Care service description

Ashcroft Care Home is a service that provides accommodation and personal care for up to five people. People living had the service have a mild learning disability, epilepsy or are elderly and frail. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. At the time of our inspection four people were living at the service.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good in all five domains and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good

People were safe with staff and staff were aware of the safeguarding procedure. There were sufficient levels of staff on duty to ensure that people’s needs were met. Recruitment was robust to ensure that only appropriate staff were employed.

Risks to people’s care was managed well by staff and people received their medicines in a safe way. Regular health and safety checks of the premises and equipment were carried out. Staff were effective in ensuring the service was clean and that they adhered to good infection control.

People were treated in a caring and respectful way by staff. We observed staff to be kind and considerate to people. People were supported with their independence and had choices around their delivery of care.

People's needs had been assessed before moving in to the service and staff took time to get to know people and to help them settle in. Care plans reflected people's needs and preferences. Care plans were evaluated regularly to help ensure they remained current. People had access to health care professionals and people were supported with their nutrition and hydration needs.

People chose how they spent their time and could take part in activities if they wanted to. Trips were arranged for people outside of the service. People were given the opportunity to discuss their wishes around their end of life. The environment was suitable for people.

There was a complaints procedure in place and complaints were investigated and responded to.

The provider carried out quality assurance checks to ensure people received a good standard of care. Staff consulted with outside professionals to ensure the best delivery of care.

People and staff were involved in the running of the service through regular meetings. Staff felt supported and received ongoing training and supervision. Notifications were sent to the CQC where appropriate.

Further information is in the detailed findings below.

This inspection took place on 21 January 2016 and was unannounced. The inspection team consisted of two inspectors who were experienced in care and support for people with Learning Disabilities.

Ashcroft Care Home is a semi-detached house that can provide accommodation and care for up to five adults. It is situated in a residential area of Redhill, Surrey. At the time of inspection, there were four people living at the home.

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 2008 and associated Regulations about how the service is run.

The home was light and airy. Some adaptations had been made for people with mobility needs, such as rails on stairs. The registered manager and staff worked well to keep the environment clean and feeling homely for people, although the décor of the building looked tired in some areas.

One person said, “It’s nice and cosy and staff are friendly.” Another person told us that they “did not need much help but the staff do help if I am stuck.” We were also told by a third person that “It’s as close to a normal home life as you can get.” Staff said, “I’m so very happy to do this job and feel well supported.”

There was positive feedback about the home and caring nature of staff from people who lived at Ashcroft Care Home. One person said, “Staff are nice, they help me if I need help and I like them.” When asked if anything could be improved they said, “No, I like them very much I think they are good.” Another person told us that “Staff care and they get on well with everyone. They do a lot for me to make sure I can get out to my church.”

People were safe at Ashcroft Care Home. There was sufficient staff to meet the needs and preferences of the people that lived there. One person said, “They are always here when I need them.”

The home had a very stable staff team many of whom told us that they had been working there for “considerable time.” Ashcroft Care Home undertook all relevant checks to ensure that the people who received care at the home are safeguarded from abuse or harm.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. One person said, “The staff are always there to care for me and help keep me make sure I keep myself safe.”

Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

There were clear procedures in place to evacuate the building in the event of an emergency. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency.

The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received induction training and ongoing training to ensure that they had the skills needed to support the individual needs of people.

People received their medicines when they needed them. The staff managed the medicines in a safe way and were trained in the safe administration of medicines. Staff told us that the Registered manager carried out regular checks on their competency when they gave medicine to people.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. People told us that staff did ask their permission before they, “Helped to care them”.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were

The last inspection found shortfalls in four areas and set compliance actions. The areas were shortfalls were found were, consent, the environment, staffing numbers and record keeping.

At this inspection we reviewed the actions the provider had taken in response to the compliance actions. We found that the provider had met all the previous compliance actions.

