The inspection took place on 28 June 2018. It was unannounced.

Ashgrove Care Home provides care and support for up to 56 people who require personal care. The service has communal areas and has opened up an extension, which provides en-suite bathroom facilities in people's bedrooms and access to patio gardens. It offers care and support to people, some of whom are living with dementia.

Ashgrove 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.

At the last inspection of this service we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations, 2014 for Regulation12, safe care and treatment and Regulation 17, good governance.

There were a variety of shortfalls within people's care records, which meant staff, did not always understand or deliver the care and support people required in a timely way. Audits were undertaken; however, they had not always found the shortfalls in the service relating to people's care records. Monitoring of the mealtime service at tea time required improvement along with a further review of pressure area care for people living at the service. The staff team had changed and staff were still trying to understand people's needs and get to know them. There were issues with medicine management and administration. Information about people's topical creams needed to be clarified and thickening agents for some people's drinks were not signed for on people's medicine administration chats (MAR). We recommended that the provider should follow guidance for all aspects of medicine management. There were also minor infection control issues that were addressed at the time of the last inspection.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question responsive and well-led to at least good and achieve compliance with Regulations 12 and 17.

At this inspection we found improvements had been made. People's care records reflected their full and current needs and people received timely care and support. Staff provided the correct care and support to meet people's individual needs. Audits were robust any issues found were acted upon straight away. Mealtimes were pleasant sociable occasions. The staff team were stable and they knew people and their needs. Medicine management, infection control and data management was robust. Mealtimes were monitored and they were relaxed social events.

The service has a manager in place who has applied to become registered with the Care Quality Commission. Their application has been validated by the registration team and they are awaiting their fit person’s interview. They have been a registered manger prior to applying to become the registered manager of this service. 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.

People’s health and safety was protected by the staff’s monitoring of their needs and the environment. Staff understood how to identify signs of abuse and harm and issues were reported appropriately. Staff understanding the risks present to people’s wellbeing and gained help and advice from health care professionals to minimise these risks. People who used the service told us they felt safe living there. There were sufficient numbers of competent staff to meet people’s needs.

Accidents and incidents were monitored. Staff understood the action they must take in the event of an emergency to protect people’s health and safety. General maintenance was undertaken.

The inspection took place on 14, 17 and 19 July 2017, and was unannounced.

At the last inspection of this service we found there were no breaches of regulation. The service gained a rating of ‘requires improvement’ .

Ashgrove Care Home is situated in a residential area of Cleethorpes and is close to local amenities. It is registered to provide personal care for 56 people, some of whom are living with dementia. Communal areas and bedrooms are located on the ground floor. There are secure garden areas for people to use. During the inspection there were 31 people using the service. There is a car park for visitors to use.

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 service has a manager in place who has applied to the Care Quality Commission (CQC) to become registered. Although their application had been received this had not been validated at the time of the inspection. Therefore the manager is not registered with CQC. This meant that the domain well-led could not be rated higher rating than ‘requires improvement’.

During this inspection we found two breaches of regulation; regulation 12 of the Health and Social Care Act (HSCA) safe care and treatment and regulation (HSCA) 17 good governance. There was a variety of shortfalls within people’s care records, which meant staff, did not always understand or deliver the care and support people required in a timely way. Audits were undertaken, however, they had not always found the shortfalls in the service relating to people's care records. Monitoring of the mealtime service at tea time still required improvement along with a further review of pressure area care for people living at the service. On one occasion people's care records were not held securely, this was rectified straight away. You can see what action we told the provider to take at the back of the full version of the report.

We found the service had been placed under pressure because 16 staff had left, some without working their notice over a two week period. This had impacted upon the care and support people received. The management team had worked to address this situation and new staff had been employed, however staff were still getting to know people's needs.

Staff were developing their skills and knowledge about people's needs and risks to their wellbeing. A summary of people’s needs had been produced to highlight specific areas of help and support people needed to receive and risks to their wellbeing.

