Ashfield (Malton)

Ashfield (Malton) is a residential care home providing personal and nursing care to up to 31 people. The service provides support to older people. At the time of our inspection there were 16 people using the service.

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

A governance framework was in place however this was not robust as it failed to identify the concerns we found during inspection. There was a lack of consistency and discrepancies in documentation relating to some aspects of the service. Quality assurance information to support and evaluate learning and improvement had commenced but was not yet fully embedded. The registered manager and deputy manager had started to review and allocate responsibilities.

Detailed risk assessments meant risks to people were monitored and managed, however on the day of our visit the number of personal emergency evacuation plans (PEEPs) did not match the number of people living at the home because 1 person had been admitted to hospital that week.

Staff were knowledgeable about how to keep people safe and felt confident to report concerns to seniors and managers should they arise. Sufficient numbers of suitable staff were employed, and care was observed to be unhurried. Medicines were administered safely, and current guidelines and protocols were followed. People were protected by the prevention and control of infection. The home was clean, tidy and odour-free.

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 did not support this practice. This is because Deprivation of Liberty Safeguards had sometimes been made when it was recorded the person had capacity.

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 8 April 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. 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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 25 and 31 January and 4 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ashfield (Malton) on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to how managers tracked and monitored risk and used quality assurance audits to ensure systems and processes were followed correctly at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashfield (Malton) (North Yorkshire County Council) is a care home which provides accommodation and personal care for up to 31 older people including some who were living with dementia. At the time of inspection 16 people were using the service. Care is provided at Ashfield over two floors with lift access available. There are various communal areas that people can use, including lounges, a dining room and an activity room.

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

People did not always receive a safe and well-led service. Care and support were not always tailored to meet people's specific needs. Care plans and risk assessments were not always personalised, and risks linked to people's care were not always considered, reviewed and monitored.

People’s ‘as and when required’ medicines were not appropriately administered. Medicines audits were completed but did not identify the concerns found at this inspection.

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

Quality assurance systems and processes were not effectively followed. Audits completed did not identify the shortfalls we found during the inspection. Records relating to people mental capacity needs were not always clear to show the provider followed the principles of the Mental Capacity Act 2005. We have made a recommendation about this.

Accidents and incidents were not continually analysed in line with the provider’s process. Opportunities to learn lessons to continuously develop the service were missed.

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

Rating at last inspection

The last rating for this service was good (published 24 December 2019).

At our last inspection we recommended the provider considered current medicines guidelines relating to the use of ‘as and when required’ medicines and reviewed their approach to quality assurance systems in place at the service. At this inspection we found the provider had not fully acted on recommendations made and improvements had not been made.

Why we inspected

We undertook a targeted inspection to look at control measures in place for infection prevention and control. As part of CQC’s response to care homes with outbreaks of COVID-19, we are conducting reviews to ensure that the infection prevention and control (IPC) practice is safe and that services are compliant with IPC measures.

We inspected and found there was a concern with window safety and risk management so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

Enforcement and Recommendations

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 safe care and treatment and good governance at this inspection.

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

Follow up

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

Ashfield (Malton) (North Yorkshire County Council) is a care home which provides residential care for up to 31 older people including some who were living with dementia. At the time of inspection 28 people were using the service. Care is provided at Ashfield over two floors with lift access available. There are various communal areas that people can use, including a lounges, dining room and activity room.

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

Medicines were predominantly safe. We have made a recommendation about the management of some medicines. Audits were in place although we have made a recommendation about the governance and oversight of the service

Systems were in place to ensure people were protected from abuse and investigate any concerns. Risks linked to people's care were considered and monitored. Environmental risks were considered. Staff recruitment was robust and people received care from staff who knew them well and had relevant experience.

People told us they received good quality care from the staff at Ashfield. All the people and relatives we spoke with said they were happy with the care provided.

People were treated as individuals and their decisions were respected. They and/or their relatives were fully involved in their care. People received care and support in line with their individual needs and preferences and they were supported to have maximum choice and control of their lives.

There were enough staff available to spend time with people and to provide them with support when required. The staff were kind, caring and polite and treated people with respect whilst upholding their dignity. People received support with their hobbies and interests to enhance their wellbeing.

People were encouraged to maintain a healthy, balanced diet, based on their individual needs and had access to food and drink whenever they wanted.

People were supported to maintain their health and the provider worked well with other health and social care services to ensure people received the support they needed, when this was required.

People and relatives told us they knew how to complain; any complaints had been investigated and action taken to resolve the issues.

Incidents and accidents were recorded, and an overview held so that any trends and themes could be identified. Where appropriate people had end of life wishes recorded within the care plan.

Staff were happy and felt well supported. People felt the manager was approachable and friendly.

Rating at last inspection and update

The last rating for this service was Good (published 16 May 2017)

Why we inspected:

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

Follow up

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

This inspection was unannounced and was carried out on 25 April 2017. The inspection was to check that the registered provider was now meeting the legal requirements we had identified at our last inspection on 16 February 2016. We asked the registered provider to take action to improve their quality assurance system in relation to audits and record keeping.

During this inspection we found that the registered provider had taken action to improve practices within the service in line with their action plan from June 2016. We found these improvements were sufficient to meet the requirements of Regulation 17. This meant the service was now meeting legal requirements.

Improvements had been made to the quality assurance system including the safety of the service, the risks relating to the health, safety and welfare of people who used the service and the way feedback from people who used the service and staff was obtained. The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We received positive feedback from people who used the service, visitors, relatives and staff about the changes taking place in the service.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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.

