Askham House is a care home with nursing. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Askham House is one of five care homes on one site, on the outskirts of the village of Doddington. Each home is registered as a separate location. There are some shared facilities such as a café and function room where some activities take place. Askham House accommodates up to 29 people in one adapted building, which reopened in January 2018 following a complete refurbishment. The home provides care to older people and people living with dementia.

At our previous inspection in January 2016 Askham House was rated Requires Improvement. During that inspection one breach of a legal requirement was found. This was because people who used the service were not protected against the risk of their care being delivered without valid and lawful consent. Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key question, effective, to at least Good.

During the inspection visit on 10 April 2018 we found that this area of the service had improved. People were being cared for in a way that did not deprive them of their rights to liberty and to make their own decisions.

This inspection was carried out earlier than planned as we had received some concerns. These were about the environment and about lack of staffing. We wrote to the provider about both matters and they assured us that any shortfalls had been met. However, during this inspection we found that there were shortfalls in both these areas.

The registered manager had left the home in March 2018. A new manager had been appointed and had been in post for one week when we visited. This new manager had previously been registered to manage this home. 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 new manager told us she would be applying to the CQC to be registered as manager of Askham House.

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

Staff had received training in safeguarding people. Not all incidents had been recognised as a safeguarding so had not been reported to the safeguarding team. Assessments of a number of potential risks to people had been carried out but some risks had not been assessed or managed successfully.

Staff had not all received up to date fire safety training, in particular in relation to the new building. Staff had not responded appropriately to a recent fire drill.

Medicines were managed well and people had received their medicines safely and as they had been prescribed. Staff followed infection prevention and control procedures so that the home was clean and hygienic. There was an effective recruitment process in place to reduce the risk of unsuitable staff being employed.

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 well. People were provided with healthy, nutritious and appetizing meals and special diets were catered for, although people did not always get the support they needed at mealtimes. A range of external health and social c

Askham House is registered to provide accommodation and care, with nursing, for up to 27 people. 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 Village Community is situated on the outskirts of the village of Doddington in Cambridgeshire.

Askham House is an extended period property and offers accommodation on two floors. There was one large lounge/dining room and several other areas where people could spend their day or eat their meals. There were 23 bedrooms, four of which were double bedrooms; bathrooms; and toilets. The main reception area of Askham Village Community had shared facilities, including a café, which was open to the general public.

This comprehensive inspection took place on 26 January 2016 and was unannounced. There were 22 people in residence.

There was no registered manager in place at the time of the inspection. The previous registered manager had left in October 2015. 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. The person managing the service at the time of the inspection (referred to throughout this report as ‘the manager’) had taken up their post in November 2015. They were in the process of applying to CQC to be registered.

People and their relatives were happy with the care being provided at Askham House and told us they felt safe. They were generally satisfied with the management of the home and with the staff. People who lived at the home and the staff got on well together and were comfortable in each other’s company.

Staff had undertaken training and were able to recognise and report any incidents of harm or abuse. Potential risks to people were assessed, recorded and managed so that people were kept as safe as possible. There were sufficient numbers of staff on duty to meet people’s needs in an unhurried way. Staff recruitment had been undertaken in a way that ensured that only staff suitable to work in a care environment had been employed.

Overall, the management of people’s medicines was satisfactory, which meant that people could be confident they were receiving their medicines safely and as they had been prescribed.

Staff had undergone an induction and further training to make sure they were equipped to do their job. People received an adequate amount of suitable food and drink and people who required special diets were provided with these. A range of healthcare professionals were involved in monitoring people’s health so that people were supported to maintain good health and well-being.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. Some applications for authorisation to restrict people’s liberty had been submitted to the relevant authority. Not all staff were aware of the principles and application of the MCA.

Many of the staff showed they genuinely cared for the people they supported and were excellent in their approach. Generally people were enabled to make choices about their daily lives but there were times when staff acted from habit instead of asking people what they wanted. Most of the time staff supported people to maintain their dignity. Some language used and written by staff was not respectful and people’s confidential personal information was not always kept securely.

Care plans were in place to give staff guidance on the way people wanted to be cared for. Work was being carried out to ensure that care plans were personalized and contained sufficient detail to ensure that staff had the information they needed to provide consistent care.

A wide range

We did not speak with people who were using the service during this inspection.

We found that care had been planned and provided so that people's individual needs were met.

We spoke with staff who informed us about the care arrangements that were in place for two people whose care plans we looked at. A nurse explained how they ensured that people's skin that was at risk of pressure sores was being regularly monitored and that this was being recorded and that the treatment that was being provided was charted. They also informed us how external health professionals had been referred to when this was necessary to ensure that appropriate health care was being provided.

During our visit on 12 April 2013 we spoke with ten people. Every person made positive comments about the way they were being cared for. One visiting relative told us that their family member had recently moved there from another care home and that they were pleased to have found Askham House because the care was, "much better".

Care plans contained adequate information about people's needs, although some elements of the plans could have provided more detail about specific care arrangements that were in place.

Safeguarding arrangements ensured that people were being protected and the home’s willingness to report concerns has further ensured that people are safe.

Infection control planning arrangements were in place, although the latest published guidance had not been referred to.

Medication records and the administration of medicines were in order.

Some parts of the home appeared worn and some areas had reduced natural light and dim electrical lighting.

We found there were arrangements in place for adequate numbers of suitably trained staff employed. This had ensured people received suitable care and support.

We spoke with14 people during our visit on 11 July 2012 and were given positive comments by everybody we spoke with about their care and treatment. People eagerly expressed their satisfaction both for the personal care and of the conduct of staff. One person said, "They get top marks". Another person said, "It’s lovely here. I think we are all looked after very well".

People told us they liked the food and meals provided and said their accommodation was satisfactory and that they were kept warm and comfortable.

We spoke with 14 people during our visit on 11 July 2012 and were given positive comments by everybody we spoke with about their care and treatment. People eagerly expressed their satisfaction both for the personal care and of the conduct of staff. One person said, "They get top marks". Another person said, "It’s lovely here. I think we are all looked after very well".

People told us they liked the food and meals provided and said their accommodation was satisfactory and that they were kept warm and comfortable.

A review of compliance was carried out on 18 October 2011. We identified moderate concerns. People told us that staff were helpful and respectful and they received the support they needed. We spoke with people when we visited on the 5 January 2012 and asked people about their health and welfare, particularly as several people were unwell. People told us that they had seen a GP. We observed one person who had been reported to have been quite unsettled during our last visit. They were restful and staff reported positive things about their general well being.

We spoke with a number of people and noted that interactions with staff throughout the day were helpful and respectful. People made positive comments about the care and support they received from staff. One person told us, “You won’t find a better place than here.” They said that staff understood their needs and dealt with them quickly. Another person said that staff demonstrated that they were concerned about meeting their needs. We spoke with another person with communication difficulties and his relative said that staff were able to understand their needs and they had a good relationship with staff.

One person told us about the independence they had gained since being at the home, which had been encouraged by staff, however they did advise us that when they needed assistance they had to wait because there was not enough staff of duty.