• Care Home
  • Care home

Archived: Acacia Lodge - London

Overall: Good read more about inspection ratings

37-39 Torrington Park, London, N12 9TB (020) 8445 1244

Provided and run by:
M D Pringsheim and Mrs J W Bethuel

All Inspections

11 July 2016

During a routine inspection

We carried out an unannounced comprehensive inspection on 11 July 2016. At our previous inspection on 17 March 2016 we carried out a focused inspection to see whether improvements had been made following an enforcement notice we had served against the provider in relation to safe care and treatment in December 2015.

At the inspection in March 2016 we judged that the provider had made improvements and had met the requirements of this enforcement notice. Whilst improvements had been made we were unable to change the rating for safe.

.Acacia Lodge is a privately run residential home for up to 32 older people, some of whom are living with dementia. The home also provides a respite service. There were 23 people living at the home at the time of our inspection.

There is a registered manager at the service. 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.

At this inspection we found that significant improvements had been made to risk assessments overall. There was still one risk assessment missing as it did not address a risk situation identified in the care plan, and one risk assessment without guidance for staff to mitigate the risk. These have since been completed by the service. The registered managed had developed quality assurance systems. We saw these were in place and were broad ranging and audits were carried out on a regular basis. However, they had not picked up the missing risk assessment.

We have made a recommendation that the service reviews its auditing procedure to ensure it is fully effective.

Staff had been carefully recruited and there were enough staff to meet people's needs. Staff felt supported and there was evidence of supervision taking place across the last 12 months. Training had taken place in relevant areas so staff had the skills and knowledge to offer a good service.

Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm. Staff and people using the service told us they felt confident any incidents or allegations would be fully investigated, and this was confirmed by relatives.

People were supported to have a healthy diet and spoke highly of the food provided by the service. The service had recently been awarded five stars (highest rating) for food hygiene. The service’s premises were clean and we could see there were systems in place to maintain good infection control.

There was a record of essential services such as gas and electricity and being checked, and equipment safely maintained. There was also clear documentation relating to complaints and incidents.

17 March 2016

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection on 12 November 2015 under the new Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and found some improvements had been made. However, the provider remained in breach of regulations relating to; Safe care and treatment and Good governance. We took action and issued enforcement notices against the provider in relation to Safe care and treatment. We told the provider they must meet the requirements of these regulations by 31 January 2016.

Acacia Lodge is a privately run residential home for up to 25 older people, some of whom are living with dementia. The home also provides a respite service. There were 18 people living at the home at the time of our inspection.

The home manager appointed in October 2015 and is currently going through the registration process to become registered manager. 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.

We undertook an unannounced focused inspection on 17 March 2016 to check that the service was now meeting legal requirements in relation to the enforcement notice served in December 2015. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Acacia Lodge on our website at www.cqc.org.uk

We did not inspect the other breach of regulation at this inspection and will do so when we return to carry out our next comprehensive inspection.

At our inspection in November 2015 we found inconsistencies to the way risk to individuals were managed. At our inspection in March 2016 we found that the provider had made a number of improvements. Staff had received training in fire safety procedures and the provider had made a number of improvements to the environment, this included the installation of new fire equipment and a fire alarm panel. Staff reported that there had been huge improvements and felt the newly introduced procedures helped them to effective carry out their role in the event of a fire. A recent visit from the London Fire Brigade Authority showed that they compliant with fire safety procedures. Risk assessments were in place and there had been some improvements to the way risks were managed.

People had their individual risks were assessed and reviewed. However, further improvements were required to ensure that all risks were clearly documented. Although in the main staff knew what to do to manage areas of risk, such as people with pressure sores or people at risk of falls, staff knowledge of risk management was limited. Staff told us they felt they would benefit from further training to understand risk management and more involvement in the risk assessment process.

We judged that the provider had made improvements and in the main had met the requirements of this enforcement notice. Whilst improvements had been made we are unable to change the rating for safe. We will review the ratings for the service at our next comprehensive inspection.

12 November 2015

During a routine inspection

We carried out an unannounced inspection on 12 November 2015.

At our last inspection in August 2015 we followed up on two warning notices served on the provider in June 2015 for breaches of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to care records kept and maintained for people who used the service and management of medicines. Records were not always updated following a change in people’s needs, and medicines were not managed safely. This put people at risk of receiving inappropriate or unsafe care and treatment. The provider was required to make the required improvements by 31 July 2015. We found the provider had complied with the warning notice relating to medicine management. However, although there had been some improvements to records, further improvements were required.

At the last comprehensive inspection in May 2015 this provider was placed into Special Measures by CQC. This inspection found that there was not enough improvement to take the provider out of Special Measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

The provider had appointed a new experienced manager who started with the service two weeks prior to our inspection and was in the process of applying to become the registered manager. 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.

During this comprehensive inspection on 12 November 2015 we found that the provider had made some improvements. We found medicines were managed safely. People were treated with dignity and respect by staff who were caring. The environment was safe and the provider had improved the general appearance of the home which had been recently decorated, with further improvements planned. The provider had introduced person centred care plans which documented people’s personal histories and preferences for care. Staff had received recent training in areas such as, the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), medicine management and dementia.

