Ashcroft Hollow Care Home

Ashcroft Hollow Care Home is a residential care home providing personal and nursing care to up to 45 people. The service provides support to people aged 65 and over in one adapted building. At the time of our inspection there were 38 people using the service some of whom were living with dementia.

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

The provider had made improvements since our last inspection and people now had up to date risk assessments in place which were reflected of their current needs and were regularly reviewed. People were supported by staff who were trained to recognise and report on abuse. People were supported by enough staff who were safely recruited to work at the home. The provider had effective systems in place to safely manage people’s medicines and effective infection, prevention and control systems were in place. Lessons were learnt when things went wrong.

People’s needs and choices were assessed prior to and following their admission to ensure their needs and preferences could be met. People were supported by trained staff who were passionate about their roles. People were supported to eat and drink enough to maintain a healthy diet and they received consistent, effective and timely care. Adaptations were made to the home to meet people’s 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 well treated and supported to express their views and were involved in their care. People’s privacy, dignity and independence was respected and promoted. People complimented the staff team and the care they received.

People received personalised care which met their needs and preferences. The registered manager understood the accessible information standard. People were supported to follow their interests and maintain relationships which were important to them. People confirmed they knew how to raise any concerns or complaints. People’s end of life care wishes, and preferences were considered and documented in their care records.

The provider had updated their quality assurance processes in place to ensure they identified areas for improvement and actioned any concerns. People were supported by staff who shared a positive culture which was passionate about people receiving person-centred care. Staff were encouraged to be open and honest when things went wrong. People, their relatives and staff confirmed they had the opportunity to make suggestions and improvements to the care people received. The provider worked in partnership with others.

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 26 October 2020) and there were 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.

Why we inspected

This inspection was prompted by a review of the information we held about this service and was carried out to follow up on action we told the provider to take at the last 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashcroft Hollow Care Home 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.

Ashcroft Hollow Care Home is a care home providing personal care and accommodation for up to 45 older people some of whom are living with dementia. At the time of the inspection, there were 29 people living at the home. Care is provided on two floors, with bedrooms and communal areas on both floors.

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

We found some risk assessments for people had not been kept under regular review. The monthly reviews conducted on people’s care needs were not comprehensive, and did not take into account their full range of needs.

Governance systems were not being applied consistently meaning that the services people received were

not always effectively monitored.

There were inconsistent recording systems to evidence if people’s care file reviews had taken place. People were being repositioned, but there was no evidence in care files to suggest why this needed to take place.

The principles of the Mental Capacity Act to safeguard people from abuse were not always followed by the manager. The provider’s quality assurance system had failed to identify this.

We found that people were supported by a sufficient number of staff. Staff were responsive to people’s needs.

Staff managed people’s medicines safely. Records demonstrated that people had received their medicines as prescribed. Staff were trained to administer medicines safely and their competency to do so was checked regularly.

People unanimously told us they felt safe in the home.

The service was clean and free of malodour. There were a number of personal protective equipment (PPE) stations positioned throughout the home and staff wore appropriate PPE. When new admissions came into the home, they were isolated for 14 days.

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 rating at the last inspection was inadequate (published on 20 January 2020) and there were

multiple breaches of regulation, resulting in enforcement action being taken due to the significant concerns found. This resulted in a condition being placed on the provider’s registration for the breach of regulation 17 (good governance). The provider completed a monthly 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, further improvements were needed. The provider was no longer in breach of Regulation 12 (Safe care and treatment) and Regulation 18 (Staffing). However, they were still in breach of regulation 17 (Good government). The condition on their registration will remain in place.

This service has been in Special Measures since 22 January 2020. 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

We received concerns in relation to people's nursing care and how the service was promoting people's

safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We undertook this focussed inspection to check whether the provider 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

improved to requires improvement.

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

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 discharge our regulatory enforcement functions required to keep people safe and to

hold providers to account where it is necessary for us to do so.

We have identified a continued breach of Regulation 17 (Good Governance) of the Health and Social Care act 2008 (Regulated activities) Regulations 2014. The registered provider had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided.

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

Follow Up

We will request a monthly 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ashcroft Hollow Care Home is a care home providing personal care and accommodation to 38 people. Care is provided on two floors, with bedrooms and communal areas on both floors. Some of the people are living with dementia. The service can support up to 45 people.

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

People continued to be placed at risk of harm as medicines were not administered as prescribed or stored safely. Risk assessments put in place to keep people safe were reviewed however, not always followed. There continued to not always be enough staff available for people and they had to wait for support.

There was a lack of governance and leadership in the service and the provider did not have effective systems in place monitor the home. The provider did not have effective system in place to learn when things went wrong.

People are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice.

Staff understand when people may be at risk of potential harm and safeguarding procedures were followed. Infection control procedures were in place and followed. The home was adapted to meet people’s needs and was clean and tidy. People’s needs were assessed and care plans reflected people’s preferences. When people had cultural needs, this had been considered and staff were aware of the support people needed.

