This inspection took place on 18 and 19 June 2018 and was unannounced.

Ashcroft Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ashcroft Nursing Home accommodates up to 88 people in one adapted building, some people may be living with dementia. At the time of the inspection 48 people were living on the ground and first floors of the service.

There was a registered manager in post, however, they were not in charge of the service on a day to day basis. Until February 2018, there had been another registered manager in post, who worked at the service daily. At the time of the inspection, there was an acting manager working at the service who was responsible for the day to day oversight of the service. They had recently made an application to us to become the new registered manager of the 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.

We last inspected the service in March 2016 and the service was rated Good. This inspection was undertaken in response to information from the local safeguarding authority about how people with behaviours that challenge had been supported. At this inspection, four breaches of regulation were identified.

Potential risks to people’s health and welfare such as epilepsy had not been consistently assessed and staff did not have detailed guidance to mitigate the risk and support people needed when they were unwell. Checks had been completed on the environment and equipment that people used to make sure it was safe. However, no action had been taken when the temperature of the water in some people’s bedrooms were above the recommended limit to reduce the risk of scalding. Following the inspection, the acting manager sent us records to show that action had been taken to reduce the water temperatures.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible. Some people had gates in their doorways and were independently mobile but were restricted from going into and leaving their rooms. There were no records about how this decision had been made and if this was the least restrictive way to support these people.

Each person had a care plan, that covered all aspects of their lives including physical and social needs. However, the care plans did not always contain detail about people’s choices and preferences. Some people had been identified as being at the end of their lives, their wishes and the support they needed was not recorded in their care plan. Staff had received training in end of life care and could support people to be comfortable.

Staff and the provider completed audits on the quality of the service. When shortfalls were identified, an action plan was put in place. However, these plans were not checked to confirm the action had been completed, plans were signed as completed before the all the action had been taken. The action taken in response to the audits and shortfalls found was not embedded as further shortfalls were found at this inspection.

Before the inspection, concerns had been raised that incidents involving people who displayed behaviours that challenge, had not been managed effectively. The acting manager had put systems in place to manage future incidents and people’s behaviour. Accidents had been recorded and analysed to identify trends and patterns. Action had been taken to reduce the risk of accidents happening and records showed that the action had been effective.

Staff and

This unannounced inspection took place on 30 and 31 March 2016 and was carried out by two inspectors.

Ashcroft Nursing Home is a privately owned care home supporting up to 88 people, who may be living with dementia. Current accommodation is over two floors accessed by a passenger lift. There were 45 people living at Ashcroft Nursing Home when we inspected.

There was a registered manager in post, the registered manager had recently been promoted to the area manager role. The registered manager was present on both days of the inspection.

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. A replacement manager had been appointed and they were in the process of registering with the CQC. Staff told us the managers were available and approachable.

The registered manager and deputy manager provided leadership to the staff and had oversight of all areas of the service. Staff were motivated and felt supported by the registered manager and senior staff and the personal development of staff was encouraged.

The staff understood the vision and values of the service, such as person centred care, treating people with respect and maintaining their privacy and dignity.

Staff had completed safeguarding training and they knew what action to take if they suspected abuse, and who to report to, such as the local authority safeguarding team. Staff knew about the whistle blowing policy, and were confident they could raise any concerns with the registered manager, who would take appropriate action.

There were sufficient numbers of staff on duty. Staff were checked before they started to work at the service and regularly received training to ensure they had the skills and competencies to provide safe care. New staff received induction training and shadowed established staff before they started to work on their own. Staff met with a senior staff member to discuss their role and practice, and to discuss their training and development needs.

People were supported to make their own decisions and choices, and these were respected by staff. Where people lacked the capacity to make complex decisions about their care, management and staff were guided by the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) as a basis to make decisions that were in people’s best interest.

Medicines were stored and administered safely. People had the support they needed to attend health appointments and to remain as well as possible. Staff responded to any changes in people’s health needs; people told us that staff always called their doctor if they felt unwell. People made positive comments about the food, there were daily choices and people took part in choosing the menu. If people were not eating enough their food was monitored. If required, a referral was made to a dietician or their doctor, and supplements were provided as necessary so that people maintained a healthy weight.

Potential risks to people were identified and staff took action to reduce risks to people. The care and support needs of each person were different and each person’s care plan was personal to them. Some care plans needed updating and the deputy manager started to address this during the inspection. There were plans to respond to emergencies. Emergency evacuation procedures were in place and the fire system and equipment were maintained and serviced regularly

The complaints procedure was available but could have been more accessible and meaningful to people living with dementia. People felt comfortable in complaining and when they did complain their complaints were looked into and action was taken to resolve them. People had opportunities to provide feedback abou

There were 54 people using the service and we met and spoke with some of them.

