Ackroyd House

We found the following examples of good practice.

All visitors were screened for symptoms of infection before being allowed to enter the home. The home had facilities for people to wash their hands or sanitize on entering and leaving the home. Information was easily accessible on arrival to ensure visitors followed guidance.

The home had a visiting ‘pod’ to help facilitate visits safely. There was a booking system in place for visits. Communal areas were used creatively to help with infection prevention and control.

The provider understood and complied with the vaccination requirements for visitors to the service.

We found the following examples of good practice:

The service was exceptionally clean, there were ample supplies of good quality hand sanitiser and cleaning products. The designated entrance had a hands free temperature monitoring machine in place.

A dedicated staff team was in place to support people. Staff worked on shifts with the same staff to ensure they were working within a bubble system.

The provider was committed to supporting staff through increased supervisions and training to ensure they were comfortable with the work they were carrying out. Staff said they were well supported and felt the systems and processes in place kept them safe.

External professionals had assessed the providers IPC measures and any recommendations had been actioned within 24 hours. The provider was acting responsively to any requests to make improvements.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Ackroyd House is a residential care home providing personal and nursing care for up to 51 people. Some people using the service were living with dementia. The home is situated on the outskirts of Rotherham, close to the local hospital and bus routes. At the time of our inspection 43 people were using the service.

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

People were safeguarded from the risk of abuse. Staff had confidence the registered manager would take appropriate actions to keep people safe. People’s needs had been assessed and risks associated with their care and support had been identified and action taken to minimise them. People’s medications were managed safely to ensure people received medicines as prescribed.

The registered manager ensured that lessons were learned when things went wrong and saw the process as a learning opportunity. The home was clean and well maintained. We observed staff using personal protective equipment [PPE] when required. The provider had a good process in place to monitor and minimise the spread of infections.

Prior to people receiving a service at the home, an assessment took place to ensure the person’s needs could be met. Staff received training and support to ensure they had the skills to carry out their role. People were supported to maintain a healthy and balanced diet. We observed lunch on our first day of inspection and found this was a pleasant experience and people received the support they required.

The staff team worked well with other services to ensure people received timely and appropriate care. The home was designed to meet the needs of people using the service. Improvements had taken place since our previous inspection. These changes had positively impacted on people living at the home.

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.

We observed staff interacting with people and found they were polite, kind and caring. We observed lots of friendly and appropriate banter between staff and people. We saw staff were thoughtful and respected people’s dignity.

Care plans were detailed and included people’s personal preferences and choices. The provider employed an activity co-ordinator who was responsible for ensuring meaningful and varied activities took place. Social stimulation was also provided by the whole staff team. People requiring end of life care were supported in a dignified and comforting way.

The service had a complaints procedure in place and the provider was responsive to concerns raised.

The management team were dedicated to ensuring people received person centred care. The registered manager had an easy to follow management system in place which was effective and understood by other members of the management team.

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 22 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service was previously inspected in February 2018, when we identified five breaches of regulations. The registered provider did not ensure care was person-centred, did not manage risks to ensure peoples safety, was not meeting the requirements of The Mental Capacity Act, did not ensure people received adequate support to be able to meet their nutritional needs and there was ineffective governance and oversight by the registered provider. The service was rated as Inadequate and it was placed in special measures.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do to improve the service.

At this inspection we checked if improvements had been made. We found that the provider had addressed all the concerns raised at our last inspection and made sufficient improvement to meet the requirements of the regulations. The overall rating of the service improved to requires improvement and removed from special measures.

You can read the report from our last inspections, by selecting the 'all reports' link for ‘Ackroyd House’ on our website at www.cqc.org.uk.

Ackroyd House 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.

The service provides accommodation for up to 52 older people in one adapted building, including people living with dementia. It is situated on the outskirts of Rotherham. It is close to the local hospital and bus routes. At the time of our visit there were 51 people using the service.

At the time of our inspection there was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. However, the registered provider had appointed a manager who was in the process of registering with CQC at the time of our inspection.

Since our last inspection the registered provider had made changes in the management team, there was a new manager and a new deputy manager, who was the clinical lead. The new team were beginning to establish and lead the service. However, the systems in place to monitor the service were new and although had identified areas of concern, the concerns had not always been addressed as the systems required further embedding into practice and improvements sustained by the new management team.

There were systems in place to manage medication administration and predominantly these were followed. However, we found issues with documentation that the providers audits had previously picked up but had not been addressed. This was actioned immediately by the provider.

People were safeguarded from the risk of abuse. Staff confirmed they received training in this subject and could explain what actions they would take if they suspected abuse.