Staffing levels had been increased by employing three agency staff and undertaking a robust recruitment programme. The local authority was supporting the service with two staff at lunch and tea time to help to meet people's needs.

There were some issues found with medicine administration at the service. We found information about topical cream prescribed by people’s GP’s needed to be clarified to ensure staff had the relevant information about how and where to apply the creams. Thickening agents prescribed to be used in some people’s drinks were not signed for on their medicine administration charts when used by staff. We found staff did not always sanitise their hands if they touched people’s medicines. We recommend that the provider follows current guidance for all aspects of medicine administration.

We found minor issues with infection control that were addressed during the inspection.

Staff knew how to recognise the signs of abuse and knew how to report issues. This helped to protect people from abuse.

Induction training was provided for staff. Supervision’s were occurring to help develop the staff’s knowledge and skills. Appraisals were to be conducted later in the year to allow the manager and st

Ashgrove Care Home is registered with the Care Quality Commission (CQC) to provide accommodation for up to 45 older people some of whom are living with dementia. Accommodation is provided on the ground floor. The service has private grounds and separate secure gardens and patio areas for people to use. Local amenities and a bus route are accessible. Onsite parking is available. An extension to the service has been completed but has not been registered for use with the Care Quality Commission.

This inspection was undertaken on 9 and 10 June 2016, and was unannounced.

We had previously inspected the service on 16 and 18 December 2016 when we found the registered provider was in breach of eight regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.These were in relation to, person centred care, need for consent and working within the requirements of the Mental Capacity Act (MCA) 2005, safe care and treatment, safeguarding people from abuse, cleanliness and infection control, medicine management, staffing levels, staff skills and training, meeting nutritional and hydration needs, complaints and assessing and monitoring the quality of service provision. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 for non-notification of incidents.

The breach regarding cleanliness and infection control was a continued breach from our inspection which was undertaken on 15 May 2015. Due to these shortfalls the service was rated inadequate in all areas and was placed in ‘special measures’. The registered provider agreed to undertake a voluntary suspension on admissions to give them time to correct the issues we found.

The registered provider sent an action plan in response to our inspection findings telling us what measures they were going to take to address the issues. This inspection was undertaken to check if the improvement action planned had been completed in regards to the shortfalls that we found. We wanted to see if the service was being managed appropriately to maintain and protect people’s health and wellbeing.

We found person centred care was in place. People gave their consent to receive care and treatment, or where this was not possible; the principles of the Mental Capacity Act (MCA) 2005 were followed to protect people’s rights. People received safe care and treatment and were protected from abuse.

Cleanliness had vastly improved and appropriate infection control measures were in place. Medicine management was robust. Staffing levels had been increased and staff had undertaken training to develop their skills. People’s nutritional needs were known and only staff who had received training assisted people to eat and drink.

A robust complaints system was in place and issues raised were dealt with thoroughly. The registered provider had implemented new auditing systems, which helped them monitor the service effectively and helped to ensure any issues were dealt with in a timely and thorough way because action plans were put in place and these were reviewed by the higher management team. This ensured appropriate action was taken to maintain the quality of the service. The registered provider and manager had systems in place to make sure they we were notified of all incidents.

We found the registered provider had improved all areas of the service and the previous breaches of regulation had been addressed. The service now met all relevant requirements. However, we are keeping all areas under review and monitoring them to make sure the improvement made are maintained consistently over time.

The service is required to have 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 R

This inspection was undertaken on 15 May 2015, and was unannounced. The service was last inspected on 17 July 2014 and was found to be in breach of regulation in relation to the safe handling of medicines. At this inspection we followed up on the breaches, we found that these issues had been addressed. However, we found other shortfalls in the service which are described in the safe and well led sections of this report.

Ashgrove Care Home is registered with the Care Quality Commission [CQC] to provide accommodation for up to 45 older people who are elderly or who are living with dementia. Accomodation is provided on the ground floor. The service has private grounds and a separate secure garden. Local amenities and a bus route are accessible. Onsite parking is, however this has been reduced due to areas being allocated for building contractors and materials. Staff were available 24 hours a day to support people.

