Askham Grove

The service took part in the national COVID-19 testing programme for care homes. Individual risk assessments were completed for staff and people. Information and guidance about COVID-19 and infection control practices were displayed throughout the home.

The manager provided clear signage and guidance about social distancing; this was supported further by rearranging furniture to provide a safer environment. The service looked clean and was free from clutter. Cleaning schedules ensured frequently touched areas were sanitised every two hours.

Visitors were required to book their visits in advance and follow the providers infection control procedures. This included a temperature check. There was a screened area provided in one room to support safe visits. The provider had good supplies of personal protective equipment (PPE).

Plans were in place to manage any potential outbreak. The home had been divided into four zones and staff were allocated to these zones at the start of their shift. This helped reduce their footprint; this was known as zoning and is good infection control practice. The infection control lead performed daily visual checks and completed infection control audits to ensure best practice was followed.

All staff received training in infection control, good hand washing technique and the correct use and disposal of PPE. Relatives were also provided with infection control training to support their knowledge and understanding. Competency assessments for staff were completed to ensure good practices were maintained.

Askham Grove is a residential care home providing personal and nursing care for up to 28 people who have rehabilitation needs. At the time of the inspection 23 people were using the service. Askham Grove accommodates people on two floors of a purpose-built property.

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

People were happy with the care home and the staff that provided their care.

People felt safe living at the home because staff knew what they were doing, they had been trained, and cared for people in the way people wanted. Staff assessed and reduced risks as much as possible, and there was equipment in place to help people remain as independent as possible. There were enough staff, and the senior staff also spoke with people regularly. The provider obtained key recruitment checks before new staff started work.

People received their medicines and staff knew how these should be given. Medicine records were completed accurately and with enough detail. Staff supported people with meals and drinks. They used protective equipment, such as gloves and aprons. Staff followed advice from health care professionals and made sure they asked people’s consent before caring for them.

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.

People liked the staff that cared for them. Staff were kind and caring, they involved people in their care and made sure people’s privacy was respected. Staff worked well together, they understood the home’s aim to deliver high quality care, which helped people to continue to live as independently as possible.

Staff kept care records up to date and included national guidance if relevant. Complaints and concerns were dealt with and resolved.

Systems to monitor how well the home was running were carried out. Concerns were followed up to make sure action was taken to rectify any issues. Changes were made where issues had occurred elsewhere, so that the risk of a similar incident occurring again was reduced. People were asked their view of the home and action was taken to change any areas they were not happy with.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 June 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Askham Grove is one building with two separate units (upper and lower floors) each offering single, ensuite bedrooms and shared facilities such as lounge/dining and kitchen areas. At the time of this inspection there were 12 people living on the upper floor. There are also four one-bedroom flats on the upper floor, separated by a code-locked door from the main unit and with their own lift/staircase access to a separate front door. At the time of this inspection, the flats accommodated one person using the service, a relative of a person living in one of the other care homes on the site and two members of staff. Rooms on the lower floor accommodated staff members.

Askham Grove is the newest of five care homes on one site, on the outskirts of the village of Doddington. Each home is registered with CQC as a separate location. There are some shared facilities such as a café and function room where some activities take place.

This inspection included two site visits to the home on 26 June 2018 and 10 July 2018. This was the first inspection of this care home since it was registered. Adults requiring long-term rehabilitation moved into the upper floor of Askham Grove at the end of January 2018.

The home has been rated Requires Improvement overall. This is the first time the home has been rated Requires Improvement.

The service was not well-led. Systems for identifying, capturing and managing organisational risks and issues were ineffective. Leadership was not visible or open and leaders were out of touch with some of what was going on in the service. People’s views were not always sought or responded to. Leadership did not understand the importance of working within a person-centred equality, diversity and human-rights approach. Staff did not always understand, promote, uphold or work within the provider’s stated values and ethos of community, empowerment, dignity, respect and quality. Oversight and governance had not identified four breaches in regulations.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the home. 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. The registered manager had not provided the leadership that people and staff needed in order to give people the best possible quality of life.

There were not enough staff deployed to make sure that people’s needs, including social and emotional needs were fully met.

Some staff treated people well and showed empathy and understanding. However, not all staff treated people with kindness and compassion and people’s emotional needs were not always recognised or met. People’s need for privacy was not always upheld and confidentiality was not always maintained. Some staff were patronising and treated people as though they were children. People were not offered a choice of having their personal care provided by male or female staff. Staff did not always support people to maintain their independence.

Care plans were in place but did not always give staff guidance that was up to date enough for them to meet people’s needs in a personalised way. Some information in care plans was contradictory. Not enough activities, based on people’s individual interests and preferences were organised to ensure that people led fulfilling and meaningful lives.

Staff understood the ways in which the Mental Capacity Act affected their work. They gained people’s consent to care and generally people were supported to have choice and control of their lives. However, people were not always supported in the least restrictive way possible.

A complaints procedure was in place and displayed so that people would know who to talk to if they had a complaint. However, not all complaints were dealt with in line with the provider’s policy. Care records relating to end of life had not been completed or updated, which meant that people’s preferences might not be known or fulfilled.

Arrangements for people to formally share their views about the home and put forward ideas for improvements were not yet fully in place. Quality assurance processes were in place but were not robust enough to ensure that a quality service was being provided. These processes had not recognised the issues we found during our visits.

Staff had received training in safeguarding people and allegations of abuse or avoidable harm were reported as required. Assessments of a number of potential risks to people had been carried out but some risks had not been assessed or managed so that people were kept safe and had maximum control over their lives.

Medicines were managed well and people had received their medicines safely and as they had been prescribed. Staff mostly followed infection prevention and control procedures so that the home was clean and hygienic. The process to recruit permanent staff was robust and reduced the risk of unsuitable staff being employed. Not all required information relating to agency staff had been acquired to make sure they were suitable to work in the home.

Assessments of people’s support needs were carried out before the person was offered a place at the home. This was to ensure that the staff could provide the care and support that the person needed and in the way they preferred. Technology and equipment, such as call bells, pressure mats and hoists were used to enhance the support being provided.

Staff received induction, training and support to enable them to do their job. People were provided with a choice of nutritious and appetizing meals and special diets were catered for. A range of external health and social care professionals worked with the staff team to support people to maintain their health.

We saw some warm, friendly, caring interactions between staff and the people they were supporting. Staff made efforts to communicate with people in a way they could understand. Visitors were made to feel welcome.

Staff were given opportunities to express their views about the service. A staff recognition scheme was in place, rewarding long service.

The registered manager was aware of their responsibility to uphold legal requirements, including notifying the CQC of various matters. The management team worked in partnership with other professionals. There were some links with the local community including a café that was open to the general public.

We found four breaches of Regulations. You can see what action we told the provider to take at the back of the full version of the report.