Risks associated with people’s care were identified and managed appropriately which kept them safe.

There were sufficient staff available to support people who used the service in a timely manner.

The service was clean and people were protected against the risk of infections.

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. Staff received the training and support required for them to carry out their roles effectively. People received support from healthcare professionals when required and their advice was followed.

People were supported to maintain a healthy and balanced diet which included their choices and preferences.

We observed staff were kind, caring and considerate. Staff respected people’s privacy and dignity and involved them in their care and support.

The service was responsive to people’s needs. Care records we looked at contained current information required to assist staff in how to support people. People were involved in social activities and enjoyed a range of social events.

The provider had a complaints procedure which was available if people wanted to raise concerns. Complaints were dealt with appropriately and used to improve the service.

Further information is in the detailed findings below.

At the time of our inspection the home had a registered manager. 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. The registered manager did not manage the home on a day to day basis. This led to some confusion about who was in charge. Other members of the management team were in place to support the registered manager in the day to day running of the home.

Ackroyd House 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. It provides accommodation for up to 52 people in one adapted building. There were 49 people using the service at the time of our inspection.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action. However issues we identified during the day did not support this and we submitted a safeguarding referral to the local authority.

We found there was a dependency tool to determine staffing levels, on the day of our inspection we found there was adequate staff to meet people's needs. However, we found staff were task orientated and not person centred.

Risks to people had not always been identified and if they were identified we found these were not always followed. Systems were in place for safe management of medicines. However, we identified some areas of documentation could be improved.

Infection prevention and control systems were not effective. We found areas of the service were not kept clean or hygienic to ensure people were protected from acquired infections.

We found procedures were followed for the recruitment of staff. Staff supervision took place and staff told us they feel supported. Staff received training that should have ensured they had the competencies and skills to meet the needs of people who used the service. However the training was not effective.

We found the service did not always meet the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Most staff we spoke with did not have a satisfactory understanding and knowledge of this, and people who used the service had not been assessed to determine if a DoLS application was required. We also found people’s best interest decisions were not always considered.

People were offered a well-balanced diet; however, we saw people were not always supported to maintain a balanced diet. People accessed health care services when required. Referrals were made quickly to health care professionals when people’s needs changed. However, advice was not always followed.

People and their relatives we spoke with all said that some staff were kind and caring. however, we received some negative comments regarding staff attitude and observed some poor interactions between people and staff.

Care plans varied in detail some identified people’s needs while others had limited information and meant staff did not have the necessary plans of care to be able to manage people’s needs.

There was no activity coordinator and people told us there were not activities. therefore people's social needs were not met.

There were processes in place to monitor the quality and safety of the service. However, these had not always been completed or if they had, actions had not been followed. This meant the quality monitoring systems were not effective.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

During our inspection, we found five 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. Full information about CQC’s regulatory response to the more serious concerns found during inspections are added to reports after any representations and appeals have been concluded.

Ackroyd House is a 52 bed nursing home, providing care to older adults with a range of support and care needs. It is known locally as Ackroyd Clinic, and this name is on signeage at the home. At the time of the inspection there were 33 people living at the home.

Ackroyd House is in Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, but close to public transport links and the town centre.

At the time of the inspection, there was 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 and associated Regulations about how the service is run.

Staff we spoke with were passionate about their work, and took steps to uphold people’s dignity and privacy. Staff spoke with people with warmth and compassion, and people told us they received a good standard of care at the home.

There was an activities coordinator employed at the home who devised a thorough and imaginative activities programme which people told us they enjoyed taking part in.

People told us that food at the home was good, and the mealtimes we observed were pleasant and enjoyable experiences.

People’s care needs were assessed in detail and care plans were devised to ensure they received appropriate care which met their needs.

Medicines were managed safely at the home, and staff had received appropriate training in relation to risk and keeping people safe.

Where there were incidents of suspected abuse or untoward incidents, the provider took the correct steps to ensure that people were kept safe.

Where people lacked the mental capacity to consent to their care, the provider had taken the appropriate, required steps to ensure that they complied with the law.

Quality audits, of the quality of the service were carried out by an external consultant, however, none had taken place for a period of several months due to the consultant’s absence from work, meaning that there was a period of time where the provider did not have documented assurance of the quality of the service provided.

Staff and people using the service gave us a positive picture of the culture of the home, and staff told us they felt supported by the home’s managers.

Ackroyd House is a 42 bed nursing home, providing care to older adults with a range of support and care needs. It is known locally as Ackroyd Clinic, and this name is on signage at the home. At the time of the inspection there were 39 people living at the home.

