Archived: Acton Care Centre

The last inspection took place 16 and 17 November 2015, when we found breaches in Regulations relating to medicines management, consent to care and treatment and good governance. The inspection of 15 August 2016 was carried out to look at whether the provider had met these breaches. The provider had supplied us with an action plan on 13 January 2016 telling us that they would make the necessary improvements by 31 January 2016. At this inspection we found that improvements had been made. However, we found that there were still some areas around medicines management, risk management and record keeping which required further improvements.

Acton Care Centre is a care home with nursing registered for up to 125 older people and younger adults (people under 65 years old). The home is divided into five units. Two of the units, Donald Sword and Garden unit, were dedicated for people living with the experience of dementia. The other three units, Oak, Park and Westerly, provided care for people with complex healthcare needs, which included some people receiving care at the end of their lives.

The service is managed by Vintage Care Limited which is part of the Catalyst Housing Group – a housing association based in London and the South East.

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 and associated Regulations about how the service is run.

People felt the service met their needs and the staff were kind and caring. The permanent staff had a good knowledge of people's needs and how to care for them. However, the service employed a large amount of temporary staff and there was a risk that people's needs would not always be met because care records were not always accurate or individualised.

There had been improvements in the way medicines and risks were managed. However, the records around these areas were not always clear or detailed enough and people were at risk of receiving inappropriate and unsafe care because of this.

The provider had improved the way in which people's consent to care and treatment was obtained. They had carried out comprehensive mental capacity assessments and included this information in the way they planned care for each person.

The previous inspection visit in April 2014 had identified that the provider needed to improve the way people's privacy, dignity and independence were maintained and promoted, care planning and the arrangements to safeguard people against the risk of abuse. During this inspection we found that the provider had made the necessary improvements.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

People we spoke with said they felt safe and they were able to raise any concerns with the staff.

Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Risks were assessed and reviewed regularly to ensure people's individual needs were being met safely.

Is the service effective?

Care records reflected people's individual needs, choices and preferences and staff had a good understanding of people's needs and how to support them.

Staff liaised with healthcare professionals to ensure people living at the home had their healthcare needs met and were receiving safe coordinated care and treatment.

Is the service caring?

People told us they were happy, well cared for and treated with respect. We observed staff interacting with people in a kind, caring and respectful manner.

People's privacy and dignity was maintained

People and their relatives were involved in making decisions about their care and staff took account of their individual needs and preferences.

Comments we received included 'Nothing is too much trouble and we are never left long without someone attending to us' and 'I like the food, I'm very happy living here.'

Is the service responsive?

The service was responsive to people's care needs. Staff sought advice from other healthcare professionals in a timely manner.

Action had been taken to address the areas where improvements had been identified at the last inspection visit in April 2014.

Is the service well-led?

The service was well-led. The management team had an open door policy, and were available to speak with people using the service, their relatives or staff.

Staff told us they were confident to raise any concerns and could speak with the general manager and clinical director.

Care records were reviewed and regular audits were undertaken by the clinical director and general manager to make sure that people were protected against the risks of inappropriate or unsafe care and treatment.

People said they were being well cared for in the service. Comments from people using the service included, 'none of us go to bed early', about staff - 'very good, they are', 'yes, they are lovely, very nice people altogether', 'staff have been very kind to me'

All relatives we spoke with gave us positive feedback about the service provided. Comments included, 'reassured when I am not here my (relative) is being looked after in every way possible', 'there is a spirit of kindness and consideration', 'they're very nice and it's lovely and clean. They are well looked after, 'I can talk to any of the staff and they make time'.

People were not always involved in decisions regarding their care and treatment. We found that care was not always assessed, planned and delivered to meet people's individual needs and ensure their safety and welfare. Care plans did not contain sufficient information for staff to follow to ensure people's safety and welfare.

People's individual rights had not been protected because the service did not have in place suitable arrangements to safeguard people. Staff did not recognise that some incidents were safeguarding concerns and had not followed the safeguarding policies and procedures within the service.

Staff received training and support to make sure they were competent and skilled to care for people.

People were supported to receive adequate food and hydration. We spoke with people who use the service and their relatives about meal times and nutrition. Although some people commented that the food was 'variable' and was 'warmed up', people said they always had enough to eat and drink.

The provider carried out the relevant recruitment checks prior to employing staff. Staff received the training they required for their roles and regular supervision with their line manager to develop their skills. A procedure was in place for the management of medicines and staff responsible for medication administration had received training in the safe handling of medicines.

People and their visitors commented that overall staff met their care and treatment needs. Some visitors commented that agency staff did not deliver care to the same standard as permanent staff. People had their care and treatment needs assessed and these were documented in their care plan which was regularly reviewed.

People and their visits commented that staff were very busy and agency staff did not always understand people's needs. We saw that there were systems in place for ensuring enough staff were on duty and monitoring the staff duty rota.

The provider had a system in place for obtaining people's views and auditing standards in the home.

People who use the service and their visitors knew how to make a complaint. Complaints had been recorded and investigated.