Acorn Lodge - Croydon

We found the following examples of good practice:

The provider had a robust system in place to ensure that visitors and external staff entering the premises had their vaccination status and lateral flow tests (LFT) checked. The provider had additional spare LFTs available for those who were unable to obtain and complete a test prior to visiting (which would be required to be negative prior to entering the home). In addition, face masks and alcohol gel were in plentiful supply by the entrance and temperatures of anyone visiting were checked and recorded by a staff member. The provider had a contact-free thermometer mounted to the wall for such checks to be conducted.

The provider had implemented appropriate social distancing in all communal areas. For example, the sensory room, dining areas and living rooms had appropriately spaced chairs to ensure a distance of 1-2 metres between residents could be maintained. In addition, the provider utilised a separate side entrance that took visitors directly to a large and airy communal room in which visiting could take place, negating the need for walking through the home unnecessarily.

The provider had an admissions process in place. The provider told us that new admissions were nursed in their room until a 14 day period had passed, and three negative LFTs had been obtained over consecutive days.

Our observations during the inspection confirmed staff were adhering to personal protective equipment (PPE) and social distancing guidance.

The provider had ensured staff who were more vulnerable to COVID-19 had been assessed and plans were in place to minimise the risk to their health and wellbeing.

Acorn Lodge – Croydon is a residential care home which can support up to 39 people in one adapted building. At the time of this inspection, the service was providing personal care to 18 people. This service is located next door to Acorn House – Croydon, a residential care home which is managed by the same provider. As a result, staff often worked across both services.

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

The quality and safety of the service had improved for people since our last inspection. People’s records were now accurate, current and contained detailed information about them and their care and support needs to help staff deliver personalised care. Staff recorded better information about people to help senior staff check for any potential issues with their health and wellbeing.

Improvements had been made to recruitment practices to reduce the risk of people being supported by unsuitable staff. There were enough staff to support people. People said they were safe. Staff knew how to safeguard people from abuse and how to manage identified risks to people to reduce the risk of injury and harm to them. Regular health and safety checks of the premises and equipment were undertaken to make sure they were safe.

Staff followed current practice when providing personal care and when preparing and handling food which reduced hygiene risks. The premises were clean and tidy and free from odours. There were a range of comfortable spaces for people to spend time in. The provider was looking at further ways to personalise people’s bedrooms and make the premises more dementia friendly.

Staff received training to help them meet the range of people’s needs. The provider had identified that staff were not receiving regular supervision. All staff were scheduled to have a supervision meeting following this inspection. However, staff had opportunities to discuss their working practices at monthly team meetings. Senior staff used these meetings to make sure staff were clear about their responsibilities for providing high quality care and support to people.

Staff were more caring and attentive to people. People told us their needs were met by staff. Staff supported people to maintain their dignity, privacy and independence. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Activities at the service had improved and people were more stimulated and engaged. The provider was continuing to look at further ways to improve this aspect of the service for people.

Staff supported people stay healthy and well. They helped people to eat and drink enough to meet their needs and to take their prescribed medicines. Extra help was sought for people if they needed this, for example, when they became unwell. Recommendations from healthcare professionals were acted on so that people received the relevant care and support they needed in relation to their healthcare needs.

People were comfortable raising concerns and making complaints when needed. The provider had improved the way complaints were handled to check these were dealt with in an appropriate way. Incidents were fully investigated and the provider kept people involved and informed of the outcome. Learning from investigations was acted on and shared with staff to help them improve the quality and safety of the support they provided. However, some decisions made by the provider in response to events and incidents did not always sufficiently protect the safety and wellbeing of people at the service. The provider was taking action to ensure future decisions would be focussed on keeping people safe from risks at all times.

The provider was now using their governance system effectively to monitor the quality and safety of the service. There were regular audits and checks of key aspects of the service and prompt action was taken to address any issues identified through these checks.

People, relatives and staff were encouraged to give feedback about how the service could further improve. The provider worked with other agencies to make improvements. They acted on recommendations made by others to improve the quality and safety of the service for people.

The service did not have a registered manager in post. The current manager had been in post since December 2018 and intended to apply to CQC to become the registered manager for the service. After this inspection the manager submitted their application which is currently being processed. Notwithstanding this issue, the manager had taken responsibility for ensuring all the necessary actions were taken to meet the breaches of legal requirements found at the last inspection.

Although the provider had acted to make improvements, it was too early to judge whether these could be maintained continuously over time. Many of the positive changes and improvements we found had been made in the months prior to our inspection which meant there was not enough evidence of consistent good practice over time.