Ackroyd House is in Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, but close to public transport links and the town centre.

At the time of the inspection, there was 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 and associated Regulations about how the service is run.

During the inspection people told us, or indicated, that they were satisfied with the home, and staff we spoke with and observed understood people’s needs and preferences well. Staff demonstrated that they knew people’s needs well, and were motivated to provide a caring and person-centred service. Activities were plentiful and people told us they enjoyed the activities they participated in.

We found that staff received a good level of training, and further training was scheduled to take place in the coming months.

The management team were accessible and approachable, and knew people using the service well. However, the arrangements in place for monitoring the quality of the service were not sufficiently robust to identify where improvements were needed. Audits did not effectively address shortfalls in service provision.

The provider had acted in accordance with the Mental Capacity Act in relation to obtaining appropriate authorisations in relation to the Deprivation of Liberty Safeguards. However, they did not always have the correct arrangements in place for obtaining and acting in accordance with consent, or reaching best interest decisions when people lacked consent.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

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

Is the service safe?

We found people were encouraged to express their views and were involved in making decisions about their care and treatment. People we spoke with gave us good examples of how they were involved in making decisions about the care and support they received. We saw staff encouraged people to be as independent as possible while offering the correct level of support.

Care and treatment was planned and delivered in a way that ensured people's safety and welfare. Records were in place to monitor any specific areas where people were more at risk and explained what action staff needed to take to protect them.

We saw regular checks had taken place to ensure the service was operating safely.

There were systems in place to make sure people received their medications safely and we saw staff responsible for administering medication had completed training in this subject.

We saw there were enough qualified, skilled and experienced staff on duty to meet people's needs in a timely way.

Is the service effective?

People were treated with respect and dignity by the staff. People using the service, and the visitors we spoke with, said staff respected people's privacy and dignity. One person told us, 'They (staff) are very good. They cover me up when washing me and always show me respect.' Staff described good examples of how dignity, respect, privacy and independence were promoted at the home.

People's health and care needs were assessed on a regular basis. People told us how they and their relatives were involved in formulating plans of care and these were reviewed as needed. We saw the majority of care files had been updated regularly to make sure they reflected people's changing needs.

Staff told us they had access to a varied training programme that helped them meet the needs of the people they supported.

Is the service caring?

People were supported by knowledgeable, caring and friendly staff. We saw staff interacting with people positively. They encouraged them to be as independent as they were able to be while providing support as needed.

People looked well-presented and cared for. We spoke with seven people who used the service and two visitors who all said they were happy with the care provided and complimented the staff for the way they cared for people. One person told us, 'They (staff) are very good. They cover me up when washing me and always show me respect.'

Care files contained satisfactory information about people's needs and preferences. We saw care and support had been provided in accordance with people's wishes.

Is the service responsive?

Care records demonstrated that when there had been changes in people's needs outside agencies had been involved to make sure they received the correct care and support. For example we saw assessments had been completed to make sure people were eating and drinking enough. Where people needed additional support timely referrals had been made to the GP or other healthcare professionals.

The home had a complaints procedure which was available to people using and visiting the service. The people we spoke with told us they had no concerns or complaints but said they would feel confident raising any issues with the manager or staff.

Satisfaction surveys and occasional meetings had been used to enable people to share their views on the service provided. This helped the provider to assess if people were receiving the care and support they needed. People's comments indicated they were overall very happy with how staff supported them and the home's facilities.

Is the service well-led?

At the time of the inspection there was a registered manager in post who had worked at the home for several years, as had many of the other staff employed. Therefore people were receiving care from an established staff team who were aware of their needs and preferences.

There was a quality assurance system in place to assess if the home was operating correctly, this included surveys and audits. We saw where shortfalls had been identified action had been taken to address them.

Staff were clear about their roles and responsibilities. We saw staff had access to policies and procedure to provide them with guidance about how the home intended to operate.

People's care and treatment was being planned and delivered in line with their individual care plans. They told us they received the care and support they needed and they were very happy with how staff delivered their care.

People were provided with a choice of suitable and nutritious food and drink. The people we spoke with told us they enjoyed the meals they received and confirmed they were provided with variety and choice.

We saw there were effective systems in place to reduce the risk and spread of infection.

The premises were clean and fresh. The people we spoke with raised no concerns about the general environment but we saw some areas of the home were in need of redecoration. However the provider had a programme in place to address these areas.

We saw appropriate background checks had been carried out on staff before they started to work at the home to make sure they were suitable to work with vulnerable people.

People were made aware of the complaints system. Those we spoke with said they had no complaints but would feel comfortable raising any concerns with the staff.