People told us they felt safe and were well cared for. The registered provider carried out recruitment checks to ensure they employed suitable people and there were sufficient staff employed to meet people’s needs. Medicine management practices were being reviewed by the registered manager and action was taken to ensure medicines were given safely and as prescribed by people’s GPs.

Staff had completed relevant training. We found that they received regular supervision and yearly appraisals, to fulfil their roles effectively.

People were supported to have 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.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People said they enjoyed good food. People's health needs were identified and their independence was promoted. Staff worked with other healthcare professionals, to ensure these needs were met.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

There was a registered manager employed at 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.

Where people had identified conditions in their care plans the service had not always carried out a risk assessment or made sure that staff had a management plan in place which would guide them in the care of the person. The staff did know people well when we spoke to them. However, the information should be available for staff. We have made a recommendation about risk assessments and management plans.

Audits had not been carried out in all areas of the service so there was no formal means of identifying where improvements were needed. Record keeping was not consistent. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the full version of this report.

Medicines were managed safely within the service. We observed medicines being given and saw that the member of staff did this with care. People's nutritional needs were met and people received nicely presented meals which they said they enjoyed. A choice of menu was offered with alternatives available if people did not like what was on offer.

Safe recruitment practices were used and staff had all necessary checks before being employed at this service. There were sufficient staff to meet people's needs on the day we inspected and rotas showed that these numbers were consistent. Staff were caring and showed this through being respectful and considerate of people. We saw different examples of positive interactions between staff and people who used the service during the inspection.

Staff knew people well and could tell us about them. We saw that people had access to a diverse programme of activities across the week. There was a dedicated activities room where crafts and other hobbies could take place.

Staff were aware of the Mental Capacity Act and able to tell us what it meant to deprive someone of their liberty lawfully. There were no deprivation authorisations in place at the service but the registered manager was going to review some people who used the service to be sure an authorisation was not necessary. Peoples consent was sought throughout the day and we saw that consents for care and support had been signed by people in their care records.

Below is a summary of what we found. The summary describes what people using the service told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were seen to be treated with respect and dignity by the staff. People we spoke with told us they had felt listened too by the staff.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). There was no one currently using the service who had a DoLS in place. People who required this to be put into place would be assessed, to help to protect their rights.

We were told that people received the care they needed but that when staffing numbers were low this could affect the quality of the care provided.

The provider had effective systems in place to deal with any emergency.

Is the service effective?

People's health and care needs were assessed and support plans and risk assessments were in place. This helped to ensure that people's needs were met. A person we spoke with said 'I am looked after well. The staff get the doctor for me if I want them. I haven't needed them lately.' We observed that the staff knew people's individual needs well.

People were asked for their verbal or written consent in regard to the care and support they received from staff.

Systems were in place for the provider to monitor if the service was effectively meeting people's needs. Staff received training to help to maintain and develop their skills.

Is the service caring?

People we spoke with said the staff were patient and kind. They told us they received the support they wanted to receive. People's likes, dislikes and preferences were known by the staff.

We saw from the care records we inspected that people's preferences, interests, aspirations and were recorded. Daily entries made by staff confirmed that care had been provided in accordance with people's wishes.

Is the service responsive?

There was a complaints policy in place which people had been made aware of. A person we spoke with said 'I talk to staff and I do say if I have a complaint.' The manager was available for people or their relatives to speak with if they wished to make a complaint or raise any issues." People told us that they believed any issues raised would be dealt with.

The staff told us how they would act on any changes in people's condition, informing relatives or health care professionals, as necessary. Staff we spoke with told us how they covered staff absence and holidays to help to provide continuity of care for people.

Is the service well led?

Systems were in place to review, develop and monitor the quality of service being provided. However, the provider may wish to note that all the staff we spoke with raised issues about staffing levels. On some shifts we saw that there were a lot of staff on duty and on other shifts staffing numbers were low. Although the staff told us that people received the care they needed to receive the provider may wish to look at this.

Compliment, comment and complaints had been encouraged. A person we spoke with said 'I would not want to move from here. They listen to my views.'

We observed people being spoken with in a kind and supportive way. The care staff took time to listen and acted upon the request in an unhurried and professional way. We saw in the care records that care was person centred, which meant that everyone had a personalised plan which met their needs.

We observed care in the dining room over the lunch-time meal. People were supported in a timely way. They were offered choices and if they were undecided, the plated meals were shown. This helped people to be supported to choose the food they preferred to eat. One person commented that the food 'Is really good here.'

At a previous inspection in January 2012 we found moderate concerns relating to inadequate staffing levels. We asked the provider to address these concerns. At this visit we found that these concerns had been addressed and there were sufficient people rostered for duty to provide safe care.

We found that suitable arrangements were in place to monitor the quality of the service provided. This included policies and procedures and quality monitoring systems.

We did not speak with people who used the service on this visit but in June they told us that they were treated with respect and that staff were considerate and caring. They liked living here. We made some observations on this visit. For instance people were being spoken to in a kind and unhurried way by the care staff. We saw people were appropriately dressed and looked comfortable and well cared for. We also saw people being supported to have their lunch and the care staff were sat next to them this helped them to interact positively with each other.

On this occasion we concentrated on checking whether improvements had been made. We looked at the way in which the home managed the care records and saw that better systems were now in place for assessing, planning and recording individuals needs. This helped to ensure people received appropriate and safe care.