We carried out the inspection of Ashcroft House on 30 June and 5 July 2017. At the time of our inspection, there were 28 people using the service. This was an unannounced inspection. We last inspected Ashcroft House in April 2016. At that inspection, we rated the service ‘requires improvement’ overall. At this inspection we found the service had made improvements.

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.

This was an unannounced inspection carried out on 18 April 2016. Our last inspection took place on 19 August 2015 when we gave an overall rating of ‘Inadequate’ for this service. We found, at that inspection, five breaches of the legal requirements in relation to need for consent, safe care and treatment, staffing, person-centred care and good governance. We took enforcement action and met with the registered provider and registered manager in October 2015 to discuss our concerns. They told us they were keen to improve their service and would make the required changes. They sent us a plan of action and told us how they were going to do this.

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 provid

At the last inspection in July 2014 we found the provider was breaching seven regulations. People's views and experiences were not taken into account in the way the service was provided and delivered in relation to people's social care needs. Care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare. People were not cared for in a clean, hygienic environment and not protected from the risk of infection because appropriate guidance had not been followed. People were not protected against the risks of unsafe or unsuitable premises. People were not protected against the risk of being supported by

unsuitable staff as there were not robust recruitment procedures in place. There were not always enough qualified, skilled and experienced staff to meet people's needs. The provider did not have effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

After the inspection in July 2014, the provider wrote to us to say what they would do to meet the regulations in relation to each breach. They told us they would complete all actions by the end of November 2014. At this inspection which took place on 19 August 2015 and was unannounced, we found that the provider had taken action to meet some of the regulations they breached at the last inspection, however, they had not completed their plan of action in relation to two regulations and legal requirements were still not met. We also found additional breaches.

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.

At this inspection we found people using the service were not protected against the risks associated with the administration, use and management of medicines. There was a lack of consistency in how people’s care was assessed, planned and delivered.

People made day to day decisions such as choosing when to get up and go to bed. However, the provider did not always meet legal requirements because they were not robustly checking people were consenting to care and treatment.

There was only a limited range of activities provided at the home and people sometimes sat for long periods with little stimulation. People enjoyed the food and had plenty to eat. There was a lack in consistency with the support people received with their health needs.

People felt safe. The provider had systems on place to protect people from abuse or allegations of abuse. People told us the staff were kind and caring. We observed people enjoyed the company of staff and others they lived with. There were enough staff to keep people safe; the provider agreed to monitor staffing levels to make sure this was maintained because they sometimes struggled to cover staff absences. Staff did not always receive appropriate training and support. The provider had effective recruitment and selection procedures in place.

The provider’s systems to monitor and assess the quality of service provision were not effective. Actions that had been identified to improve the service were not always implemented. The management team were visible and described by the staff team as approachable.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

This inspection considered our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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.

During our visit, we had the opportunity to talk with three people who used the service and with two relatives. People told us they were happy with the care and support they received.

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 we spoke with were pleased with the service they were receiving and complimented all the staff that cared for them. One person said “We are very well looked after here.”

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.

People told us they were very happy with the care and support provided by staff and that staff were kind, considerate and caring and always respected their right to privacy and dignity.

People told us they were very happy with the food and the home was always clean. They were very complimentary about the activities organiser and said they were able to get involved when they wanted to.

All staff we spoke with were positive about the support they received from management.

We spoke with some visitors. They told us they were happy with the care that was provided. They said the “Staff are very helpful and people are getting good care.”