Ashcroft Nursing Home

Ashcroft Nursing Home is a residential care home providing accommodation with personal and nursing care to up to 88 people. The service provides support to people with nursing needs, physical disabilities and people living with dementia. At the time of our inspection there were 48 people using the service. The accommodation is arranged across two floors with lift access. There is a third floor, currently out of use.

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

Audits on the service had been completed but quality assurance processes were not robust enough to identify shortfalls and take appropriate action. People had been asked their opinions of the service, but their feedback had not always been acted on.

People and their relatives told us they felt safe living in Ashcroft Nursing Home. One person said, “I am safe here, all the people are friendly.” Another person said, “I feel safe, permanent staff are good and make it safe, but there are a lot of agency.” One relative said, “Yes, I believe [relative] is safe. The staff respond.” Another relative said, “Oh yes, it’s a very good home. I can’t praise them enough. There’s plenty of people to keep an eye on them.”

Peoples’ needs were assessed before they moved into the service to make sure their needs could be met. Potential risks to peoples’ health and welfare had been assessed. There was guidance in place for staff to minimise the risks and keep people as safe as possible. Checks had been made on the environment including fire safety and electrical checks.

The service had been adapted to meet peoples’ needs. There were signs around the service and pictures on communal areas to help people find their way around. The service had cleaning schedules in place. People and relatives said the home was kept clean. One relative said, “The room is very clean and I’m very impressed.”

People received care from staff who knew them well and people and relatives used words to describe the staff, such as kind, caring, lovely, helpful and friendly. One relative said, “The staff are excellent, gentle, patient and go above and beyond. I see enough staff present. You see a change of faces with agency coming in.”

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.

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 7 July 2021).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, training and standards of care. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe section of the full report. However, we found evidence the provider needs to make improvements. Please see the well led section of the full report.

The overall rating for the service has remained good based on the findings of this inspection.

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, which will help inform when we next inspect.

Ashcroft Nursing Home is a residential care home providing personal and nursing care to 34 older people at the time of the inspection, including five people receiving nursing care. The service can support up to 88 people. People are supported in one purpose built setting, over two floors, the top floor is not used.

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

People and relatives told us they thought the service was safe. People told us, they felt safe with the staff and were supported as they wanted.

Potential risks to people’s health, welfare and safety had been assessed and there was guidance in place to reduce the risk. Accidents and incidents had been recorded and analysed to identify trends and patterns. Action had been taken to reduce the risk of them happening again. There were systems in place to protect people from abuse and discrimination.

People’s medicines were managed safely. People’s health was monitored, and staff referred them to relevant health professionals. Staff followed guidance to keep people as healthy as possible.

Staff had been recruited safely and received training appropriate to their role. Staff received supervision and their competency checked to develop their skills and knowledge.

The service was clean and hygienic. Staff followed current government guidance including wearing personal protective equipment. Visitors had been supported to enter the service safely and people enjoyed seeing their relatives.

The management team completed assessments before people were admitted to the service to check staff could meet people’s needs. People had care plans in place giving details of their choices and preferences.

People were supported to eat a balanced diet; people had a choice of meals. People’s dietary needs were catered for. People had access to activities they enjoyed and were given information in formats they could understand.

People were supported to be as independent as possible. Staff treated people with dignity and respect. People’s end of life wishes had been recorded and a care plan developed.

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.

The management team completed checks and audits on the quality of the service and acted when shortfalls were found. There was an open and transparent culture within the service. People and relatives told us they knew how to complain and were confident action would be taken.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement, (published on 9 October 2019.) The provider completed an action plan after the last inspection to show what they would do and by when to improve. We completed a targeted inspection on 22 July 2020 but this inspection did not affect the last rating. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

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.

Ashcroft Nursing Home is a residential care home that is registered to provide people with nursing and/or residential care. In practice, the service does not provide nursing care. It accommodates older people and people who live with dementia.

At the time of this inspection there were 18 people living in the service. People living at the service only required residential care. The service can support up to 88 people.

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

People and their loved ones told us they were safe at the service and well supported by staff. Risks to people were assessed and plans were in place to minimise risks. When appropriate, people were involved in managing their own risks. Staff had the guidance they needed to keep people safe and could tell us about how they would manage risks related to people’s health or support needs. Risks to the environment had been assessed and action had been taken to ensure it was safe for people. For example, equipment had been serviced and checked to ensure it was fit for purpose.

