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Acorn Luxury Care Limited Good Also known as Genesis Care Home Limited

Reports


Inspection carried out on 5 July 2019

During a routine inspection

About the service

The service is registered to accommodate up to 13 people and provides care and support for older people. The service is split over two floors which were all accessible by stairs or a lift. There were 12 people using the service at time of inspection.

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

People rights were not always protected in regards to giving consent for their care or for photographs. The registered manager sought to immediately rectify this during our inspection.

People told us they felt safe living at Acorn Luxury Care Limited. The staff demonstrated a good understanding of how to meet people’s individual needs. People’s outcomes were known, and staff worked with people to help achieve these. People were supported and encouraged to maintain their independence and live their lives as fully as possible.

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 were supported to maintain contact with those important to them including family and friends. Staff understood the importance of these contacts for people’s health and well-being. Staff knew people well and what made them individuals.

The management of the service were respected. Staff had a good understanding of their roles and responsibilities and were supported to reflect on their practice and pursue learning opportunities. The staff team worked and got on well together demonstrating team work.

Quality and safety checks helped ensure people were safe and protected from harm. This meant the service could continually improve. Audits helped identify areas for improvement and this learning was shared with staff.

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

Rating at last inspection

The last rating for this service was good (published 13 March 2017).

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.

Inspection carried out on 14 February 2017

During a routine inspection

Care service description.

Acorn Luxury Care Limited provides accommodation, care and support for up to 13 older people, many of whom were living with dementia. At the time of this inspection 10 people were living at the home. The home had 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.

Rating at last inspection.

At the last inspection, the service was rated Good.

Staff were trained in safeguarding and understood how to respond to safeguarding concerns.

Risks in delivering care to people and in making sure the environment was safe had been assessed with plans put in place to mitigate any identified risks.

The registered provider had followed recruitment procedures and carried out all required checks to make sure suitable staff were employed at the service.

There were sufficient numbers of staff on duty to support people with their assessed needs.

Medicines were managed safely and systems were in place to make sure people were administered medicines as prescribed by their GP.

The registered provider had a robust training plan in place to ensure staff were appropriately trained to meet the needs of the people using the service.

Staff were supervised in their roles and received an annual appraisal to aide their personal development.

People’s nutritional needs were met

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported by kind and attentive staff who were respectful of people’s privacy and dignity. Staff knew people’s abilities and preferences, and were knowledgeable about how to communicate with people.

Care plans were individualised and person centred focussing on people’s goals, skills and abilities. Plans were reviewed and evaluated regularly to ensure planned care was current and up to date.

People had access to health care when necessary and were supported with health needs.

There were complaint systems in place and people were aware of how to complain.

Should people need to transfer to another service, systems were in place to make sure that important information would be passed on so that people could experience continuity of care.

The home was well-led. There was a very positive, open culture in the home with staff proud of how they supported people.

There were systems in place to audit and monitor the quality of service provided to people.

Inspection carried out on 13 and 15 January 2015

During a routine inspection

This was an unannounced comprehensive inspection carried out on 13 and 15 January 2015. Our previous inspection of the home on 28 and 29 July 2014 found a breach of regulations relating to the care and welfare of people who use services, assessing and monitoring the quality of service provision, management of medicines, safety and suitability of premises, consent to care and treatment, the maintenance of records and requirements relating to workers.

We required that the provider send us an action plan by 11 September 2014 detailing the improvements they would make to keep people safe. We received the action plan and reviewed the actions the provider had undertaken as part of this comprehensive inspection. We found that improvements had been made to meet the relevant requirements.

Acorn Luxury Care Limited provides accommodation, care and support for up to 13 older people, many of whom have a diagnosis of dementia. At the time of the inspection 11 people were living at the home. The home had 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.’

The provider had a system in place to ensure staff understood their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). The DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that a care home only deprives someone of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The majority of the people living at the service had been assessed as lacking mental capacity due to their condition of dementia. There were records that showed the provider had a system in place to ensure they recognised where an individual may require a DoLS application to ensure their rights were upheld. DoLS applications were correctly completed and submitted to the local authority.

People told us they felt safe living in the home. The provider had suitable processes in place to safeguard people from different forms of abuse. Staff had completed training in safeguarding people and were knowledgeable about the provider’s whistleblowing policy. The provider’s safeguarding policy was accurate and up to date with the relevant local authority contact details clearly highlighted for staff to access. Staff told us they knew the correct process for raising concerns if they should observe any form of abuse.

The provider had a range of systems in place to protect people from risks to their safety. These included premises and maintenance checks, regular servicing and checks for equipment such as hoists, stair lifts and all electrical equipment and risk assessments for each person living in the home.

Medicines were managed safely and stored securely. People received their medicines as prescribed by their GP.

There were enough appropriately trained staff available on each shift to ensure people were cared for safely. Staff spent time talking and interacting with all the people in the home and told us they had enough time to do their job effectively. We observed staff delivered support and assistance in a friendly manner and spent quality time with people, ensuring they were comfortable, content and had activities to do and drinks and snacks available.

The provider had a system in place to ensure staff received their required training courses. Staff were knowledgeable about their role and spoke positively regarding the induction and training they received from the provider. Staff told us they were well supported by the management team who they found very approachable and stated were always ready to listen or help if required. They spoke of the close, family atmosphere in the home and how the staff worked so well as a team together. They told us communication within the home was very good and they felt fully involved and respected working in the home

The provider had implemented a system to ensure accidents and incidents were recorded and analysed. This meant any trends and patterns could be identified and preventative measures put in place where required. Incidents and accidents were regularly discussed at staff meetings and staff were encouraged to share their views on how to address any concerns.

