About the service:

•Ashcroft nursing home is a care home that was providing personal and nursing care to 38 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

•Action had been taken to reduce risks since the last inspection.

•Staff were recruited safely and there were sufficient numbers of staff on duty to meet people’s needs. New staff received induction and there was an on-going programme of training and supervision for existing staff.

•Records were personalised, were updated at regular intervals and were stored securely.

•The management of people’s medicines was safe.

•The home was clean and suitably maintained.

•Staff were kind and caring. They respected people’s right to privacy and maintained their dignity.

•Complaints were acted upon and the registered provider and registered manager were pro-active in seeking feedback from people, their relatives, other visitors to the home and staff. Staff understood their roles and responsibilities. It was evident the management team and staff were committed to ensuring people received high level of care and support.

•The service met the characteristics for a rating of "good" in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was "good".

Rating at last inspection:

•Requires Improvement (published February 2018). This service has been rated ‘Requires Improvement’ at the last three inspections.

Why we inspected:

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

Follow up:

•We will continue to monitor the service to ensure that people receive safe, compassionate, high

quality care. Further inspections will be planned for future dates.

•For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected Ashcroft Nursing Home (known to people using the service, their relatives and staff as Ashcroft) on 15 and 17 January 2018. The first day of inspection was unannounced. This meant the home did not know we were coming.

Ashcroft is registered to provide nursing and residential care for up to 40 people. When we inspected, 34 people were using the service. It consists of one building with three floors accessed by two passenger lifts. The majority of rooms are single with ensuite facilities. In one part of the ground floor there is a communal lounge and dining area within a large conservatory which has access to an outdoor paved seating area. A separate unit for up to six people living with dementia called Terrace Way is also located on the ground floor; this has an enclosed garden area with seating.

Ashcroft is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection we rated the home as ‘Requires Improvement’ in four of the five key questions and overall, and as ‘Inadequate’ in the key question of well-led. We identified breaches of the regulations relating dignity and respect, staffing, consent, safe care and treatment, and good governance. As a result, we served the registered provider with three warning notices and two requirement notices.

Following the last inspection, we met with the provider to discuss the improvements required at Ashcroft. They provided an action plan to show what they would do and by when to improve all the key questions to at least good.

Ashcroft had a registered manager. At the time of the last inspection in June 2017 she was on extended leave; at this inspection the registered manager was back 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.’

Risks to people were assessed and managed. Hoists were serviced but not subject to ‘thorough examination’ as required by Lifting Operations and Lifting Equipment Regulations 1998. Action to minimise Legionella risk was lacking.

Most feedback from people, their relatives and staff about staffing levels at Ashcroft was positive. Some concerns were raised about the staffing of Terrace Way; we fed these back to the registered manager and she immediately implemented a solution.

Medicines were managed and administered safely. This was an improvement from the last inspection.

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.

Records showed staff access to training and supervision had improved since the last inspection. Staff we spoke with told us they felt supported.

Feedback about food and drinks at Ashcroft was positive. People were given choices at each meal and the cook knew the specific dietary needs of individuals.

A system of communication was in place at the home to facilitate team-working. People were supported to meet their wider health needs. Care and treatment provided was based upon established evidence-based good practice.

People told us staff were caring and respected their privacy and dignity. All interactions we observed during this inspection were polite and supportive. This was an improvement from the last inspection.

People and their relatives were involved in planning and reviewing the care and treatment people received. The service supported people to meet their diverse needs.

Care plans at Ashcroft had been improved. We saw they contained person-ce

We inspected Ashcroft Nursing Home (known as ‘Ashcroft’ to the people who live and work there) on 19 and 22 June 2017. Both days of the inspection were unannounced. This meant the home did not know we were coming.

Ashcroft is a care home registered to provide nursing and residential care for up to 40 people. It consists of one building with three floors accessed by two passenger lifts. The majority of rooms are single with ensuite facilities. There were 33 people living at the home at the time of this inspection.

In one part of the ground floor there is a communal lounge and dining area within a large conservatory which has access to an outdoor paved seating area. A separate unit for up to six people living with dementia is also located on the ground floor; this has an enclosed garden area with seating.

Ashcroft was last inspected in November 2015. At that time it was rated as Requires Improvement overall as it was deemed to be Requires Improvement in all five of the key questions of care: Safe, Effective, Caring, Responsive and Well-led. We asked the registered provider to send us an action plan to tell us how they were going to tackle breaches of regulation relating to consent, safeguarding people and good governance.

The home had a registered manager; at the time of this inspection she had been on a period of extended leave since December 2016 and was due back to work in October 2017. 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.

Not all risks to people had been assessed and managed. For example, people’s care plans did not contain information on how to support them to bathe and shower safely.

Control measures identified as required to reduce risk posed by the building were not in place. Other checks on the building’s utilities and equipment had been completed.

