The Care Quality Commission
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Archived: Ackworth House Nursing Home

Overall: Requires improvement read more about inspection ratings

The Beach, Filey, North Yorkshire, YO14 9LA (01723) 515888

Provided and run by:
Ackworth House Limited

All Inspections

2 June 2015

During a routine inspection

Ackworth House is a care home providing nursing for up to 43 older people with a physical or sensory impairment. The main building is a converted hotel with four floors. At the rear of the home there is a newer extension over two floors. The home is situated along the beach front in the small seaside town of Filey. We carried out an inspection on 2 June 2015 and it was unannounced. At the time of our visit there were 20 people living at the service.

There was a registered manager working at this service. 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 our last comprehensive inspection on 19 August 2014 we identified continued breaches of the Health and Social Care Act 2008 regulations relating to care and welfare, the management of medicines and staffing levels which had been identified at an inspection carried out in January 2014.We also found additional areas of concern in relation to the environment, quality assurance and completion of records. This resulted in action been taken by the Care Quality Commission. We received an action plan from the provider telling us they would make improvements by 31 December 2014. We carried out focused inspections of the service on 5 February 2015 and 10 April 2015 to check the welfare of people who used the service and to check on any improvements made by the provider. Although we saw that the provider had made some improvements they had not completed their identified actions. At this inspection, carried out on 2 June 2015, we found that the provider had continued to make improvements. While further improvements are still required in some areas we found that all previous breaches of the regulations had now been met.

Peoples care plans reflected their care needs and risk assessments were in place. People we spoke with told us that they were well cared for. People’s nutritional needs were met and they were supported at mealtimes when it was needed.

Medicines were now managed safely for people though areas for further improvement were identified.

The home was now clean and the environment had improved though there were areas within the service which still required refurbishment.

Staff had received an induction when they began working for the service and access to training had improved. Plans for supervision were in place but not yet implemented across the whole staff group. Care provided to people was now based on best practice guidance.

People told us that staff were kind to them and we observed that some staff had a good rapport with people.

People were involved in planning their own care and we found people’s end of life wishes had been recorded. Reviews were carried out by the staff and people had been involved in any reviews their care. There had been no complaints since the last inspection.

We saw that there were still very few activities organised which meant that there was a risk of social isolation for some people.

People told us that they felt the leadership of the service had improved since the last inspection by CQC. Audits and other checks were now in place but needed further time to demonstrate impact on the safety and quality of the service.

10 April 2015

During an inspection looking at part of the service

We carried out an announced comprehensive inspection of this service on 19 August 2014 and five breaches of regulations were found. These related to peoples care and welfare, the management of medicines, infection control, staffing levels and the quality of the service. You can see what action we told the provider to take at the back of the full version of the full version of the report. We undertook an unannounced focused inspection on 5 February 2015 to check on the welfare of people who used the service and to confirm the provider was meeting the legal requirements. We found improvements in staffing and infection control but there were still some areas that required further improvement. We carried out this further unannounced focused inspection on 10 April 2015 to ensure that people who used the service were safe and check that improvements made in February had been maintained and whether further improvements had been made.

This report only covers our findings in relation to the five breaches of regulations. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Ackworth House Nursing Home’ on our website at ‘www.cqc.org.uk’

Ackworth House is a care home providing nursing for up to 43 older people with a physical or sensory impairment. The main building is a converted hotel with four floors. At the rear of the home there is a newer extension over two floors. The service is situated along the beach front in the seaside town of Filey. At the time of our visit there were 27 people living at the service.

There was a registered manager at this service who had been in post since September 2014 and registered with the Care Quality Commission on 19 March 2015. 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 found that that although some improvements had been made the service was not always safe. People told us that they felt safe living at Ackworth House. One person told us, “The staff speak nicely to you” and another said, “I am safe here.”

We found, however that the management of medicines was not safe and some of the same issues in respect of medicines from previous inspection in August 2014 and February 2015 were repeated at this inspection.

The registered manager used a tool to determine what staff was required in order to meet people’s needs. We saw there was sufficient staff on duty to meet people’s needs.

Improvements had been made to the environment and cleanliness of the premises but there were still areas that required improvement.

The service did not always work within the principles of the Mental Capacity Act 2005 and so people did not always have specific decisions made in their best interest when they lacked the capacity to make them themselves.

Interactions between staff and people who used the service showed that staff knew people well. People who used the service described staff as caring.