The registered manager carried out a range of audits to monitor the quality of care people received. These included health and safety checks of the environment, care plan audits and reviewing staff training needs. Completed audits formed the basis of an action plan which recorded when actions were completed. Staff told us they were all aware of the improvements to be made and were involved in improving quality.

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 (published 10 October 2019). The service was in breach of four regulations of the Health and Social Care Act (2014) related to safe care and treatment, the environment, person centred care and good governance.

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 however, we did not inspect all areas related to the breaches of regulation so we cannot say if the breaches had been resolved.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the management of risk and quality improvement. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

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.

Ashcroft Nursing Home is a residential care home that is registered to provide 88 people with nursing and/or residential care. In practice, the service does not provide nursing care. It can accommodate older people and people who live with dementia. It can also provide care for people who have physical and/or sensory adaptive needs.

At the time of this inspection there were 52 people living in the service. All the people only required residential care. Most of the people lived with dementia some of whom had special communication needs.

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

People and their relatives were positive about the service. A person said, “The staff here are good to me and as I’m okay here.” Another person smiled and pointed in the direction of a passing member of staff when we used signed-assisted language to ask them about their home. A relative said, "I’m happy with the care provided here as the staff are very attentive.” A health and social care professional wrote to us saying they considered the service to provide ‘commendable’ care.

We found there were four breaches of regulations three of which had continued since our inspection in June 2018. People did not always receive safe care and treatment to reduce risks to their health and safety. Some parts of the accommodation did not meet people’s needs and expectations. Care was not always provided in a person-centred way to promote people’s dignity. The registered persons did not have all the necessary systems and processes to enable them to effectively supervise the running of the service.

Our other findings were as follows

Although care staff had received training and guidance they did not always have the skills and competencies they needed to care for people in the right way. We have made a recommendation about ensuring care staff have the competencies they need.

People were safeguarded from the risk of abuse. There were enough care staff on duty and safe recruitment practices were in place.

People received coordinated care when they moved between services. People had been helped to quickly receive medical attention when necessary. People were supported to have maximum choice and control of their lives and care 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 given information in an accessible way so it was easier for them to understand. People were supported to pursue their hobbies and interests. There were arrangements to quickly investigate and resolve complaints. People were treated with compassion at the end of their lives so they had a dignified death.

People had been consulted about the development of the service. There was good team work and joint working was promoted.

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

Rating at last inspection (and update)

The last comprehensive inspection was completed on 18 June 2018 and 19 June 2018. The inspection report was published on 1 August 2018. The rating for the service was Requires Improvement.

The registered persons completed an action plan after the inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made or sustained and the registered persons were still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three continuing breaches of regulations. People did not always receive care and treatment that was safe and person-centred. The service was not consistently well-led. There was a new breach of regulations. This was because some parts of the accommodation were not designed, adapted and decorated to meet people's needs and expectations.

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

Follow up

We will meet with the registered persons following this inspection 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 the service in line with our inspection programme. If we receive any concerning information we may inspect sooner.

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

Ashcroft Nursing Home accommodates up to 88 people in one adapted building, some people may be living with dementia. At the time of the inspection 48 people were living on the ground and first floors of the service.

There was a registered manager in post, however, they were not in charge of the service on a day to day basis. Until February 2018, there had been another registered manager in post, who worked at the service daily. At the time of the inspection, there was an acting manager working at the service who was responsible for the day to day oversight of the service. They had recently made an application to us to become the new registered manager of the service. 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.

We last inspected the service in March 2016 and the service was rated Good. This inspection was undertaken in response to information from the local safeguarding authority about how people with behaviours that challenge had been supported. At this inspection, four breaches of regulation were identified.

Potential risks to people’s health and welfare such as epilepsy had not been consistently assessed and staff did not have detailed guidance to mitigate the risk and support people needed when they were unwell. Checks had been completed on the environment and equipment that people used to make sure it was safe. However, no action had been taken when the temperature of the water in some people’s bedrooms were above the recommended limit to reduce the risk of scalding. Following the inspection, the acting manager sent us records to show that action had been taken to reduce the water temperatures.