People enjoyed the food available and were happy with the staff that supported them. People could make choices and were encouraged to remain independent. People, relatives and staff spoke positively about the registered manager. We received notification as required and the rating from the previous inspection was displayed in line with our requirements.

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 (18 December 2018) and there were multiple breaches of regulations. The provider completed an action plan after the last 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 provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last six consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. We were also following up on enforcement action we had told the provider to take.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

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

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

Enforcement

We have identified breaches in relation to how risks are managed in the home. Staffing levels and people waiting for support. The understanding of capacity and consent. People's communication needs were not always fully considered. We also found concerns with the governance in the home as systems and audits were not always in place to identify areas of improvement.

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

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 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.

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 Hollow 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.

Ashcroft Hollow accommodates 45 people in one adapted building. There are two floors which both have various communal areas for people to access including, communal lounges and bathrooms. On the ground floor there is a large communal dining area. There is also a large garden area for people to access. At the time of our inspection 36 people were living at the home.

Following our last inspection, we requested the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good. The provider has not made the necessary improvements and remain in breach of regulations.

There was a registered manager in place, however they are no longer working within the home. There is a new manager in post who is in the process of registering with us. 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 are not enough staff available for people and they continue to wait for support. Risks to people are not fully considered or managed in a safe way. We found people are not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support this practice.

Peoples cultural or commination needs were not always fully considered. The care people received was not always responsive to their needs as records were not always up to date. Improvements were needed to the governance of the home. Audits were not always completed in key areas such as the management of medicines. When other audits were completed they were not always effective in identifying areas for improvements.

People were offered choices and enjoyed their meals however people’s dietary requirements were not always fully considered. People had access to health professionals such as GP’s.

Staff understood safeguarding and how to protect people from potential harm. There was a process in place to ensure staffs’ suitability to work within the home. Medicines were managed in a safe way and infection control procedures were followed. The home was decorated in accordance with people’s like and dislikes.

People were supported by staff they liked and the atmosphere within the home had improved. People were encouraged to be independent and make choices about how to spend their day. Their privacy and dignity was maintained. Visitors felt welcomed by the home and were free to visit when they chose.

People had the opportunity to participate in activities they enjoyed. People and relatives knew how to complain and were happy with the responses they receive. Staff felt listened to and supported by the new manager and people spoke positively about the changes and improvements they were making.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

Ashcroft Hollow 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.

Ashcroft Hollow accommodates 45 people in one adapted building. There are two floors which both have various communal areas for people to access including, communal lounges and bathrooms. On the ground floor there is a large communal dining area. There is also a large garden area for people to access. At the time of our inspection 33 people were living at the home.

Following our last inspection, we met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led to at least good. At our last inspection we had found that people had to wait for support. Care plans were not always reviewed to reflect people’s current needs. People were not always having baths or showers as they wished. People’s cultural needs were not considered or assessed. We also found it was unclear when people lacked capacity to make decisions for themselves and decisions had not always been made in people’s best interests. Staff did not demonstrate an understanding of the act. The provider had not acted on concerns with the equipment within the home and it was not always available for people. People were not always treated in a dignified way and staff did not always have time to treat people in a kind and caring way. The provider had not sustained previous improvements made. Not all the audits in place were effective in highlighting concerns or making improvements. At this inspection we found that some improvements had been made however the provider had not made the necessary improvements to comply with all the regulations.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found that people continued to wait for support, this included at mealtimes and when they needed assistance to transfer. The lack of support people received impacted on people’s dignity. As it was unclear when people lacked capacity, people are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice. Capacity assessments were not always fully completed or an outcome reached. There was no evidence that decisions were being made in people’s best interests.

Risks to people were not always fully considered as we observed that people received the incorrect diet and fluids that had been recommended to keep them safe. Care plans that were in place were not always reflective of people current needs including when they had wounds and in relation to their dietary requirements.

When people were living with dementia or had communication needs they did not always receive the support they needed. When people used pictures as a form of communication we did not see these were used. Improvements were need so that people could recognise their rooms and other communal areas within the home.

There were quality monitoring systems in place however we could not be assured how effective these were. The audits completed had not identified the concerns we found during our inspection. And although the home had access to monitor the call bell system no action had been taken when bells were not been answered for longer periods of time. The provider had sent us an action plan stating how they were going to comply with previous regulations they were in breach of; despite marking the actions as completed we found they were still non-compliant in some areas. A more comprehensive survey had been introduced however the information had not yet been collated or action taken to make the suggested improvements.

Other risks to people had been considered and they were reviewed when needed. Staff knew about these individual risks to people including how to support people to evacuate from the home in an emergency situation. There were systems in place to manage medicines and daily audits of medicines were completed to ensure people were protected from the risks associated to them. Staff understood safeguarding procedures and how to report and protect people from potential harm. The provider had ensured staffs suitability to work within the home. Staff received training and an induction that helped them support people and their competency in different areas had started to be assessed.