People’s needs were not always clearly reflected in their care plans which meant that they may not receive the care and support that they need appropriately.

Improvements were being made to the quality assurance systems for the service but there were still areas for concern.

5 February 2015

During an inspection looking at part of the service

We carried out an  unannounced comprehensive inspection of this service on 19 August 2014. Breaches of legal requirements were found. As a result we undertook a focused inspection on 5 February 2015  to follow up on whether action had been taken to deal with the breaches. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 19 August 2014

The inspection took place on 19th August2014 and was unannounced At our inspection in September 2013 and again in January 2014 we had identified breaches of regulations relating to care and welfare, the management of medicines, staffing levels and meeting nutritional needs. Following this the provider sent us an action plan telling us about the improvements they intended to make. During this inspection we looked at whether or not those improvements had been made. We found that improvements still needed to be made in regard to management of medicines, care and welfare and staffing levels. We also found additional areas of concern in relation to the environment, quality assurance and completion of records. At the last inspection on 18 January 2014 we asked the provider to take action to make improvements in relation to meeting nutritional needs and we found this action had been completed.

Ackworth House is a care home providing nursing for unto 43 older people with a physical or sensory impairment. The main building is a converted hotel with four floors. At the rear of the home there is a newer extension over two floors. The home is situated along the beach front in the small seaside town of Filey. At the time of our visit there were 29 people living at the service. The acting manager, who was also a director of the company which owned this service, had been in post since the previous manager left the service in December2013. They had applied to become registered but had not been successful in their application. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. They continue to act as manager until suitable person is employed to be the registered manager.

Although people told us they felt safe we found that this service was not providing consistently safe care. We found staffing levels appeared good but there were a high proportion of agency staff and account had not been taken of people’s needs and other factors when deciding on staffing levels which meant people’s safety was compromised. We found people’s care plans did not always reflect their care needs and risk assessments were not always in place. There were areas within the service which were odorous and dirty. We found the service did not meet the requirements of the Mental Capacity Act 2005 (MCA)and associated Deprivation of Liberty Safeguards (DoLS). Some people at the service were not able to tell us if their freedom was restricted but we could see that there were no recorded decisions about why, for instance, those people did not go out in the fresh air. The MCA and DoLS require providers to submit applications to a ‘Supervisory Body’ for authority to restrict people’s liberty.It was clear from paperwork we inspected that this had not been done and that staff did not fully understand the requirements or principles of the MCA.

Medicines were not always managed safely for people.There were discrepancies in numbers of tablets available and number of tablets given. Medicines were in use that were out of date and were not always stored safely.

The service was not effective. People we spoke with told us that they felt well cared for but one relative expressed concern about staff skills and knowledge. Staff had received an induction when they began working for the service but supervision was not up to date. There were gaps in staff training.Peoples identified health needs were not always met and some people did not have risk assessments in place which meant that staff had not always identified when people needed additional support. Nutritional needs were met but we saw people had varied experiences at mealtimes. Some relatives told us they felt that people living at the home did not receive the support they required to eat and drink. There had been no adaptations made to the environment to help people maintain their independence..

People had a mixed experience with staff. They told us that some staff were kind but some focussed on tasks rather than the person. People were not always involved in planning their own care.There were no activities seen to be taking place although we were told that some were planned. People using the service told us there were no regular activities.

There was no registered manager at this service and there was no consistent leadership.

Focused Inspection of 5 February 2015

After our inspection of 19 August 2014 the provider, that is, the legal entity that provides a regulated adult social care or healthcare service to members of the public, wrote to us to say what they would do to meet legal requirements in relation to breaches of regulations identified with a completion date of 31 January 2015. The breaches were of Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 Care and welfare of people who use services,Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010 Assessing and monitoring the quality of service providers, Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010 Cleanliness and infection control, Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010 Management of medicines, Regulation 15 HSCA 2008 (Regulated Activities) Regulations 2010 Safety and suitability of premises, Regulation 20 HSCA 2008 (Regulated Activities) Regulations 2010 Records and Regulation 22 HSCA 2008 (Regulated Activities) Regulations 2010 Staffing .

We undertook a focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found that while some improvements had been in some areas, concerns remained in others.

We found that the service was not safe. This was because medicines were still not managed safely. One person had been identified at the comprehensive inspection of 19 August 2014 as having their medication administered covertly with no records in place to support the decision to do so. Covert administration is when medicines are given in food or drink to people unable to give their consent or refuse treatment. The medication was still administered covertly when we carried out the focused inspection of 5 February 2015 and when we examined medicine administration records and care plans we found that staff had not reviewed the records and had not documented the decision or any best interest decision making in line with the principles of the Mental Capacity Act 2005. A safeguarding alert was made to the local authority about this.