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 14 February 2019) 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.

At our previous inspection in April 2018 we found the provider was in breach of legal requirements relating to dignity and respect, need for consent, safe care and treatment, staffing and good governance. We rated the service 'requires improvement' overall and in each of the five key questions. Following the inspection, we asked the provider to complete an action plan to tell us what they would do to address the breaches of legal requirements we found.

At this inspection we found the provider had addressed the breaches of legal requirements relating to dignity and respect, need for consent, safe care and treatment and staffing. However, they had not taken sufficient action to address the breach of legal requirements relating to good governance. We also found an additional breach of legal requirements. The service remains rated 'requires improvement' overall and in each of the five key questions.

Appropriate recruitment checks were not made on staff to ensure they were suitable to support people. There were however enough staff to support people safely. Staff received relevant training to help them in their roles and they were encouraged to improve their working practices through supervision. But, there was no system in place to monitor that supervision took place at regular and appropriate intervals.

Some improvement had been made to the quality of information for staff on how people’s care needs should be met. However, the quality of information contained in people’s care records was inconsistent and variable by individual. Staff were still not maintaining accurate and complete daily records of the support provided to people.

Staff had access to improved information about how to manage risks to people’s safety. Staff understood the risks posed to people and how they should support them to stay safe. Staff were trained to identify abuse and understood when to report concerns to the appropriate person. However, they were not always consistent when recording and reporting accidents and incidents involving people.

Arrangements to support people with their health needs were not fully effective. However, staff liaised with visiting healthcare professionals and when people became unwell they sought appropriate support from them. People received their prescribed medicines as required. These were stored safely and securely. However, guidance for staff on when to administer ‘as required’ medicines was not easily available to staff. Recording forms with body maps were not used by staff when they applied topical creams or lotions.

People had more choice over daily decisions. Staff respected people’s privacy when supporting them with their personal care needs. But staff were sometimes not observant to people’s appearances to ensure this was appropriate. Communication between people and staff was still inconsistent.

People were supported to eat and drink enough to meet their needs. Menus had been revamped following consultation with people and their relatives to include more choice and options for meals that people preferred. But people did not always have a dignified dining experience.

Activities provision at the service had improved. However, some staff were still not providing the level of engagement and stimulation for people that was expected. Staff supported people with their social, cultural and religious needs and to be as independent as they could be. There were no restrictions placed on people’s friends and relatives about when they could visit the service.

The provider had acted to make the premises safer for people. There was regular maintenance and servicing of the premises and of equipment used in the home, to check these remained in good order and safe to use. The environment had been improved to make this more suitable for people living with dementia. There was better information for people around the environment. However, people’s bedrooms were sparsely furnished and lacked personalisation.

The environment were clean and hygienic. Staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care and when preparing and serving food.

Staff were now aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and supported people in the least restrictive way possible. The policies and systems in the service supported this practice.

The provider continued to maintain arrangements to support people at the end of their lives. Relatives, where this was appropriate, had been included in discussions to ensure that end of life decisions were made with their involvement.

The provider maintained arrangements for dealing with people’s complaints. However, complaints were not responded to in writing, so people might not have been informed of their rights to take their complaint further.

The provider’s governance system was still not fully effective. No substantive management audits or checks of the service had been undertaken since September 2018 and the provider had not identified the issues we found during this inspection with the quality and safety of the service. The provider had not sufficiently monitored progress against their own action plan to address the breaches in legal requirements we found at the last inspection.

Relatives felt the provider had not always been open and transparent with them about management changes at the service. There was no registered manager in post. A new home manager had been appointed prior to our inspection who had had an immediate positive impact on people and relatives.

It was evident that the provider had made some improvements to the service since our last inspection. The provider had acted to capture the views of people and their relatives to identify how the service could be improved. The provider was continuing to invest in the service and planned to make further changes to improve standards and service quality.

At the time of this inspection the provider was continuing to meet regularly with the local authority as part of their ongoing contract quality monitoring arrangements. We noted that they responded to the local authority’s requests for information promptly and dealt with concerns in an appropriate way.

At this inspection we found the provider in breach of legal requirements with regard to fit and proper persons employed and good governance. We are taking enforcement action in relation to the breach of legal requirements with regard to good governance and we will report on this when our action is complete. You can see what action we told the provider to take with regard to the other breaches at the back of the full version of the report.