Since purchasing the home during 2012 the provider had undertaken a significant amount of refurbishment in all areas of the home. Improvements included, addition of a wet room bathroom on the first floor, new stair lift, new beds and new pressure relieving mattresses for all beds. The front garden had been cleared and tarmacked to allow for safe access and parking.

Inspection carried out on 28, 29 July 2014

During a routine inspection

This was an unannounced inspection, which was undertaken over the course of two days. A second inspector was part of the inspection team during the second day of the inspection. Time was spent speaking with people who live in the home, visitors, staff, and the manager. We also spent time looking at various records and touring the building. There were 12 people living in the home during our inspection.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

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 caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

There were effective systems in place to reduce the risk and spread of infection. We spoke with two people and two visitors during our inspection who told us they thought the home was kept clean. One person said, "My room is cleaned for me". A visitor told us that their relatives' room was kept clean and tidy.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. One person had been prescribed a food supplement. However, when we looked at their medicine administration records (MAR), we found that for a period of three days the medicine had not been given. We discussed this with the registered manager, who told us that the prescription had been altered and there was a delay in the person receiving their prescription.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. We found no record that showed if a legionella test had been completed. There was no risk assessment in place. Legionella are water-borne bacteria that can cause serious illness. Health and safety regulations require persons responsible for premises to identify, assess, manage and prevent and control risks, and to keep the correct records. We discussed this with the registered manager, who told us that they would arrange for the test to take place.

Appropriate checks were not always undertaken before staff began work.

Is the service responsive?

Care was not always planned to meet people's needs. Where a need was identified, a plan was not always in place to meet this need. One person was identified as being at high risk of skin breakdown. We saw that their care plan did not consider sufficient actions that staff should take to protect this person from skin breakdown. For example, there was no consideration of pressure relieving equipment on the person's bed, nor whether staff were required to assist the person to change position regularly to relieve the pressure on their skin.

Is the service caring?

During the both days of our inspection, we spent time talking with and observing people in various parts of the home. There was a relaxed atmosphere throughout the home. We saw that a number of people received visits from family members and friends. Some people chose to spend their time outside in the garden enjoying the sunshine, other people spent time in the lounge or their bedrooms. During both days of our inspection we saw that people living in the home were participating in various activities, such as ball games, watching the TV, and board games.

We spoke with two people who were living in the home. They told us they felt well cared for and that the staff were always there for them if they needed support. Throughout the inspection we observed that staff were kind and caring and in some instances were able to anticipate people's needs. People's privacy, dignity and preferences were respected.

Is the service effective?

Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements. We found that where people had cognitive impairments associated with dementia, mental capacity assessments had not always been completed. We looked at the care plans for five people with dementia and found that mental capacity assessments and best interest decisions were not always recorded. For one of these people, we saw that their relative had signed to consent to the care and treatment provided. There were no records to show whether the person had appropriate legal authority to consent to the care and treatment for this person.

People's personal records including medical records were not always accurate and fit for purpose. We looked at the care plans and associated records for five people during this inspection. All of the files contained inaccuracies, inconsistencies and omissions.

Is the service well led?

The provider had some systems for reviewing and monitoring the quality of service provided to people, but these had not been implemented effectively to ensure that people were not at risk of unsafe or inappropriate care. We found that between 15 November 2013 and 07 June 2014, there had been six occasions where people had left the home without staff support, or staff being aware of their actions. We noted that one person had left the home on three times and on one occasion had been found by police after falling and was subsequently admitted to hospital. There were no records that showed any investigation or learning from each of these incidents to prevent reoccurrence. The provider had not notified CQC of the police incident in accordance with regulation 18 of the Care Quality Commission (Registration) Regulations 2009. Following our inspection we raised a safeguarding alert with the local authority safeguarding team for further investigation under the safeguarding procedures.

Inspection carried out on 10 February 2014

During a routine inspection

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant that some were not able to tell us their experiences.

One member of staff told us "we offer choices for example we offer for them to sit somewhere else if they are refusing to eat. If someone continued to decline support we would record it in their care plan and respect their decision".

People chose how to occupy themselves in the service. We observed that people were spending time with staff doing jigsaw puzzles and playing dominoes. Observation during the inspection showed staff supporting people to make their own choices about what they had for lunch.

Care plans were person centred and documented people's wishes in relation to how their care was provided. Staff members understood how people expressed their needs and wishes about how they wanted to be supported with their care. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

Inspection carried out on 15 October 2012

During a routine inspection

In July 2012 Genesis Care Home was purchased by new the directors of Genesis Care Home Limited and the previous directors no longer have involvement in the running of the home. A new nominated individual was appointed and they assisted us throughout this inspection.

We spoke with five people living at Genesis Care Home; however, they were not able to tell us what it was like to live at the home as they suffered from dementia. We therefore used the short observational framework for inspection (SOFI).

We found there were positive interactions between staff and people living at the home and there were good relations between them. Each person had a care plan that had been developed from assessments that reflected how they should be supported and looked after.

We spoke with three members of staff and one visiting relative. The staff we spoke with told us that they felt well trained, supported and valued in the role.

The relative spoke highly of the home. They told us that their relative was well cared for, always looking clean and well presented. They also told us that health and welfare needs were met by a kind and caring staff team.