Other areas had improved. The manager showed us records of the assessment tool they had used to determine what staffing levels were needed to meet peoples needs. The staffing level on the day of our visit were sufficient and rotas confirmed that these levels were consistent. A programme of  training had started and staff were able to tell us about the training they had completed which was relevant to the needs of people who used the service. This meant that people were protected because there were sufficient staff on duty with the appropriate knowledge and skills to meet their needs. 

Action had been taken to improve the effectiveness of the service.We observed people who used the service receiving support during mealtimes. Staff spent time with people and the mealtime was unhurried and calm. People were given the support they needed to ensure they were able to eat and drink

We saw that work had started to improve the environment. There was appropriate signage throughout the building. In the dining room there were menus displayed with pictures of the food to be offered which helped those people living with dementia to make a choice about what they would like to eat. There was also a memory board displaying the day, date, and season with words and pictures helping to orientate people. The provider told us that further improvements were being planned.

People who used the service told us that they found the staff kind and caring. They told us that there had been improvements in the attitude of some staff since the last inspection and the addition of a nurse manager and experienced nurses to the team was helping to improve the management and leadership of the service. There was now a manager employed at the service who had applied to the Care Quality commission to become registered.

19 August 2014

During a routine inspection

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. The inspection took place on 19th August2014 and was unannounced At our inspection in September 2013 and again in January 2014 we had identified breaches of regulations relating to care and welfare, the management of medicines, staffing levels and meeting nutritional needs.Following this the provider sent us an action plan telling us about the improvements they intended to make.During this inspection we looked at whether or not those improvements had been made. We found that improvements still needed to be made in regard to management of medicines, care and welfare and staffing levels. We also found additional areas of concern in relation to the environment, quality assurance and completion of records. At the last inspection on 18 January 2014 we asked the provider to take action to make improvements in relation to meeting nutritional needs and we found this action had been completed.

Ackworth House is a care home providing nursing for unto 43 older people with a physical or sensory impairment. The main building is a converted hotel with four floors. At the rear of the home there is a newer extension over two floors. The home is situated along the beach front in the small seaside town of Filey. At the time of our visit there were 29 people living at the service. The acting manager, who was also a director of the company which owned this service, had been in post since the previous manager left the service in December2013. They had applied to become registered but had not been successful in their application. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. They continue to act as manager until suitable person is employed to be the registered manager.

Although people told us they felt safe we found that this service was not providing consistently safe care. We found staffing levels appeared good but there were a high proportion of agency staff and account had not been taken of people’s needs and other factors when deciding on staffing levels which meant people’s safety was compromised. We found people’s care plans did not always reflect their care needs and risk assessments were not always in place. There were areas within the service which were odorous and dirty. We found the service did not meet the requirements of the Mental Capacity Act 2005 (MCA)and associated Deprivation of Liberty Safeguards (DoLS). Some people at the service were not able to tell us if their freedom was restricted but we could see that there were no recorded decisions about why, for instance, those people did not go out in the fresh air. The MCA and DoLS require providers to submit applications to a ‘Supervisory Body’ for authority to restrict people’s liberty.It was clear from paperwork we inspected that this had not been done and that staff did not fully understand the requirements or principles of the MCA.

Medicines were not always managed safely for people.There were discrepancies in numbers of tablets available and number of tablets given. Medicines were in use that were out of date and were not always stored safely.

The service was not effective. People we spoke with told us that they felt well cared for but one relative expressed concern about staff skills and knowledge. Staff had received an induction when they began working for the service but supervision was not up to date. There were gaps in staff training.Peoples identified health needs were not always met and some people did not have risk assessments in place which meant that staff had not always identified when people needed additional support. Nutritional needs were met but we saw people had varied experiences at mealtimes. Some relatives told us they felt that people living at the home did not receive the support they required to eat and drink. There had been no adaptations made to the environment to help people maintain their independence..

People had a mixed experience with staff. They told us that some staff were kind but some focussed on tasks rather than the person. People were not always involved in planning their own care.There were no activities seen to be taking place although we were told that some were planned. People using the service told us there were no regular activities.

There was no registered manager at this service and there was no consistent leadership.

