Ashcroft House - Leeds

Ashcroft House - Leeds is a care home providing personal care to a maximum of 32 people. The service provides support to older people, some of whom were living with dementia. At the time of our inspection there were 27 people using the service.

People’s experience of the service and what we found

People were not kept safe in the service. The provider did not always properly assess risks, and effective measures were not in place to mitigate identified risks. Actions were not always taken when incidents occurred to reduce the risk of recurrence.

Environmental risks had not always been identified, assessed, and mitigated. This placed people at risk of harm.

Care plans were unclear about how staff were to support people to reach and maintain a healthy weight. There was a lack of information about adequately monitoring people’s nutrition and promptly acting upon concerns.

There were insufficient staff to support people’s lifestyle choices. People were not supported to access the local community when they wished due to the lack of staff to enable this.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The premises was not adapted or designed to meet the needs of people living with dementia. The environment was tired, poorly maintained, and did not meet people’s needs.

The provider had a poor history of compliance with this service. The need for improvements had been identified and shared with the provider at previous inspections, but they had failed to make and sustain the necessary improvements.

Whilst staff were kind and caring, failure to meet regulations and fundamental standards meant people have come to harm, received care that did not protect them from risks and have had their wellbeing compromised. This does not demonstrate a caring service.

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

Rating at last inspection

The last rating for this service was Requires Improvement (published 9 July 2022).

Why we inspected

The inspection was prompted in part by notification of two incidents following which a person using the service died and another person sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of choking and environmental risks. This inspection examined those risks.

You can see what action we have asked the provider to take at the end of this full report. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to person centred care, dignity and respect, consent to care and treatment, premises and equipment, safe care and treatment, nutrition and hydration, staffing and good governance.

Please see the action we have told the provider to take at the end of this report.

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.

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. 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 overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.

People’s experience of using this service and what we found

People told us they were happy living in the home and overall, people received personalised care from staff who knew them well. However, risks were not always properly assessed, planned for or well managed, and medicines were not always managed safely. Not all concerns had been reported to the appropriate bodies in a timely way.

Recruitment and selection procedures were in place to make sure suitable staff were employed.

Some people would have benefitted from more social interaction. We have made a recommendation about staffing.

Management records and audits were not always kept up to date, and staff did not always receive supervision and support. Although most people had appropriate care plans and risk assessments in place, audits were not effective in picking up shortfalls in areas such as people’s risk assessments and care plans and the management of medicines. When things went wrong, lessons learned were not always communicated effectively in the team or used to improve the service.

The provider’s checks and audits had failed to identify some shortfalls in the safety of the environment and equipment and, additional cleaning of frequently touched surfaces was not adequately recorded.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests, the policies and systems in the service supported this practice.

Rating at last inspection

The last rating for this service was good (published 8 August 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the admissions process, medicines, the Mental Capacity Act 2005 and deprivation of liberty safeguards, record keeping, safeguarding people, staff training, and learning lessons when things go wrong.

The inspection was prompted in part by notification of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about care planning, risk assessment, responding to people’s changing needs and illness or injury. This inspection examined all of these risks.

As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings of this inspection. Please see the safe, effective and well-led sections of this full report.

We have found evidence that the provider needs to make improvements. We have identified breaches of regulation in relation to the safety and management of the service.

You can see what action we have asked the provider to take at the end of this full report.

The provider had taken some action during the inspection to mitigate risks and continued to liaise with the inspectors after the inspection to advise of further improvements scheduled and carried out.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ashcroft House is a converted building located in Bramhope, Leeds. It is close to the local shops, pubs, and a post office. The provider has just this one registration and they provide residential care for up to 32 older people with varying physical and mental health needs.

The home did not 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 Regulations about how the service is run. The home’s manager confirmed they were in the process of registering with the Care Quality Commission.

People and their relatives and friends told us they felt safe. Staff had been trained and knew what to do to keep people safe from the risk of harm.

People who lived at the service told us they were happy with the care provided. Risks to people’s health and care had been identified and staff knew how to help reduce risks to people, for example, from falling or pressure sores.

We saw appropriate pre-employment checks, including criminal records checks, had been carried out for new members of staff. This ensured, as far as possible, that staff with the appropriate skills and experience were employed. People told us there were enough staff to meet their needs.

The staff told us they were supported to complete training which gave them the skills to carry out their roles. The staff told us the manager was very approachable and responsive to requests for training.

Staff understood the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff understood the need to ask people for their consent before carrying out care tasks. The provider had followed the correct procedures where people’s liberty needed to be restricted for their safety.

People were complimentary about the choice of foods available to them. People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health.

People had access to healthcare professionals when this was required. Staff followed direction from professionals and if they had any concerns they reported these immediately.

The arrangements in place for people’s medicines meant people received these when they needed them. Storage of medicines was safe and people were not rushed when medicines where being administered.

We saw staff talking and listening to people in a caring and respectful manner. We observed staff were kind and spoke warmly to and about the people they cared for. All staff we spoke with were able to demonstrate they knew people well. There was an emphasis on protecting people’s dignity.

People had been involved in identifying their care needs and staff knew how to support people to meet their needs. Care records provided guidance to staff as to how to do this appropriately. Staff demonstrated an understanding of people’s individual needs and preferences and knew how people communicated their needs.

People told us they enjoyed the opportunities for activities provided in the home, such as dominos or singing. They also enjoyed trips out for lunch and to attend church.

People told us they were able to raise their concerns or complaints and were confident they were listened to. The service had a complaints policy in place. The Statement of Purpose for the service documented information about how to complain. The service had not received any recent complaints.