In addition to the four previous areas of non-compliance that we reassessed, at this inspection we also looked at the care and welfare of people who use services where there were no previous concerns to be sure we could fully report on how well cared people were cared for. We found that people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Is the service safe?

People who used the service told us they liked living at Ashcroft and they liked their rooms which they said were had working washing facilities and was warm enough on cold nights.

The service provided safe, appropriate care, through carrying out initial assessments, and planning care based on collating all the required information, and making decisions based on risk assessments.

We saw people had a risk profile to identify potential risks and where identified there were individual risk assessments to protect people from those identified risks.

We noted that previous concerns with the safety of the environment had been addressed.

We noted progress with the new consent forms for those with capacity and the physical solution of more staff as opposed to a locked kitchen.

We noted that previous concerns with the kitchen being locked had been addressed. At this unannounced inspection we found the kitchen to be unlocked and was properly supervised so that people could use it freely. We spoke to staff who confirmed that the kitchen did not need to be kept locked anymore because the extra staffing could now provide supervision of the kitchen and people who lived there.

Is the service effective?

People’s health and care needs were assessed with them, and people who used the service told us that they were involved in their care plans.

We saw that the previous concerns about the environment and staffing had been effectively addressed and were having positive outcomes in practice. For example, people being able to attend church regularly again and new procedures regarding keeping hazards locked away were being followed by staff.

Is the service caring?

We saw that people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s care plan.

We observed staff had a good knowledge of peoples’ needs, communications methods and demonstrated this through their positive interactions with the people who used the service. For example in interacting with people when needed and not when people desired privacy, in the manner they preferred and as recorded in their plans of care.

Is the service responsive?

The provider gave us an example of where they were responsive to people, where a person recently complained about the state of their carpet and was provided with a new floor covering of their choice.

Is the service well-led?

We found that existing practices that protected the security and confidentially of staff records had continued to be put into practice. We also found new practices had been put in place to make sure the records of people who used the service were kept securely and confidentially and that this was occurring in practice.

The service has a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. For example the curtains were replaced following comments from the previous quality assurance surveys. As a result the quality of the service was continuously improving.

We noted that the providers worked at the home and so had a day to day knowledge of the service.

We saw that the home had areas of good practice and, other than outcome 13 which we have re assessed, outcomes assessed as compliant in previous reports remain the same. However, there were areas for improvement needed that we identified.

People told us they had enjoyed their meal, liked the food, got enough to eat and could choose what they wanted to eat.

People also told us their room was warm enough in winter and cool enough in summer, that their taps worked properly and they were happy with their rooms.

We found that people who used the service could not be confident that their human rights would always be upheld because decisions and restrictions were being made for people without their consent and without a formal assessment of the need for decisions to be made for them in their best interests, under the Mental Capacity Act.

We found that although the building was in reasonable decorative condition, hygienic and clean, the provider had not always taken steps to provide care in a home that was adequately maintained in all areas.

There were not always enough staff to meet people’s needs when the manager was away.

We found that files containing information about staff were kept securely and confidentially, but the information about people who used the service was not kept confidentially and in compliance with the Data Protection Act.

People spoke about how the building was looked after well, being happy living there, and liking their rooms.

People told us that there were enough staff, that the staff treated them well, and they liked living at the home and felt safe there.

One person told us they never needed to complain but if they were worried about anything they would tell a staff member they named.

People said that they liked living at the home and that they felt safe there. They said it was clean, and that the staff were good, treated them with respect, protected the more vulnerable people, and interacted with people sensitively and were above professional.

People told us that the food was good and they were involved in choosing the meals, and can have alternatives if they wanted to.

People spoke about going on trips often, going out in the community, for example to church every week, and about the relatives and friends they visited, and those that visited them at the home.

People told us they didn’t have any complaints, knew how to make on if they did, but would usually talk to staff before it developed into a complaint.

We saw people choosing where to be around the home, and choosing which activities to be involved in. Staff were seen to offer support and guidance in a sensitive, knowledgeable and caring manner.