At our last inspection on 16 July 2016 we rated the service ‘good’ overall and for each key question. At this inspection we identified breaches of legal requirements and the rating for the service had deteriorated to ‘requires improvement’ overall and for each key question.

The registered manager remained 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.

Care records did not always provide clear, accurate and complete information about people’s needs. Nevertheless, information was provided about people’s life histories and daily routines. Records were maintained about the daily support provided. The provider did not adhere to the Mental Capacity Act 2005 and had not followed process for legal authorisation to deprive a person of their liberty.

A safe environment was not provided. Environmental risks had not been appropriately assessed and mitigated. Individual risk assessments were in place but there were insufficient and inconsistent plans to manage and mitigate risks.

The provider had not ensured that staff received regular training to ensure their knowledge and skills were up to date to undertake their duties in line with best practice guidance.

A new governance framework had been introduced but this was not fully embedded and needed expanding to ensure it captured all areas of service delivery. There were no formal systems in use to capture the views of people and their relatives about the service or to use this to improve the quality of service provision. The provider did not always use feedback from local authority quality visits to improve service delivery.

There was rigid structure at the service which did not accommodate flexibility within people’s routines. People had a lack of choice over daily decisions. People were not supported to communicate, particularly if they were unable to speak English or were unable to verbally communicate. We recommend the provider adheres to the accessible information standard.

Activities were provided. However, these were repetitive and did not always take account of people’s interests and hobbies. We observed some people were isolated whilst activities were delivered. Activities did not always take account of people’s individual needs and we recommend the provider consults national guidance about activity provision and engaging people living with dementia.

The provider was in the process of completing a redecoration and refurbishment programme of the service. However, at the time of inspection the environment did not meet the needs of people living with dementia and we recommend the provider consults guidance for implementing a dementia friendly environment.

On the whole safe medicines management processes were in place. However, systems for maintaining accurate stock checks were not robust.

Staff followed procedures for safeguarding adults’ and adhered to infection control procedures. Staff adhered to the provider’s incident reporting process. Safe recruitment processes were followed and there were sufficient numbers of staff to support people.

People were supported with their dietary requirements and staff arranged for healthcare professionals to visit and for people to attend appointments in order to have their health needs met.

Information about people’s religion, culture and sexuality was collected as part of the admission process and people were provided with any support required. There were no restrictions to visitors.

A complaints process remained in place and the management team reviewed all complaints on a monthly basis to identify any trends and learning.

The provider was in the process of recruiting to strengthen the management team across both this service and their sister service. We will assess the impact of this change at our next inspection.

The service was currently in ‘provider concerns’ with the local authority and they were working with the local authority to demonstrate improvements with the quality of service delivery. The registered manager was aware of their CQC registration responsibilities and to submit statutory notifications about key events that occurred at the service.

The provider was in breach of legal requirements relating to need for consent, safe care and treatment, treating people with dignity and respect, staff training and good governance. You can see what action we have asked the provider to take at the back of the main report.

Acorn Lodge – Croydon provides residential care for up to 36 older people. The service changed its registration with CQC in 2015 and no longer provides nursing care.

The home still did not have a registered manager in post at the time of this inspection however the acting manager had submitted an application to be registered with CQC. 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.

People felt safe living at Acorn Lodge - Croydon and spoke positively about the care provided to them. They said staff treated them with kindness and respect. Relatives and friends were welcomed and people were supported to maintain relationships with those who matter to them. Visitors spoken with were positive about the service being provided and said they could visit at any time.

Staff had received training around safeguarding vulnerable people and knew what action to take if they had or received a concern. They were confident that any concerns raised would be taken seriously by the acting manager and acted upon.

People were protected against the risks associated with the unsafe use and management of medicines. Improved arrangements were in place for the recording, safekeeping and administration of medicines.

Improvements had also been made to make sure that people’s care and support needs were fully assessed, documented and reviewed at regular intervals.

There was a system in place for dealing with people’s concerns and complaints. People using the service, staff and visitors said that the home had benefited from the leadership provided by the acting manager. This view was shared in the feedback received from health professionals who had involvement with the service.

Improved quality assurance procedures had been introduced including regular audits of medicines, infection control, care plans and falls.

Staff told us they had received lots of training, they attended staff meetings and they received supervision. A visiting National Vocational Qualification assessor told us that twelve staff was progressing in completing Qualifications and Credit Framework courses.

We found there were appropriate arrangements in place to manage medicines.

We observed positive interactions between staff and people using the service during the course of our visit.