The comprehensive inspection visit took place on 13 November 2018 and was unannounced.

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.

The comprehensive inspection visit took place on 5 June and was unannounced.

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 pl

We inspected this service on 27 October 2016. This was an unannounced inspection. Our last inspection took place in August 2016 and we found improvements were needed. We found there was not always sufficient staff to offer support to people. People were not always supported in a dignified or caring way. People’s preferences were not always considered and improvements were needed when people lacked capacity to consent. At this inspection we found the provider had not made the necessary improvements.

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.

We inspected this service on 24 August 2016. This was an unannounced inspection. Our last inspection took place in July 2015 and we found some improvements were needed. We found there was not sufficient staff to keep people safe. Checks on the service were not completed so when improvements were needed this was not identified and people were not supported in line with The Mental Capacity Act 2005. The provider sent us an action plan in September 2015 stating what action they were taking to address the concerns identified. At this inspection we found some improvements had been made, however further improvements were needed.

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.

This was an unannounced scheduled inspection. We also checked that the home had addressed the issues we had raised at our previous inspection. During this inspection we spoke with people who lived at the home, relatives, care and nursing staff, the manager and a health professional.

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.

People we spoke with told us they were pleased with the care they had received in the home. One person told us, "It's very friendly here. The staff make my stay here very pleasurable". One relative told us, " We are thrilled with the home, I could recommend it to anyone. There's always a lovely atmosphere and a warm welcome greets me every time I visit".

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.

People that use the service told us the provider and manager ensured they all received a quality service by asking them on an almost daily basis if everything was as they wanted. One person told us "I know the staff filled out some risk assessments, as I like to walk outside on my own, the staff always ask me to take someone with me but I prefer to be independent." One relative told us "We were very impressed from day one with the home, the manager and staff were very welcoming and informative. Since we have been visiting our relative on a daily basis the whole family are delighted with the choice we made. We are very impressed with all aspects of the experience."

We inspected this service on 16 and 22 July 2015. The inspection was unannounced. At our previous inspection in June 2013, the service was meeting the regulations that we checked.

The service provided accommodation for up to 45 people. Thirty five people were living at the home on the day of our inspection.

There was a registered manager in post at the time of our inspection. 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.

We observed that at times people waited for support. Staffing levels were not reviewed to ensure they were sufficient to meet people’s individual needs at all times.

The staff did not fully understand and act in accordance with the requirements of the Mental Capacity Act 2005. People’s rights were not respected when decisions were made on their behalf. At the time of our inspection, no one had a Deprivation of Liberty Safeguarding (DoLS) authorisation in place but the manager had submitted referrals to the local DoLS team and decisions were awaited.

The provider carried out some checks to assess the quality of the service but these were not always effective. Information from accidents and incidents was not used to minimise the risk of further repeated accidents or incidents. There were no audits in place to identify shortfalls we found with the quality of care plans or medication charts. The provider did not have adequate systems in place to gather people’s opinions to enable them to make improvements to the service where necessary.

Staff were supported and trained to meet people’s individual care needs. Most of the staff told us they felt supported by the manager but some felt their concerns were not always listened to.

People living at the home told us they felt safe and their relatives felt they were well looked after.

People’s risk of harm was being assessed and there was guidance in place to manage people’s risks. Staff understood their responsibilities to keep people safe from harm.

People told us they liked the staff and told us they looked after them well. People were able to make choices about how they spent their day and staff respected their individual wishes. People felt able to talk to staff about any concerns they had and felt confident they would be listened to. People’s complaints were recorded and investigated.

People were supported to take part in a range of activities and social events at the home. Relatives were able to visit freely and were kept informed about their relation’s care and support needs.

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