The home has 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who used the service were cared for by staff who understood they had a duty to protect people from abuse. Staff knew how to report abuse and said they felt able to raise any issues, which helped to keep people safe.

Staff knew people’s care needs and risks to their health and wellbeing which enabled them to support people. Training was provided to all staff to help them to develop and maintain their skills. Staffing levels appeared adequate to meet people’s needs at the time of our inspection.

The environment was affected in some areas by the building work that was being undertaken. We found some issues relating to cleanliness, security, medicines and effective monitoring of the service provision. Most of the issues we found were addressed at the time of our inspection. However we have asked the registered provider to take further action in relation to the shortfalls we found with medicines at the service.

People’s bedrooms were personalised, names or numbers were displayed on bedroom doors and pictorial signage was provided to help guide people to their rooms, bathrooms, toilets and lounge areas.

People were involved in making decisions about their care. Staff supported people to make decisions for themselves. Information was presented to people by staff in a way they were able to understand and their privacy was respected.

Home cooked food was provided to people living at the service and those who required prompting or support to eat were assisted by patient and attentive staff. Staff monitored people’s dietary intake and gained help and advice so that their nutritional needs could be met.

A complaints procedure was in place, anyone wishing to make a complaint could do so. Issues raised were investigated by the registered manager and people were informed of the outcome.

People living at the service and their relatives were asked for their opinions. The registered manager undertook regular audits, these helped them to monitor the quality of the service. However, the shortfalls we found had not been identified through the auditing process. We have therefore made some recommendations and have asked the registered provider to address the areas in need of improvement.

A breach of regulation 12 has occurred and we have deemed this to have a minor risk to people who lived at the service. You can see what action we told the registered provider to take at the back of the full version of the report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Ashgrove Care Home provides accommodation for older people who require personal care. There were 34 people living at the home when we visited. The accommodation is provided in single bedrooms, none of which are ensuite. The accommodation has several communal areas, two dining rooms, a kitchen and a laundry. There are approved plans in place to extend the property to provide 19 ensuite rooms for people currently living in the home. There are large secure gardens to the front and rear of the property. The home is in a populated area with good access to local amenities and public transport.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

People and their relatives told us they were happy with the care provided at the home and their care and social needs were being met. From our observations, and from speaking with staff, people who lived at the home and relatives, we found staff knew people well and were aware of people’ preferences and care and support needs.

We found the home required some improvement in the management of medicines. We found medicines had been stored incorrectly. This was a breach of Regulation 13 of the Health and Social Care Act 2008 and we have asked the provider to take action.

We found the home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and staff followed the Mental Capacity Act 2005 for people who lacked capacity to make decisions for themselves.

The registered provider had robust recruitment processes in place which protected people from being supported by unsuitable or unsafe staff.

The home was meeting people’s nutritional needs; people were supported to ensure they had enough to eat and drink. People told us the food at the home was good and they had a choice. People were supported to do their own shopping and choose the foods they liked.

Staff involved people in choices about their daily living and treated them with compassion, kindness, and respect. People were supported by staff to maintain their privacy, dignity and independence. Everyone looked clean and well-cared for. People had access to activities and relatives and friends were able to visit the home at any time.

People told us there were enough staff to give them the support they needed. Our observations confirmed this. The local authority told us they had confidence that staff had the appropriate skills to meet people’s needs. The majority of staff had received training considered mandatory and had also received specialist training, for example, on dementia care.

We observed care was centred on people’s needs and preferences. There was a wide variety of activities available for both individuals and groups.

People knew how to make a complaint and we noted the home openly discussed issues so that any lessons could be learned. People felt they were able to express their views at any time and that they were listed to and acted on.

Leadership and management of the home was good. There were systems in place to effectively monitor the quality of the service and drive a culture of continuous improvement.