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. Some people had gates in their doorways and were independently mobile but were restricted from going into and leaving their rooms. There were no records about how this decision had been made and if this was the least restrictive way to support these people.

Each person had a care plan, that covered all aspects of their lives including physical and social needs. However, the care plans did not always contain detail about people’s choices and preferences. Some people had been identified as being at the end of their lives, their wishes and the support they needed was not recorded in their care plan. Staff had received training in end of life care and could support people to be comfortable.

Staff and the provider completed audits on the quality of the service. When shortfalls were identified, an action plan was put in place. However, these plans were not checked to confirm the action had been completed, plans were signed as completed before the all the action had been taken. The action taken in response to the audits and shortfalls found was not embedded as further shortfalls were found at this inspection.

Before the inspection, concerns had been raised that incidents involving people who displayed behaviours that challenge, had not been managed effectively. The acting manager had put systems in place to manage future incidents and people’s behaviour. Accidents had been recorded and analysed to identify trends and patterns. Action had been taken to reduce the risk of accidents happening and records showed that the action had been effective.

Staff and the acting manager understood their responsibilities to keep people safe and report any concerns they may have. Staff were confident that the acting manager would take appropriate action. People received their medicines safely and when they needed them.

There were sufficient staff, who had been recruited safely, to meet people’s needs. Agency staff were used to cover staff shortages, agency staff told us they did not work by themselves and had received an induction. Staff received training appropriate to their role and additional training had been introduced when needed to meet people’s needs. New staff received an induction and staff received supervision and felt supported by the acting manager.

People were assessed before moving to the service to make sure that staff could meet their needs. People’s needs were assessed in line with current guidelines. Staff monitored people’s health and any changes were reported to healthcare professionals and staff followed the guidance given.

People were supported to eat and drink enough to maintain a balanced diet. People were given a choice of meals and staff supported them to make choices throughout the day. People were encouraged to take part in exercise and lead a healthy lifestyle.

People told us staff were caring and respected their privacy and dignity. We observed this throughout the inspection, staff treated people with respect and encouraged them to be as independent as possible. People were supported to express their views and where possible involved in planning their care. People were given information in a format they could understand.

People and relatives told us they knew how to complain. When complaints had been received they were investigated in line with the provider’s policy and action taken to learn from the complaint.

The acting manager had a vision for the service and staff supported this, to make the service person centred. People were encouraged to take part in activities they enjoyed and meetings to express their views and shape the service. Staff and people completed quality surveys, these had been analysed and improvements had been made. The acting manager attended provider meetings to keep up to date with changes.

The service was clean and free from odour. The building was adapted to meet people’s needs including secure outside space. Signage around the building was designed to support people living with dementia. Checks had been completed on the building and equipment to ensure it was safe for people to use.

Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. CQC check that appropriate action had been taken. The provider had submitted notifications to CQC in an appropriate and timely manner in line with guidance.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall and on the provider website.

At this inspection four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. You can see what action we have asked the provider to take at the end of the report.

Ashcroft Nursing Home is a privately owned care home supporting up to 88 people, who may be living with dementia. Current accommodation is over two floors accessed by a passenger lift. There were 45 people living at Ashcroft Nursing Home when we inspected.

There was a registered manager in post, the registered manager had recently been promoted to the area manager role. The registered manager was present on both days of the inspection.

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. A replacement manager had been appointed and they were in the process of registering with the CQC. Staff told us the managers were available and approachable.

The registered manager and deputy manager provided leadership to the staff and had oversight of all areas of the service. Staff were motivated and felt supported by the registered manager and senior staff and the personal development of staff was encouraged.

The staff understood the vision and values of the service, such as person centred care, treating people with respect and maintaining their privacy and dignity.

Staff had completed safeguarding training and they knew what action to take if they suspected abuse, and who to report to, such as the local authority safeguarding team. Staff knew about the whistle blowing policy, and were confident they could raise any concerns with the registered manager, who would take appropriate action.

There were sufficient numbers of staff on duty. Staff were checked before they started to work at the service and regularly received training to ensure they had the skills and competencies to provide safe care. New staff received induction training and shadowed established staff before they started to work on their own. Staff met with a senior staff member to discuss their role and practice, and to discuss their training and development needs.

People were supported to make their own decisions and choices, and these were respected by staff. Where people lacked the capacity to make complex decisions about their care, management and staff were guided by the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) as a basis to make decisions that were in people’s best interest.

