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Inspection carried out on 11 February 2019

During a routine inspection

About the service: Askham Court is residential care home that provides accommodation and care, with nursing, for up to 12 adults. People who live at the home have complex physical and mental health needs, mainly because of acquired brain injury. At the time of the inspection there were 11 people living in the home. Askham Court is part of the Askham Village Community, which comprises of four care homes, each catering for a different client group, built around a central courtyard garden. Askham Court is on one floor, with a large lounge/dining area, which has a kitchenette, and all bedrooms are single rooms with an en suite bathroom. There is a shared café opening onto the courtyard, which is open to the general public.

People’s experience of using this service:

• People continued to feel safe living at the service. Risk assessments had been completed to ensure that action was taken to keep people safe. Staffing levels were appropriate to meet people’s needs in a timely manner. People received their medication as prescribed. There were systems in place to record, monitor and learn from accidents and incidents.

• Staff had the knowledge, skills and support they required to meet people’s needs effectively. People’s physical, emotional and social needs were identified so staff could meet these. People received support with eating and drinking when needed. People were supported to maintain good health and were supported by or referred to the relevant healthcare professionals. People consented to their care or when appropriate best interest decisions were taken on their behalf.

• People continued to receive care and support from staff that were kind and caring. People’s privacy and dignity was protected and promoted. Staff knew people well and what made them happy and how to motivate them to work towards re-ablement programmes.

• People received person centred care that met their needs. Care plans were detailed so that staff knew people’s preferences and how people would like to be supported. Activities were provided according to people’s interests and hobbies. People knew who to make a complaint to if needed.

• People, visitors and staff told us the service had strong leadership and an open and supportive culture. The service identified areas for improvement so that people received a good service. One person said that the lead nurse was, “Caring, efficient and sympathetic.”

Rating at last inspection: Good (report published 20 July 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remains Good.

Follow up: We will continue to monitor all information received about the service to ensure the next inspection is scheduled accordingly.

Inspection carried out on 22 June 2016

During a routine inspection

Askham Court is registered to provide accommodation and care, with nursing, for up to 12 adults. People who live at the home have complex physical and mental health needs, mainly because of acquired brain injury. Askham Court is part of the Askham Village Community, which comprises of four care homes, each catering for a different client group, built around a central courtyard garden. Askham Court is on one floor, with a large lounge/dining area, which has a kitchenette, and all bedrooms are single rooms with an en suite bathroom. There is a shared café opening onto the courtyard, which is open to the general public.

This comprehensive inspection took place on 22 June 2016 and was unannounced. There were 12 people living at the home when we visited.

As part of its conditions of registration, this home is required to have 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 home is run. There was no registered manager in place as the registered manager had left about six weeks before the inspection. The provider’s Operations and Quality Manager was managing the home.

People were comfortable with the staff and people’s relatives were happy with the support provided to their family members. Staff liked working at Askham Court and were well-supported by the manager and senior staff.

Staff had undergone training and were competent to recognise and report any incidents of harm. Potential risks to people had been assessed, which meant that people were kept as safe as possible. Medicines were managed well so that people received their prescribed medicines safely.

There were sufficient staff on duty to make sure that each person had the support they needed to do whatever they wanted to do. Staff had been recruited in a way that made sure that only staff suitable to work in a care home were employed. Staff had undertaken a range of training in topics relevant to their role so that they were equipped to do their job well.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed. Staff had a good understanding of the principles of the MCA. Appropriate applications had been made to the relevant authorities to ensure that people’s rights were protected if they lacked mental capacity to make decisions for themselves.

People’s healthcare needs were monitored and staff involved a range of healthcare professionals to make sure that people were supported to maintain good health and well-being. People were given sufficient amounts of food and drink and people’s dietary needs were met.

Staff showed that they cared about the people they were supporting. Staff treated people with kindness, respect and compassion and made sure that people’s privacy and dignity were upheld at all times. People’s personal information was kept securely so that their confidentiality and privacy were maintained.

People’s relatives were involved in the planning of their family member’s care and support. Staff gathered as much information as possible about each person so that their support plans were personalised. This meant that people received the support they needed in the way they preferred. People received therapy from trained professionals to support them to meet their goals for rehabilitation. A number of people had achieved their goals and had left the home.

A wide range of activities and outings was organised to make sure people had opportunities to do whatever they wanted to do. People and their relatives knew how to complain and complaints were responded to in a timely manner.

The manager was approachab

Inspection carried out on 14 October 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 14 April and 7 May 2015. A breach of three legal requirements was found. This was because there were not always enough suitably qualified, competent, skilled and experienced staff deployed to meet the needs of people who lived at the home. Medicines had not always been managed safely. People were not involved in planning their care and support. Care plans did not contain sufficient information for staff to deliver consistent, personalised care.