People who used the service and staff told us the manager was approachable, listened and was supportive to them. There were systems in place to monitor and improve the quality of the service provided.

At this inspection we found the provider had taken most of the necessary action, although we found one regulation regarding consent to care was still in breach. We have rated the overall service as requires improvement. To improve the rating to ‘Good’ would require a longer term track record of consistent good practice.

Ashcroft House is a large detached property set in its own gardens in the village of Bramhope. The care home provides personal care for up to 32 older people and people living with dementia. At the time of the inspection, the service had a registered manager. 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 told us they felt safe. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. We found one incident which had not been reported to the CQC and the local safeguarding authority.

People lived in a safe, clean and homely environment. Medicines were managed consistently and safely. We saw risks were appropriately assessed and reviewed.

Recruitment processes in place were safe, although we found further detail could have been captured at interview stage. Staff were satisfied with the support they received during their induction which included attending training and shadowing experienced staff. Staff received supervisions and appraisals were scheduled to be carried out during April 2016 inspection. We found some gaps in the training programme, however the registered manager had already identified this and staff were booked to attend courses.

Although the service had carried out some mental capacity assessments, we found the process followed was not appropriate. We also saw some care plans which indicated people did not have capacity in specific areas, although this had not been formally assessed. The service had not submitted any DoLS applications, although the registered provider told us they would prioritise this piece of work.

Staff were familiar with people and their care needs. We observed staff provided kind and compassionate care to people who spoke positively about them. Staff were able to describe how they protected peoples’ privacy and dignity and people confirmed this happened.

Healthcare needs were met by regular contact with health professionals and people’s nutritional needs were met. Care plans were completed with the involvement of people and their families, who were also part of reviews.

The service made people aware of how to complain and people told us they knew who to contact if they were not satisfied.

The service had introduced a number of effective audits which were completed on a regular basis. We saw the registered provider had a visible presence in the home and they had taken on some of the responsibility for these checks. Staff spoke positively about the registered manager and we found there was a positive culture within the service.

We found a breach of the regulations 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.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them as well as from looking at records.

Is the service safe?

People told us they felt safe. However the manager and staff did not recognise some elements of safeguarding adults. For example a person who had become disinhibited and whose behaviour to another resident, who lacked capacity, was inappropriate had not been referred to adult safeguarding. Nor had any proactive action had been taken or incidents recorded to ensure the well being of both people and the best approach to support them. We asked the manager to create a plan of care to support both people and to make sure they are referred to safeguarding.

We made a tour of the home and found there was a lack of awareness of infection control and the general standard of cleanliness was poor.

We saw carpets in many parts of the home needed replacing they were old, stained, and had tears which are a trip hazard and could lead to a person falling.

We were concerned at staff numbers and the different tasks staff needed to do. On some weekends there were two less care staff on throughout the day and no cleaning staff.

We looked at the recruitment of new staff. This showed some required recruitment checks were not being followed.

Is the service caring?

People spoke well of the staff and their care, some of their comments included:

'Staff are kind and they work hard' 'I am comfortable. The staff are kind'

Everyone said staff were respectful and preserved their dignity whilst supporting them.' They always knock before they enter' One person said.

Is the service responsive?

The manager and staff all spoke of the good relationships they had with other professionals.

Care records contained letters regarding people's discharge from hospital or decisions made at out-patient appointments.

The manager was aware staff needed more training on dementia and the MCA and all decisions effecting people who may not have capacity need to be clearly documented as best interest decisions. For example one person was moved from a single room to the only remaining double room in the home, which is on the ground floor. The manager said this move had a positive effect on the person and their relative was consulted but there was no formal best interest decision recorded.

Is the service effective?

People's health and care needs were assessed with them, but they were not always involved in writing their care plans. Some people were not aware of what was in their care plans.

People we spoke with said they had gone out of the home on outings or visits in the past but rarely did so now. One person told us an activity organiser goes to the home three times a week and a person plays the organ once a month. There was no record of any social events had taken place outside of those afternoons and only if family or friends escorted people out did they go into the garden or out of the home.

Is the service well led?

All of the staff we spoke with knew of the whistleblowing policy. All of the staff said that if they witnessed poor practice they would report their concerns.

The provider did not have an effective system to regularly assess and monitor the quality of service people received nor to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

People said, 'I'm very well looked after here. I like living here, I have no worries.' A relative said, 'I feel that my mother is safe here and they often stop and have a chat with her as they pass by.'

One person said, 'They always try and meet your needs and always give you a choice of things to wear and eat.' Another person said, 'The staff are very friendly and helpful and I have no complaints.'

People who used the service told us there were always plenty of staff on duty and they felt able to approach staff when they wanted to. Both relatives we spoke with told us they felt staff listened to them. They told us they felt involved in decisions regarding their relatives care.

One person told us that, 'They (staff) always treat me with great respect.'

We observed that people were treated respectfully and that staff were attentive to maintaining the privacy and dignity of those they cared for.

People were complimentary about the food and said they had more than enough to eat. They told us they felt safe in the home and were aware of the complaints system and would be confident they would be listened to and acted upon.

One person said, 'I always said that I would never live in a home, but people really care here. I really like it here.'

People we spoke with said the home was always clean. We also spoke with a relative of someone who used the service. They said, 'The place is always clean when I come. I have never experience any bad odour at this home.'

Staff said they are confident that the management of the home would deal with safeguarding issues or concerns appropriately and systems were in place to make sure people were safe.