Askham House

We found the following examples of good practice.

Procedures were in place to prevent the transmission of infection to and from friends and relatives. The registered manager had an outdoor ‘visiting area’ so that people could meet with their relatives. At the time of our inspection however, the service was only accepting essential visitors.

Staff wore full personal protective equipment (PPE), and had received training on how to wear and remove it safely.

Whole home testing was carried out for both people and staff.

Cleaning of the home, including frequently touched surfaces, had increased to reduce the risk of transmission of infection.

The registered manager was open and transparent and welcomed any suggestions of good practice. The day after we inspected, they confirmed they had introduced additional precautions in the home. For example, people who were COVID-19 positive had their cutlery and crockery placed into red bags after use. This ensured that staff in the kitchen could clearly identify and take extra precautions to reduce the spread of infection.

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. The home provides care to older people and people living with dementia.

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

People who lived at Askham House received care from staff who were passionate about delivering a service based on individual needs. Staff knew each person well. People’s views were respected, and they were involved in everything that happened in the service. People were happy living there and relatives trusted the staff team to look after their family members.

Staff delivered care and support that was personalised and responsive to people’s likes, dislikes and preferences. Staff were kind, caring and motivated. People, their relatives and external professionals were complimentary about the care provided. Staff respected people’s privacy, dignity and independence. Staff encouraged people to lead their life in the way they wanted to.

Staff understood the risks to people and the measures in place to keep them safe. Systems were in place to manage people's medicines safely and to reduce the risks associated with the spread of infection.

Enough staff were employed to meet people's needs. Staff received training that gave them the necessary skills and knowledge to carry out their roles and meet people’s needs.

People were supported to maintain good health. Staff made referrals to health professionals when required. People were provided with the care, support and equipment they needed to stay independent. Staff were kind and caring and had developed good relationships with people using the service.

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 had food and drinks based on their individual choice and preferences. People enjoyed a wide range of activities in the community and within the service, that reflected their specific needs and interests.

Care plans were in place which guided staff to provide support that met people's needs which were in line with their preferences.

Systems were in place to monitor the service, which ensured that people's risks were mitigated, and lessons were learnt when things went wrong. There was an open culture within the service, where people and staff could approach the registered manager who acted on concerns raised to make improvements to people's care.

Rating at last inspection

The last rating for this service was requires improvement (published 25 June 2018)

Why we inspected

This was a planned inspection based on the previous rating.

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

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 care professionals worked with the staff team to support people to maintain their health.

The new building was not being used in a way that met people’s needs or promoted their independence. People were generally supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

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.

Staff made efforts to communicate with people in a way they could understand. Visitors were made to feel welcome.

Care plans gave staff guidance on how to meet people’s needs in a personalised way. However, staff were not always made aware of changes to care so people were at risk of receiving unsafe care. Not enough activities, based on people’s individual interests and preferences were organised to ensure that people led fulfilling and meaningful lives.

A complaints procedure was in place and advertised so that people would know who to talk to if they had a complaint. End of life care was delivered well, with staff working closely with the GP and community nurses.

Staff were given opportunities to express their views about the service and were aware of their responsibility to deliver a high quality service in line with the provider’s ethos and values. A staff recognition scheme was in place, celebrating a ‘star of the month’ nominated by anyone involved with the home. Staff long-service was rewarded.

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 always robust enough to ensure that a quality service was being provided. These processes had not fully recognised the issues we found during our visit.

The new 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 to ensure that joined-up care was provided to people. There were some links with the local community including a café that was open to the general public.

Providers will be asked to share this section with the people who use their service and the staff that work there.

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 of activities were offered to people and entertainments and outings were arranged. People knew how to complain and concerns and complaints were responded to in a timely way.

People and their relatives described the management team as approachable and accessible. People, their relatives and the staff were given a number of ways in which they could put forward their views about the service. Checks on the quality of various aspects of the service were carried out.

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.

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.

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.