The inspection took place on 22 October 2018 and was unannounced which meant the people living at Ackroyd House and the staff working there didn’t know we were visiting.

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

We carried out this inspection on 27 February 2018. The inspection was unannounced, which meant the people living at Ackroyd House and the staff working there didn’t know we were visiting. The service was previously inspected in November 2016 and was meeting all the fundamental standards. However, we had received concerns regarding this service so we bought the comprehensive inspection forward.

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 p

The inspection was unannounced, and was carried out on 30 November 2016. The home was previously inspected in November 2015, where we identified breaches of regulation in relation to safety; how the service was managed; and how the service addressed the needs of people who did not have the capacity to consent to their care. We judged the service as “requires improvement” following the inspection of November 2015. You can read the report from our last inspection, by selecting the 'all reports' link for ‘Ackroyd House’ on our website at www.cqc.org.uk.

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.

The inspection was unannounced, and was carried out over two days; 5 and 10 November 2015. The home was previously inspected in August 2014, where no breaches of legal requirements were identified.

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.

Our inspection looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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.

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. The people we spoke with told us they made decisions about the care and support they received and staff respected their decisions.

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.

People told us they were happy with the care and support they received and felt the home was a safe place to live. We saw that they were offered choice and staff respected their privacy and dignity while encouraging them to be as independent as possible. One person told us, “I am very happy with everything, they look after me well.” A relative commented, “The staff are very good, they keep us well informed and they are very approachable.”

The people we spoke with said staff were supportive and helpful. They told us there were enough staff on duty to meet their needs and they were good at their job.

No-one raised any concerns with us during our visit. People told us they felt confident taking any concerns to the manager or any of the staff. One person said, “It’s great, there’s nothing to complain about.”