We observed some good interactions between staff and people who used the service. The provider had submitted DoLS applications for people where their liberty had been restricted, we saw evidence in people’s care files that these had been authorised by the local authority. Staff told us they felt things had improved since our inspection in May 2015 and since the new manager was appointed.

People’s nutritional needs were met by the service and we observed that people were given choices at mealtimes. People’s risks were assessed, however duplication of records made it difficult to know what was current and up to date.

We saw improvements to the way records for people at the service were maintained, such as individual diet care plans for people with diabetes, seizure chart in place for people with epilepsy, some care delivered in accordance with people’s care plans. However, we noted some inconsistencies with care records. The new manager told us that further work was required to ensure all records were up to date and relevant. This is an area she told us she will be focusing on over the next month.

We have made recommendations about how the service responds to people who may lack capacity to make decisions.

We found the provider in breaches of Regulations relating to risk assessing and quality assurance systems.

You can see what action we have asked the provider to take to address these concerns at the end of this report.

12 August 2015

During an inspection looking at part of the service

We carried out an unannounced inspection on 12 August 2015 to follow up on warning notices issued to the provider in June 2015 for a continued breach of Regulations relating to care records kept and maintained for people who used the service and management of medicines. Records were not always up to date following a change in people’s needs, and medicines were not managed safely. This put people at risk of receiving inappropriate or unsafe care and treatment. We served two Warning Notices for Regulations 12 (1)(2)(f)(g) and 17(1)(2)(c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was required to become compliant by 31 July 2015.

At our last inspection in May 2015 we found care plans had not been reviewed and there was inconsistent information pertaining to people’s care needs. People’s Malnutrition Universal Screening Tool (MUST) assessments were inaccurate because information about people’s weight had not been recorded, therefore people had their nutritional needs incorrectly documented. We also found medicines were not managed, stored and administered safely. In May 2015 the overall rating for this provider was rated as ‘Inadequate’. This means that it has been placed into ‘Special measures’.

During this inspection we found that the provider had made some improvements. We found appropriate systems in place to safely manage, store and dispose of medicines. People received their medicines as prescribed. We noted that the medicine room was tidy and organised.

We saw improvements to the way records for people at the service were maintained. MUST assessments were correctly calculated and people’s height and weight correctly recorded. However, we noted that further improvements were required to ensure that all care records were accurate and up to date.

While overall improvements had been made we have not revised the rating for the key questions relating to safe and caring as this would require a longer term track record of consistent good practice and other breaches of legal requirements identified in May 2015 inspection would need to be met. We will undertake another unannounced comprehensive inspection to check on all outstanding legal breaches for this service and to ensure that the improvements found at this inspection are sustained.

11 May 2015 and 15 May 2015

During a routine inspection

This inspection was unannounced and took place over two days on 11 May 2015 and 15 May 2015. When we last inspected the service in May 2014 we found breaches in standards relating to infection control and cleanliness and records.

Acacia Lodge provider accommodation with personal care for up to 32 older people, some of whom have dementia and physical disabilities.

The registered manager has been absent since September 2014 and the service is being managed by an interim manager, who told us that they would be applying to be the registered manager in the near future. 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 submitted a notification of this change in September 2014 informing us that the registered manager would be absent for one month, however the registered manager is still currently absent.

Our last inspection in May 2014 highlighted breaches in cleanliness and infection control and accuracy of records. We asked the provider to take action to make improvements. We received an action plan from the provider stating that these actions would be completed by end of January 2015. We saw that although some of these actions had been completed, the actions related to records had not been completed.

At this inspection we found improvements in the way the service managed infection control. However, we found care records were not always accurate and up to date, consent to care and treatment, and medicines were not appropriately managed and unsafe premises.

People were not always treated with respect and their dignity, privacy, choice and independence were not always promoted. At mealtimes people’s dignity was not always maintained and choice was not always promoted.

Training, supervision and support were not effective to ensure staff had the right knowledge and skills to carry out their roles and responsibilities.

People were not provided with regular access to meaningful activities and stimulation, appropriate to their needs, to protect them from social isolation, and to promote their wellbeing.

Deprivation of Liberty safeguards (DoLS) had not been appropriately applied. These safeguards provide legal protection for adults using services who do not have capacity to make their own decisions and require constant supervision by staff. Applications had not been made for appropriate assessment and authorisation by professionals for a best interest decision on any restriction on their freedom and liberty.

The management of the service was inconsistent following a period of change. This had led to the poor guidance for staff and unsafe practices.

People did not always receive the encouragement they needed to eat and drink well. There were enough staff to meet people’s needs but we found that the delegation and organisation of their duties did not always mean people received the support they needed consistently and in a timely way.