People we observed were involved in what was happening in the home. Staff engaged with them every time they walked past and they were encouraged to participate in the activities. People indicated that they were happy at the home.

People told us they were satisfied with their care. They were supported to attend health care checks and community health professionals were involved to provide advice and intervention when needed. However, care plans did not always reflect the individual and personalised care being provided and did not show how risk would be managed. Care plans had not been evaluated and updated when a care need or a risk was evident. Records were therefore not fully accurate, completed or up to date. This meant that staff had no guidance to follow about how to support people's needs and reduce potential risks.

Everyone we spoke with said or indicated that they felt safe at the service.

We found that there were enough skilled and experienced staff to meet people’s needs. However the tool the service used to determine staffing levels was not reliable. Staff received training to give them the knowledge and skills to care and support people at the service.

People and their relatives told us they did not have any complaints about the service. They were confident if they did the manager would take action to resolve any issues.

People told us that they were happy with the care and support they received and that their needs were being met and that they liked the service. People told us that the staff were friendly and approachable. One person said "I like living here, it's a nice home with a nice atmosphere and the staff are very good". Another person said "The manager came to see me before I moved here to make sure I would like it and answered all of my questions, which made me feel more confident about moving in. Everyone was very welcoming when I arrived and the food is good".

Several of the people we spoke to told us that the manager was approachable and had an open door policy. In addition, they told us that they have regular residents meetings where they can discuss improvements to the service. One person told us "We have meetings where we can talk about anything we are not happy about but if we don't want to talk in front of everyone, we can talk to the manager who always listens and tries to put things right". A visitor told us "My relative has been here for a few months and I am very happy with their care, the staff always make me feel welcome and I can visit whenever I want too".

This was an unannounced inspection that took place on 9 and 13 October 2014.

Ashcroft Nursing Home provides accommodation for up to 88 people who require nursing or residential care. Care and support is provided to older people, some of whom are living with dementia. The service is set out over two floors. At the time of our visit there were 45 people using the service.

There was a registered manager in post. 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.

Quality assurance procedures were in place to check the quality of the service as well as the safety of the service. Some of these checks either did not identify a shortfall or had not been able to correct an area of concern.

Not all areas of the service were clean and hygienic with some areas needing further cleaning to make sure people were not at risk of acquiring an infection.

Medicines such as tablets were administered safely and people received their medicines at the times they needed them. However, some people were prescribed individual creams which were not safely managed as creams were being shared.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some of the people in the home had been assessed as lacking mental capacity to make complex decisions about their care and welfare. There were clear records to show how decisions were made in people’s best interests.

People said they felt safe. There was enough staff to meet their needs and staffing levels were kept under review. There were safe recruitment procedures that made sure new members of staff were suitable to work at the service. Staff had received appropriate training and supervision so they had the skills to meet people’s needs. Staff understood how to keep people safe. They knew about different types of abuse and what action to take if they had any concerns about people’s safety. People said staff were kind and caring and understood their individual needs. Staff respected people’s privacy and knocked on doors before going into people’s rooms.

Assessments of people’s needs were completed before they moved into the service. Care plans and risk assessments were kept up to date and reviewed regularly and reflected people’s needs. People received the care they needed. It was clear from what we saw and from speaking with staff that staff understood people’s care needs and that they knew people well.

People’s food and drink needs were assessed and staff were familiar with people’s individual dietary needs. People enjoyed their meals and told us they were happy with the food.

Staff responded to changes in people’s health needs and made referrals to healthcare professionals, including GPs, speech and language therapists and dieticians, when needed.

Activities were well organised and gave people ample opportunity to participate in a range of different pastimes. Individual likes, dislikes and preferences were considered when activities were planned. Reminiscence was important to people and staff understood this. Staff sat with people and talked about the different things they liked.

People attended meetings to air their views and their comments were listened to and acted upon. People told us that they felt listened to and relatives said they felt confident about talking to staff or the manager. People were asked their opinions about different events in the home and if there was something they did not like, different arrangements were made.

Staff knew what their roles and responsibilities were and what was expected of them. There were clear lines of management. Staff said the manager was approachable and encouraged staff to voice any concerns or to share ideas for change. The manager had a clear vision for the service and staff understood the ethos of the service and told us that people who used the service were at the centre of the service. Staff told us that communication throughout the service was good and they were kept informed of any changes to people’s needs.

We have made a recommendation about the management of some audits.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.