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Inspection carried out on 4 September 2019

During a routine inspection

About the service

Acorn House – Croydon is a residential care home which can support up to 31 people in one adapted building. At the time of this inspection, the service was providing personal care to 16 people. This service is located next door to Acorn Lodge – Croydon, a residential care home which is managed by the same provider. As a result, staff often work 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. The provider had made sure people’s needs were assessed prior to them using the service to help plan the care and support they needed. 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. Senior staff reviewed the care and support provided to people to make sure it continued to meet their needs.

Staff recorded better information about people to help senior staff check for any potential issues with their health and wellbeing. 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.

Staff were more caring and attentive to people and 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.

Improvements had been made to recruitment practices to reduce the risk of people being supported by unsuitable staff. There were adequate numbers of 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. Cleanliness and hygiene around the premises had improved since our last inspection and communal areas and people’s rooms were clean and tidy and free from odours. Some parts of the premises had been redecorated and there were a range of comfortable spaces for people to spend time in.

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.

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. Events and 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. T

Inspection carried out on 4 December 2018

During a routine inspection

Acorn House - Croydon is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 31 older people in one adapted building. At the time of our inspection 20 people were using the service, many of whom were living with dementia.

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 need for consent, safe care and treatment and staffing. However, they had not taken sufficient action to address breaches of legal requirements relating to dignity and respect and good governance. We also found additional breaches 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.

People’s needs were not always assessed when they started to use the service, so staff may not know how to support them in a safe and appropriate way. When people’s needs changed, reviews of their care were not done in a timely manner to check for any changes needed to the level of support they required. Information for staff on how people’s care needs should be met had improved. However, this was not consistent which meant some people may not receive personalised care that was responsive to their needs and preferences.

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. Staff were still not maintaining accurate and complete daily records of the support provided to people.

People were still not being supported to maintain their dignity. Some staff did not speak with people as they supported them with aspects of their care. However, others were polite and kinder in their interactions with people. Staff appeared not to notice that people were not always clean and appropriately dressed. However, staff did respect people’s privacy when supporting them with their personal care needs.

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.

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.

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 independ

Inspection carried out on 24 April 2018

During a routine inspection

Acorn House - Croydon is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Acorn House does not provide nursing care. Acorn House accommodates up to 31 older people in one adapted building. At the time of our inspection 21 people were using the service, many of whom were living with dementia.

At our previous inspection on 21 and 23 February 2017 we found the provider was in breach of legal requirements relating to need for consent, premises and staff recruitment. We rated the service ‘requires improvement’ overall and for the key questions ‘safe’, ‘effective’ and ‘well-led’. They were rated good for the key questions ‘caring’ and ‘responsive.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to address the breaches of regulation and improve the key questions ‘safe’, ‘effective’ and ‘well-led’ to at least good.

At this inspection we found whilst the provider had addressed the breaches of legal requirements relating to premises and staff recruitment, they had not taken sufficient action to address the breach of legal requirement relating to need for consent. We also found additional breaches of legal requirements. The service remains rated ‘requires improvement’ overall and are now rated ‘requires improvement’ for each of the key questions.

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.

Staff did not always treat people with dignity and respect. Staff did not always speak to people politely and there was little interaction between staff and people. Some elements of the service were overly structured impacting on the flexibility of people’s preferred routine and choices. Staff did not adhere to the principles of the Mental Capacity Act 2005 and had not applied for legal authorisation to deprive people of their liberty.

A safe environment was not provided and risks to people’s safety were not adequately identified or managed. Accurate and complete records were not maintained about the daily support provided to people. Care records outlined people’s needs but at times these lacked detail.

The provider had not arranged for staff to receive regular training to ensure they had the knowledge and skills to undertake their duties and adhere to good practice guidelines.

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.

Activities were available and staff had been encouraged to provide more stimulation and engagement for people. However, we found there was a lack of flexibility in the activity programme and it did not adequately take into account people’s individual interests. We recommend the provider consults national guidance on providing activities for people living with dementia. The provider did not make information accessible and we recommend the provider consults guidance about implementing the accessible information standard.

The provider had improved the environment. However, we saw further work was required to complete the refurbishment and redecoration plans. We recommend the provider consults national good practice about developing their environment to support the needs of people living with dementia.