People enjoyed the food that was available and were offered a verbal choice. Health professionals raised no concerns about the home and worked closely with them. Referrals to health professionals were also made when needed. People were given the opportunity to participate in activities they enjoyed such as gardening.

There were infection control procedures in place and these were implemented. The home was clean and decorated in line with people’s preferences. Some people were encouraged to be independent and make choices how to spend their day. People and relatives were happy with the home, staff and support their received. Friends and relative were free to visit anytime and felt welcomed.

There was a complaint procedure in place and people felt more confident to complain. When complaints had been made these had been responded to. Staff felt listened to and had the opportunity to raise concerns, when needed they felt action was taken. People and relatives had the opportunity to attend meetings and when suggestions had been made these had been acted upon. The registered manager understood their responsibility around registration with us and notified us of event that occurred within the home. The previous rating was displayed in the entrance hall to the home in line with our requirements.

This is the fourth consecutive time the service has been rated Requires Improvement.

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

The service was registered to provide accommodation for up to 45 people. At the time of our inspection, 35 people were using the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were not enough staff available and people had to wait for support. The provider used a dependency tool to work out staffing levels however we could not be assured this was accurate as it did not always reflect people’s individual needs. The lack of staff in the home meant care was rushed. People were not always treated in a dignified and caring way by staff.

Care plans and risk assessments were not always reviewed to reflect people’s current needs. People's preferences or cultural needs had not always been considered. When people lacked capacity to consent this was often unclear and we could not see how decisions were made in people's best interests. Staff did not demonstrate an understanding when people were being restricted unlawfully or how to support people who lacked capacity to make decisions for themselves.

Not all of the audits introduced were effective in highlighting concerns or making improvements. We could not be assured the recruitment systems in place kept people safe. Previous improvements had not been sustained by the provider. People did not feel confident to complain as they were concerned about the consequence of doing this.

Staff knew what constituted abuse and how to protect people from potential harm. Staff received an induction and training that helped them offer support to people. There were effective systems in place to administer record and store medicines to ensure people were safe from the risks associated to them.

People were given the opportunity to participate in activities they enjoyed and were happy with the food and were offered a choice. When needed people had access to health professionals. Staff felt supported by the registered manager and people knew who they were. The registered manager understood their responsibility of registration with us and notified us of important events that occurred in the service. The previous rating was displayed in the home in line with our requirements.

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

The service was registered to provide accommodation for up to 45 people. At the time of our inspection, 37 people were using the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were rushed and people did not feel there were enough staff available for them. People were not always supported in a caring and dignified way and people and relatives told us they were not receiving baths or showers as preferred.

People told us they felt safe and staff knew how to recognise and report potential abuse. Risks to people were identified and staff had the information available to manage these in a safe way. People received their medicines as prescribed and it was recorded and stored to keep people safe from the risks associated to these.

Mental capacity assessments had been completed where people were unable to consent, We saw that decisions were being made and recorded in peoples best interests. Where people were considered to be restricted applications for this had been made.

People were able to make choices about their day and were encouraged to be independent. People liked the food available and were offered choices, they were encouraged to drink sufficiently and maintain a healthy diet. When people needed support from health professionals this was provided for them. People enjoyed the activities that were offered and were encouraged to pursue their hobbies and interests. Friends and family were free to visit when they chose and felt involved with reviewing their care.

Quality monitoring checks were completed by the provider and when needed action was taken to make improvements. The provider sought the opinions from people who used the service to bring about changes. People knew who the registered manager was and they understood their responsibilities around registration with us. Staff felt listened to and were happy to raise concerns. People knew how to complain and we saw when complaints were made these were responded to in line with the provider’s policy.

People who lived at the home and their relatives said they were very happy with the care provided. One person told us "They are very good here. There's nothing the staff won't do". One relative told us: "I can't speak highly enough about the home. I would recommend it". Another relative said: "They are brilliant. They look after [my relative] really well".

Our examination of records confirmed that the manager had taken action to address the omissions in records we saw at the last inspection. Records confirmed that people were consulted about their care.

People told us care staff respected their preferences. They said that their privacy was respected and they were treated with respect.

People were supported to have their health and personal care needs met. Medication procedures were in place and checks made sure that people had their medication as prescribed.

People told us they had lots of things to do. Regular group and individual activities took place that took account of people's preferences.

The home had a complaints procedure. People and relatives told us that they would raise any concerns. They told us they were confident that any issue would be addressed.

One person told us, "The staff are gentle, kind, considerate and everything you'd expect them to be. They sit and chat to me when they can; they make sure I have my frame. I would recommend it to anyone. There is a good entertainment officer and I can't fault the food, its home cooked and well presented".

Staff we spoke with were fully aware of how to protect people from abuse and how to recognise signs of abuse. People we spoke with told us they felt safe living in the home as the staff were so caring and friendly.

We saw that suitably trained staff were employed at the home in sufficient numbers.

We saw evidence and were told of the high level of satisfaction in the home. People that used the service, relatives and staff all spoke highly about the home. People that we spoke with told us they were content living at Ashcroft Hollow and some people had returned for their second visit.