Medicines were stored and administered safely. People had the support they needed to attend health appointments and to remain as well as possible. Staff responded to any changes in people’s health needs; people told us that staff always called their doctor if they felt unwell. People made positive comments about the food, there were daily choices and people took part in choosing the menu. If people were not eating enough their food was monitored. If required, a referral was made to a dietician or their doctor, and supplements were provided as necessary so that people maintained a healthy weight.

Potential risks to people were identified and staff took action to reduce risks to people. The care and support needs of each person were different and each person’s care plan was personal to them. Some care plans needed updating and the deputy manager started to address this during the inspection. There were plans to respond to emergencies. Emergency evacuation procedures were in place and the fire system and equipment were maintained and serviced regularly

The complaints procedure was available but could have been more accessible and meaningful to people living with dementia. People felt comfortable in complaining and when they did complain their complaints were looked into and action was taken to resolve them. People had opportunities to provide feedback about the service both informally and formally.

Throughout the inspection people were treated with kindness and respect. People told us the staff were kind, and respected their privacy and dignity. People were encouraged to be as independent as possible. Staff were attentive and the atmosphere in the service was calm and people looked comfortable in their surroundings. Staff encouraged and involved people in conversations as they went about their duties.

People were given support to carry out their preferred hobbies and interests. There was a range of activities on offer. Staff were familiar with people’s likes and dislikes, such as how they liked their food and drinks and what activities they enjoyed.

Accidents had been recorded and action had been taken to reduce the risks, however incidents were not always analysed to identify any patterns or similar trends to reduce the risk of them happening again. Records were available and stored securely, three care plans we sampled needed updating.

Cleaning plans had been updated and improved and the service was clean.

Services that provide health and social care to people are required to inform the Care Quality Commission, (the CQC), of important events that happen in the service like serious injury and safeguarding incidents. This is so we can check that appropriate action had been taken. The management were aware that they had to inform CQC of significant events without delay, but one incident had not been reported to CQC and two other incidents had not been reported appropriately to the coroner. We have made a recommendation about this.

Since our last inspection the provider sent us an action plan showing how they intended to improve the service and achieve compliance. The provider had sent us updates about the action being taken to improve the service.

The manager had audited care plans, risk assessments and charts, including food and fluid intake charts, and had made referrals for extra support to health professionals including dieticians for people when needed. Care plans were complete, organised and up to date so gave staff guidance about how people preferred to be supported. Care plans and risk assessments had been reviewed and updated where needed and any changes had been recorded leading to any required change in care and support.

Charts for recording things like people's food and fluid intake and their weight were complete, reliable and up to date. This meant that any changes could be picked up quickly and acted on by staff. We found that when a change occurred, for example if a person lost weight quickly; the staff took action and responded by seeking advice and making a referral for extra support.

Concerns were raised to us before the inspection about staffing levels. Visiting professionals told us that they observed call bells not being answered and people having to wait for assistance. We looked into this and found that there were sufficient staffing levels to meet people's needs. We saw that call bells were answered quickly. A relative who visited several times a week told us that they felt the staffing levels were adequate.

Concerns had been raised about people's personal care needs not being met and that the home was not clean enough. We looked into this and found that people had the support they needed with their personal care. The home was clean, including toilets and bathrooms on both days of our inspection. A visitor told us that they thought the home was generally clean and their relative's personal care needs were met.

People we observed were involved in what was happening in the home. Staff engaged with them every time they walked past and they were encouraged to participate in the activities. People indicated that they were happy at the home.

People told us they were satisfied with their care. They were supported to attend health care checks and community health professionals were involved to provide advice and intervention when needed. However, care plans did not always reflect the individual and personalised care being provided and did not show how risk would be managed. Care plans had not been evaluated and updated when a care need or a risk was evident. Records were therefore not fully accurate, completed or up to date. This meant that staff had no guidance to follow about how to support people's needs and reduce potential risks.

Everyone we spoke with said or indicated that they felt safe at the service.

We found that there were enough skilled and experienced staff to meet people's needs. However the tool the service used to determine staffing levels was not reliable. Staff received training to give them the knowledge and skills to care and support people at the service.

People and their relatives told us they did not have any complaints about the service. They were confident if they did the manager would take action to resolve any issues.