We found that there were a number of breaches in 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.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

  • Ensure that providers found to be providing inadequate care significantly improve
  • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

2 May 2014

During a routine inspection

The inspection team who carried out this inspection consisted of an adult social care inspector and a specialist advisor (nursing). During the inspection, the team worked together to answer five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

As part of this inspection we spoke with four people who use the service, two relatives, the registered manager, the administrator, three care staff and healthcare professionals. We also reviewed records relating to the management of the home which included, seven care plans and daily care records.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were put at risk of being affected with a healthcare associated infection because the provider did not have systems in place to monitor infection control practices. Although staff knew how to deliver care, records relating to people using the service were not always accurate or up to date, therefore not fit for purpose.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. Staff we spoke with understood people's needs. A relative told us when their relative arrived at the home they couldn't walk and now is able to. They said of the care, 'excellent, they (staff) paid full attention to dad's needs.'

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People and relatives told us that they were happy with the way staff cared for them. One person said, 'they look after us very nicely here.'

Is the service responsive?

We saw evidence of referrals to healthcare professionals, such as the dietician and podiatry. This helped facilitate communication between different professionals involved in the people's care and to ensure continuity of care. However, healthcare professionals told us that referrals were not always completed in a timely manner.

Is the service well-led?

Staff we spoke with showed that they understood the needs of individual people they cared for. People were cared for by staff who understood their needs.

Although there were systems in place for monitoring the quality of the service, the lack of audits in areas of infection control and records meant that the provider could not be sure that people were protected from the risk of unsafe or inappropriate care.

16 May 2013

During a routine inspection

People's privacy, dignity and independence were respected. We spoke with three care staff. They told us that they ensured dignity and respect were integral to care by, for example, knocking and waiting before entering a person's room. They also told us that at meal times, they waited until a person had said their prayers before assisting them with their meal. We spoke with three people who used the service, who spoke positively about care staff. One person told us, 'staff are very caring.'

We looked at five care plans; four of which had person centred risk assessments covering falls, manual handling and pressure sores. Although all five care plans had recently been reviewed there was no evidence that the reviews had involved the person receiving care or their relatives.

We saw that care was delivered in safe accessible surroundings that promoted people's wellbeing. The home's communal areas and people's bedrooms were clean, warm and well maintained.

We looked at provider staff training records. We saw that the manager was holding regular supervision meetings with staff. We also saw that staff had recently undergone training. Care staff told us that the new manager was supportive, helpful and approachable.

10 December 2012

During a routine inspection

People who use the service were satisfied with the care provided and they indicated that their care needs had been met. They stated they had been treated with respect and dignity. Their views can be summarised by the following comment, 'I am satisfied, food is good. They look after me well. I can choose to stay in my bedroom or come downstairs.'

We noted that people appeared comfortable and well cared for. Staff were supervising and assisting people. Comprehensive assessments had been carried out and care plans had been prepared for people. Care provided had been carefully monitored. The healthcare needs of people had been attended to. The arrangements for the administration of medication was satisfactory and the medication administration charts had been regularly checked by the manager.

People indicated that staff were capable and able to care effectively for them. We saw that staff worked well as a team and were busy assisting people who use the service. There were arrangements to ensure that staff received supervision and support from the manager. There were no records available to indicate that the manager had received any formal supervision. This meant that the manager was unsupported and this could lead to inconsistent care practice.

Some maintenance issues were noted in the kitchen. However, the provider took prompt action to rectify them.

15 March 2012

During an inspection in response to concerns

People who use the service expressed satisfaction with the care provided and they indicated that their care needs had been attended to. They stated that staff had treated them with respect and dignity.

We observed that people who use the service appeared comfortable and well cared for. Staff were seen assisting them with their meals and drinks. Comprehensive assessments had been carried out and plans of care had been prepared for people who use the service. The care provided had been carefully monitored and there was evidence that the healthcare needs of people who use the service had been attended to.

People who use the service confirmed that they had received their medication. The arrangements for the administration of medication was on the whole satisfactory. However, the medication policy had not been updated and there was a gap in one of the medication administration charts.

Arrangements were in place to ensure that people who use the service are protected from abuse. The home had a safeguarding policy and procedure and staff had received the required training. A small number of staff were however, not fully aware of the procedure for reporting incidents of abuse.

People who use the service indicated that staff were responsive and on the whole staff responded promptly when they needed assistance. People who use the service and staff indicated that the home had adequate numbers of staff.

There were arrangements to ensure that staff received regular supervision and support from the acting manager and the providers. However, we noted that there were relationship difficulties between some staff and some expressed dissatisfaction with the attitude of one of the registered providers.

9 October 2011

During an inspection in response to concerns

People who use the service and their representatives expressed satisfaction with the care provided and they indicated that the care needs of people who use the service had been attended to. They stated that staff had treated people who use the service with respect and dignity. Their views can be summarised by the following comments :

"They are wonderful. They take good care of me.'

'They take good care of my relative. The staff are pleasant and helpful.' (relative)

We observed that people who use the service appeared comfortable and well cared for. Staff were seen assisting them with their meals and drinks. Assessments had been carried out and plans of care had been prepared for people who use the service. These had been prepared with the agreement of people who use the service or their representatives. The home had a programme of social and therapeutic activities. Suggestions made by people who use the service had been responded to.

Staff were knowledgeable regarding their roles and responsibilities. The records indicated the necessary recruitment checks had been carried out. People who use the service informed us that staff were attentive and would respond if they needed assistance. We noted that there were sufficient staff to attend to the needs of people who use the service.