After the comprehensive inspection the provider wrote to us to tell what they would do to meet the legal requirements in relation to the breaches.

We undertook this unannounced focused inspection on 14 October 2015 to check that the provider had followed their plan and to confirm that they now met the legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Askham Court on our website www.cqc.org.uk.

Askham Court is a registered care home that provides accommodation and care, with nursing, for up to 12 adults who have a physical disability and/or mental health needs. It is part of the Askham Village Community, which comprises of four care homes, each catering for a different client group, built around a central courtyard garden. Askham Court is a single storey building, with a large lounge/dining area and kitchenette. All bedrooms are single rooms and have an en suite bathroom. There is a shared café opening onto the courtyard, which is open to the general public. There were 11 people in residence at the time of our inspection.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our focused inspection on 14 October 2015 we found that the provider had followed their plan, which they told us would be completed by 21 July 2015, and legal requirements had been met.

Staffing numbers had improved and there was evidence that there were sufficient staff on duty to meet people’s care and support needs safely. Medicine management had improved so that medicines were handled safely.

An incident had occurred and the provider had failed to follow the correct reporting procedures, as required by law and by local protocols.

Improvements had been made to the care planning system. People or their relatives had been involved in planning the person’s care and support to ensure that staff delivered care and support in the way the person needed and preferred. Care plans had been updated and guidance for staff improved to enable staff to deliver more consistent and personalised care. Some further improvements were still required to ensure that the care plans were fully personalised.

We found a breach 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.

Inspection carried out on 14 April and 07 May 2015

During a routine inspection

Askham Court is registered to provide accommodation and care, with nursing, for up to 12 adults. It is part of the Askham Village Community, which comprises of four care homes, each catering for a different client group, built around a central courtyard garden. Askham Court is on one floor, with a large lounge/dining area, which has a kitchenette, and all bedrooms are single rooms with an en suite bathroom. There is a shared café opening onto the courtyard, which is open to the general public.

The inspection took place over two days and was unannounced. There were 11 people in residence. The last full inspection of Askham Court was on 27 September 2013. During this inspection we found that improvements were needed relating to the management of medicines. The provider sent us an action plan detailing the improvements they were going to make. In December 2013 we carried out a review of the evidence sent to us by the provider and found that the required improvements had been made.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager is also registered to manage Askham Place, one of the other three care homes on the site.

Staff had undergone training to recognise and report abuse. Any potential risks to people were managed so that people were protected from harm.

There were not enough staff on duty to keep people safe and meet their assessed needs. Pre-employment checks had been carried out to ensure that only staff suitable to work at the home were employed. Medicines were not always managed safely.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed by staff trained to do so. However, staff’s knowledge was not sufficient to ensure that people’s rights were protected if they did not have capacity to make decisions for themselves.

People were given a choice of food and special diets were catered for. People’s health was monitored and maintained by staff with the involvement of a range of healthcare professionals.

Relationships between people who lived at Askham Court and the staff were very good and staff showed they cared about the people they were looking after. Staff treated people well but did not always uphold their privacy and dignity. People’s personal information was not always kept confidential.

People and their relatives were not involved in the planning and reviewing of their care. Care plans did not contain sufficient, up to date information to give staff guidance on how to offer people consistent and personalised care and support. There were not enough activities, outings and entertainment offered to people to keep them occupied.

There was an open culture in the home and people, their relatives and other visitors were encouraged in a number of ways to put forward their views about the service and make suggestions for improvements. Audits carried out were not always effective in driving improvements in the quality of the service provided.

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

We have made a recommendation about upholding the rights of people who lack the mental capacity to make all their own decisions.

During a check to make sure that the improvements required had been made

We found that the provider had taken suitable action since the last inspection to ensure that medication was being safely managed and accurately recorded when administered to people. New protocols had been put in place to ensure that regular audits would be used to check the accuracy of the records for medication that had been administered to people.

Inspection carried out on 27 September 2013

During a routine inspection

We found that people were respected and that they and their relatives had been involved in making decisions about their care arrangements. One person told us how they had made much more progress since moving into the home.

People received planned care that was provided according to their individual needs.

We found improvements were necessary to ensure that the administration and control of medicines is suitably recorded.

Complaints had been appropriately responded to when these had been made known to the provider.

Inspection carried out on 10 August 2012

During a routine inspection

During our visit to Askham Court on 10 August 2012 we observed that two of the four people living at the home communicated in a non verbal manner. They were able to inform staff through physical methods about how they felt and what support they wanted. We observed that care staff could interpret what people were communicating and what support they required or wanted. Our observations showed that people were treated with respect and wherever possible people had been included in their care planning arrangements.