 

 

18 January 2014

During an inspection in response to concerns

We visited this service in response to concerns we had received from two sources. We focused our visit on care and welfare of people who used services, meeting nutritional needs and staffing.

Care and treatment was not planned and delivered in a way that was intended to ensure people’s safety and welfare.

We found that care was not always delivered in line with people's care plans and risk assessments were not always completed which could result in unsafe care. People told us that they sometimes had to wait for long periods for assistance with their care needs. Staff said they did not always feel that they could do their job properly.

We looked at the way that nutrition was managed within the service. People had sufficient food and a choice of what to eat however staff did not have time to offer support to people who needed assistance with eating and drinking.

There were 25 people who used the service on the day we visited. Eight people were identified as having complex needs and five people had a dementia type condition. There appeared to be sufficient staff on duty however the way in which the staffing was organised and managed meant that there were insufficient staff to meet peoples needs. The staff were not skilled in meeting the needs of people with a dementia.

13 August 2013

During an inspection in response to concerns

Most people living in the home were unsure of what medicines they were prescribed. This meant that they were unable to talk to us about their medicines in a meaningful way. Nobody we spoke with expressed any concerns about how their medicines, or those of their relative, were handled.

18 April 2013

During an inspection looking at part of the service

We carried out an unannounced inspection in April 2013 following a visit to the home in February 2013 where concerns had been raised about the levels of staffing, quality of care and social interaction.

When we visited Ackworth House we spoke with five members of staff, a relative of a person who used the service, and a person who used the service. All those we spoke with felt there had been improvements regarding the number of staff working at the home and the way staff were organised.

People felt the care being given had improved and staff had more time to deliver support that was not rushed. Although there were still times when people were waiting to receive personal care support this had improved since our last visit.

Staff morale was reported to be improved although there were still relatively high levels of absence. Staff felt more supported and the need for further training was being monitored and managed more effectively.

The service was following its complaints procedures and the service had taken steps to improve the process and recording of complaints. We looked at the quality assurance systems that were in place for the service and saw the providers were improving these systems gradually to ensure the service was responding to the feedback from staff and people who used the service.

It was identified that improvements were required regarding effective management of the home and issues that had been identified as part of the inspection process.

6 February 2013

During an inspection in response to concerns

We carried out an unannounced inspection following concerns raised with us about the levels of staffing and the quality of care at Ackworth House. This included food and drink and medication as well as personal care and social interaction. There were also concerns from the local authority and the Care Quality Commission (CQC) that CQC had not been receiving notifications about incidents that warranted reporting.

When we visited Ackworth House we spoke with eight members of staff, three relatives of people who used the service, and six people who used the service. All of those we spoke with were concerned about the number of staff working at the home. People felt that the care being given was basic and often rushed. There were times when people were waiting to receive personal care support and meals were sometimes delayed.

We looked at the dispensing and administration of medicines. Some of the practices were inappropriate but this had improved recently. Staff morale was very low and there were high levels of sickness and absence. Staff were not supported to work to a high standard and had been subject to inappropriate staff procedures. The service was following it's complaints procedures in some instances but was not fostering an open approachable culture for raising issues.

There were several incidents in the home where notifications should have been submitted to CQC but this had not been done.

28 August 2012

During a routine inspection

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people who used the service had complex needs which meant they were not able to tell us their experiences.

We spoke with the owners and the manager about the care and well being of people who used the service. We also gathered evidence of people’s experiences of the service by reviewing care records and associated documentation.

Those people able to express their opinions told us that they felt they were well cared for in the home. They said they were encouraged to be as independent as possible, and were given plenty of choice in their daily lives.

During our inspection we spent time observing care provided over a meal time. We saw that members of staff were kind and patient, and no one was rushed during their meal. One person said “the food is very good."

Records of discussions held by the manager with people on an individual basis showed that the people were happy with the service provided. They found the staff friendly and said they were treated with respect and dignity. Comments included “happy with everything” and, “no complaints here, I am very happy and satisfied with everything.”

20 December 2011

During a routine inspection

People who use the service told us the staff were nice, they treated people with respect and maintained peoples dignity. They also said that they can follow their own routines during the day and the staff use their chosen name at all times. people told us that visitors can come at any time.

Visitors spoken with said that they were please with the care their relatives get. They all said that if they had any concerns or complaints they would discuss them with the manager or the owner.

Staff spoken with said that they could access regular appropriate training. They all said they have regular supervision and have an annual appraisal. The nurses said they are given time to complete their professional development training. They also said that the staff team works well together.