During the inspection we spoke with five care staff, the registered manager and five people who used the service. We found there were enough staff employed to support the people who used the service.

Staff told us they had had enough staff on duty to meet people’s needs although they would prefer more time to be able to sit and talk to people. Comments included, “We were short staffed but it is better now. Staff do ring in sick and they always try to get cover” and “The managers and senior carers will come onto the floor to help us on the odd occasion we are short and care is affected.”

People who used the service told us that call bells were usually answered promptly and they were happy with the care they received. Comments included, “Staff are rushed but they are caring” and “Sometimes they have time to talk and sometimes they don’t.”

The manager told us there was to be a refurbishment programme next year, which would not affect the numbers of bedrooms available but would update a significant number of them by providing toilets and showers en suite. Existing toilets, bathrooms and the shower room were also to be refurbished.

We did not speak to people who used the service during this follow up inspection. We spoke with the manager and a new member of staff. We checked records such as cleaning schedules, medication administration records and infection control audits. We also completed a short tour of the building and checked the sluice room.

We found improvements had been made since the last inspection in arrangements for cleaning specific equipment used in the home. The sluice room was clean and tidy and cleaning schedules were in place. Equipment was checked by senior staff to ensure it was clean and ready for use.

We found improvements had been made in the management of medicines since the last inspection. People received their medicines as prescribed. There were some minor recording issues and these were discussed with the manager to address.

We found that people were asked their views formally in meetings and questionnaires but also informally during day to day contact with staff. People told us they could make decisions about aspects of their lives. Comments included “I’m an early riser and like to get up at 5.30am. I like to read and watch television in my room.”

People’s needs were assessed and care plans were produced to guide staff in how to care for them. People told us they were able to see health professionals involved in their care. Comments included, “I have no complaints. I see the doctor when I need to” and “I’m looked after very well – I like to be independent.”

We found that due to stock control issues and on one occasion an error, some people had not received their medicines as prescribed.

We found that some items of equipment had not been cleaned properly so they would be ready for use by the next person.

We found there was a range of equipment provided to help move and handle people safely. Equipment was serviced so it remained safe to use.

We found that staff were recruited appropriately and checks were carried out before staff worked in the home.

We found there were enough members of staff employed to work in the home although some reorganisation of staff during busy periods would help to relieve pressure on staff.

We found the service had a quality monitoring system in place which ensured checks were made and people could comment on the quality of the service.

People told us that staff treated them with respect and promoted their dignity and independence. They said they were able to make choices about aspects of their lives such as the times of rising and retiring, meals, activities and where to sit during the day.

People told us that staff looked after them well and involved other healthcare professionals when they needed them. They said they answered call bells as promptly as they could but there were times when there was not enough staff on duty. Relatives told us that they were kept informed about health related issues. One relative commented, “My dad feels like part of the family here but they are short staffed and activities are really good and the food here is marvellous it’s like a hotel.”

People told us, “I like to get up early myself”, “I can get up when I like" and "There is a good choice of food." A visiting healthcare professional told us, “It’s a nice home and there is always someone available.”

Visiting relatives told us “The staff are brilliant but often seem run off their feet and staff are marvellous but there is just not enough of them.”

People told us they were well after, comments included “The girls are really nice and kind”, “They look after me really well”, and “Nothing is too much trouble.”

People told us the food was very nice and there was always plenty of it and there was a good choice.

People told us they would see the manager if they had any concerns or complaints. Some people who used the service told us about people who had dementia coming into their rooms and how they found this threatening. However, they told us they could call the staff and they ensured the situation was safely dealt with.

This inspection was undertaken on 16 & 18 December 2015, and was unannounced. The service was last inspected on 15 May 2015 and was found to be in breach of regulation 12 in relation to infection control. We undertook this inspection to follow up on this breach; we also wanted to fully evaluate the service that people were receiving because we had received information of concern that the service may not be managed effectively. We were aware that the Clinical Commissioning Group [CCG] had placed a suspension on admissions to this service. At this inspection we found the registered provider was still in breach of regulation 12 in regard to infection control and medication. We found other shortfalls in the service which are described throughout all sections of this report.