We identified concerns around the way medicines were administered, stored and recorded. Medicine stock levels reconciled with recorded amounts.

Feedback about staffing levels from people, their relatives and staff was mixed. We raised concerns about the dementia unit which was staffed by one senior care worker. Our observations showed people’s needs were met but staff were busy.

People said they felt safe at Ashcroft. Staff could describe the forms of abuse and knew how to report concerns appropriately.

Records showed staff did not have access to regular supervision; records made of supervision sessions were not detailed. The same concerns were raised at the last inspection in November 2015.

The home was not compliant with the Mental Capacity Act 2005 as mental capacity assessments had not been made for some people known to have problems making decisions. This was a breach of regulation at the last inspection in November 2015.

People and relatives gave us positive feedback about the food and drinks served at Ashcroft. We observed the dining experience was pleasant and people were offered choices. One person’s records contained contradictory information about their nutritional needs and their records did not evidence whether they received their prescribed supplements.

Most interactions between care staff and people were kind and caring, although we observed some which were disrespectful.

People were supported to maintain their independence and told us staff respected their privacy and dignity.

It was not possible to tell from people’s records whether they had been involved in planning their own care. People had access to independent support with decision-making if they needed it.

The thank you cards we saw from relatives of people who had received end of life care at Ashcroft were highly complimentary. Care staff could describe the important aspects of good end

The inspection of Ashcroft Nursing Home took place on 9 November 2015 and was unannounced. The previous inspection had taken place on 3 October 2013. The service was not in breach of the health and social care regulations at that time.

Ashcroft Nursing Home is registered to provide accommodation for up to 40 people who require nursing or personal care. There were 40 people living at the home at the time of the inspection. The home was a detached property with accommodation provided over three floors, which were accessible by two passenger lifts. There was an enclosed, well maintained garden.

The service had 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 a 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 living at Ashcroft Nursing Home. Staff had received safeguarding training and were able to recognise potential signs of abuse.

Some safeguarding incidents had not been reported in line with safeguarding procedures. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Care and treatment was not always provided in a safe way, in line with the person’s needs and care plan.

Some risk assessments had been completed to ensure people could maintain their independence whilst minimising risks. However, risk assessments had not been completed in some situations, for example when oxygen was being used and stored.

The building was maintained and appropriate health and safety checks were completed regularly, in order to help keep people safe.

Staff were recruited safely with appropriate checks being made. Although staff received regular training in areas such as safeguarding, first aid, fire safety and infection control, many staff had not received training in the Mental Capacity Act 2005.

Although some people were asked for consent in relation to some aspects of their care, some people did not receive care and support in accordance with the principles of the Mental Capacity Act 2005. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some people were being deprived of their liberty and the registered manager had made applications to the local authority, in order for this to be lawful and for people’s rights to be protected.

People received appropriate support to help them maintain a healthy diet.

There were mixed responses from people regarding whether they found staff to be caring. Our observations were that some staff were more caring than others.

People told us they could make their own choices and we saw choice being offered.

People’s needs were regularly reviewed and people were involved in their care planning.

Relatives, people and staff told us they felt the registered manager was approachable. We found the registered manager to be open and transparent during the inspection.

Regular audits took place but it was difficult to establish what action had been taken because this was not accurately recorded.

Systems and processes had not been operated and established to ensure the regulations of the Health and Social Care Act 2008 were being met. This was breach of Regulation 17 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.

We found people were involved in making decisions about their care and asked to consent to aspects of their care where applicable. We found people's care plans were person-centred and clearly highlighted people's main needs. People were asked to sign their care plans in order to consent to their use.

We found staff interacted with people in a caring way and were respectful. We spoke with three people who used the service, one person said they were "very happy at the home" and they said they had a good rapport with staff. Another person we spoke with said they were happy at the home and there was a "good choice of food"; they also said staff were friendly. A third person we spoke with did not find it easy to communicate but they confirmed they had no complaints about the service or staff.

We found the environment of the home was safe and the lay-out enabled people's needs to be appropriately met. We found that necessary safety checks had been completed within the expected time-frames including fire safety and security.

In addition, we found there was an effective complaints system and the complaints process was clearly brought to the attention of people who used the service.

People who used the service told us they enjoyed living at the home and were very complementary about the care and support provided by the manager and staff. Comments included "The home is clean and comfortable, the food is excellent and all the staff are kind and caring" and "I am very happy living at Ashcroft, all the staff are friendly and will do anything they can to help and assist you."

The visitors we spoke with told us they had no concerns at all about the standard of care their relatives received. One person said "I have visited at all times of the day and have always been made to feel welcome by the staff." Another person said "I cannot fault the care and support my relative receives, the staff are very approachable and extremely caring."

The care staff we spoke with told us there were clear lines of communication and accountability within the home and they were supported by management to carry out their roles effectively through a planned programme of supervision, appraisals and training.