not been resolved. Audits undertaken by staff at the home and by the registered provider had failed to identify issues with care plans and medicines management.

The provider’s governance arrangements for the extended absence of the registered manager were not adequate. The deputy manager was not given protected time to manage the home because they were needed to cover nursing shifts.

Regular meetings were held at which people, their relatives and staff could feed back about the home.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

We found staff interacted with people in a caring way and were respectful. We spoke with three people who used the service, one person said they were "very happy at the home" and they said they had a good rapport with staff. Another person we spoke with said they were happy at the home and there was a "good choice of food"; they also said staff were friendly. A third person we spoke with did not find it easy to communicate but they confirmed they had no complaints about the service or staff.

We found the environment of the home was safe and the lay-out enabled people's needs to be appropriately met. We found that necessary safety checks had been completed within the expected time-frames including fire safety and security.

In addition, we found there was an effective complaints system and the complaints process was clearly brought to the attention of people who used the service.

The visitors we spoke with told us they had no concerns at all about the standard of care their relatives received. One person said "I have visited at all times of the day and have always been made to feel welcome by the staff." Another person said "I cannot fault the care and support my relative receives, the staff are very approachable and extremely caring."

The care staff we spoke with told us there were clear lines of communication and accountability within the home and they were supported by management to carry out their roles effectively through a planned programme of supervision, appraisals and training.