Ashgrove Care Home is registered with the Care Quality Commission [CQC] to provide accommodation for up to 45 older people some of whom are living with dementia. Accomodation is provided on the ground floor. The service has private grounds and a separate secure garden. Local amenities and a bus route are accessible. Onsite parking is available. An extension to the service has been completed but has not been registered for use with the Care Quality Commission.

At the time of our inspection the home had a registered manager.A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the registered provider was in breach of eight regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to, person centred care, need for consent and working within the requirements of the Mental Capacity Act [MCA] 2005, safe care and treatment, safeguarding people from abuse, cleanliness, infection control and medicine management, staffing levels, staff skills and training, meeting nutritional and hydration needs, complaints, and assessing and monitoring the quality of service provision, We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 for non-notification of incidents. The majority of these breaches were assessed by CQC as high, and posed a possible or probable on-going risk to people’s health and wellbeing.

Care records we inspected were difficult to follow; information was not present about people’s full and current care needs and risks to their health and wellbeing. We were not able to determine if people were receiving the care they required. People’s care plans and risk assessments were not updated as people’s needs changed. People who needed to be supported to change their position regularly to prevent pressure sores did not have this undertaken in a timely way by staff. This placed people at risk of harm.

The staff did not have the knowledge and skills to support people to consent or follow legal processes to make decisions in their best interests. People living at the home were subject to restrictive

practice which had not been identified or managed in line with the Mental Capacity Act [MCA] 2005 and The Deprivation of Liberty Safeguards [DoLS.] Consent had not been gained from people or their legal representatives in relation to covert medicine administration and do not attempt cardiac pulmonary resuscitate orders [DNACPR]. This did not protect people’s rights.

People’s preferences for their care and support were not provided. There was a lack of stimulation and activities suitable for people living with dementia.

There had been a failure to protect people from harm and to recognise and report to the Care Quality Commission when people had been put at risk or had been subject to harmful situations. There are currently six safeguarding concerns being investigated in regard to people living at this service.

There was a continued breach of regulation in regard to infection control throughout the service. We had to ask for a number of issues to be addressed during our inspection. Safe systems were not in place regarding the ordering, storing, administration, stock control and return of medicines. People did not receive their medicines safely the systems were inadequate and placed people at risk of harm.

We found that there were not enough staff available to meet the needs or maintain the safety of people living at the service in a timely or safe way. Staff training was not up to date for all staff which meant that some people were being looked after by staff who did not have the relevant up to date skills and knowledge to care for people safely.

People who required their nutrition and fluid intake to be monitored by staff to ensure their health and wellbeing was maintained did not have this undertaken in an effective way by staff. Timely and action was not taken by staff to ensure all departments and relevant health care professionals were aware of people’s needs. Advice given by health care professionals was not always followed by staff. Where people had lost weight this had not been acted upon robustly. This meant that people were at risk of not receiving adequate nutrition.

The systems in place to deal with complaints were hard to review and it was not clear if the complaints raised had been effectively investigated or responded to in line with the registered providers policy.

The registered manager and registered provider had failed to monitor the quality of the service provided to people and had failed to provide a safe, effective service which met people’s needs

The quality assurance systems in place were ineffective and inadequate. Audits were not undertaken in a timely way, action plans were not implemented to ensure issues found were corrected. Where audits had occurred their findings were inconsistent with the shortfalls we found during our inspection. The registered provider did not have clinical leads in pace or training departments to help improve the quality of the service provided.

Due to the concerns found by North east Lincolnshire Clinical Commissioning Group (NELCCG) at their quality monitoring visits, our findings at the inspection and concerns about the management of the service. After the inspection the registered manager resigned from her post, the registered provider has two area managers running this service. The North East Lincolnshire Clinical Commissioning Group have staff monitoring the service at times when the area managers are not on site to ensure people’s safety and welfare.

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.