Staff were able to describe signs of possible abuse and were aware of safeguarding adults’ procedures. On the whole we found sa

Inspection carried out on 21 February 2017

During a routine inspection

This inspection took place on 21 and 23 February 2017. Our first visit was unannounced. At our last inspection in June 2016, we found that improvements had been made around medicines management as required following our previous visit.

Acorn House – Croydon provides care and support for up to 31 older people, some of whom may be living with dementia. There were 22 people using the service at the time of our inspection.

The home had a registered manager in post who was present at our inspection. 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.

Acorn House - Croydon had been placed into a provider concerns process by Croydon Council owing to safeguarding and quality concerns. The ownership and management of the service was working closely with the Council and partners to improve the service delivery to people using the service. This joint working process was working well at the time of this inspection.

Staff had received training in the MCA (Mental Capacity Act) however improvements were found to be required around the application of the Act.

Bathrooms provided for people using the service presented poorly and were not well maintained. We found that people would also benefit from an accessible outdoor space suitable for their needs.

We also found improved arrangements needed to be put in place for the recruitment of staff. Staff records contained the required information however one staff member was working at the home without a completed criminal record check.

Staff received the training and support they needed to help carry out their job roles effectively. They had received training around safeguarding people from abuse 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 registered manager and acted upon.

The service completed assessments of people’s needs and these were used to inform the care plan for each person. Records showed people’s needs were kept under review and changes were made as required.

People were supported to take their medicines as prescribed and to access healthcare services when they needed them.

Inspection carried out on 17 June 2016

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service in December 2014. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Acorn House - Croydon on our website at www.cqc.org.uk.

We found improvements had been made around the management of medicines and ensuring that they were safely administered to people using the service. There were now appropriate arrangements in place for the storage, administration, recording and disposal of medicines. Medicines kept on behalf of people using the service were being administered correctly with up to date records kept.

Inspection carried out on 25 November & 3rd December 2014

During a routine inspection

This inspection took place on 25 November and 3 December 2014 and was unannounced.

Acorn House provides care and support for up to thirty one older people, some of whom may be living with dementia.

We last inspected Acorn House - Croydon in April 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

There was a registered manager in post at the time of our inspection. 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 using the service and their representatives told us they felt safe and well cared for at Acorn House - Croydon. They were able to take part in activities and were supported to maintain relationships with family and friends who were important to them.

There were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these. Staffing numbers on each shift were sufficient to help make sure people were kept safe.

Medicines were stored securely and safely. However, safe practice was not always being followed around the administration of medicines. You can see what action we told the provider to take at the back of the full version of this report

Staff were caring and treated people using the service with dignity and respect. They received training and support to help them carry out their role effectively.

The registered manager communicated a strong person centred ethos and communicated a clear vision about how care and support was to be provided to people.

The home was being renovated at the time of our visit with improvements being made to the communal areas benefitting people who used the service.

Inspection carried out on 30 April 2013

During a routine inspection

We spoke to two people using the service. They told us that staff respected their privacy, dignity and independence. They told us that they felt they could talk to staff, staff were friendly and listened to them. They told us they enjoyed the food at the home. One person told us they knew how to make a complaint if they needed to and the home would do something about their complaint.

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

Inspection carried out on 29 January 2013

During a routine inspection

We spoke to three people who used the service and a visiting relative. One person said �The staff always ask me if I want to do things or go places, I am very happy here�. Another person said �I prefer to stay in my room with my wife and watch the television, staff take us out for walks in our wheelchairs on warmer days�.

People told us they enjoyed the food provided at the home. One person said �The food is exceptionally nice but it�s not always well presented, apart from that I cannot complain�. Another person said �The food is not too bad. I enjoy it most of the time�.

People told us about staff. One person said �There are plenty of staff around, they do as much as they can for me and my wife�. Another person said �I get on with everyone here and the staff are so nice�. A visiting relative said �The staff are kind and even handed with everyone, my relative always looks well dressed and well looked after when I visit, there is always a nice kind atmosphere here�.

One person said �I have nothing to complain about but I would tell the manager if I did have to complain, I have told the manager of some minor concerns in the past and they dealt with them straight away�. Another person said �I would tell staff if I was not happy and they would sort it out for me�.

We found that some people using the service were not being supported to eat and drink in a sensitive manner that respected their dignity and ability.

Inspection carried out on 29 June and 27 July 2011

During a routine inspection

People we spoke to said �its ok�, �there�s nothing much wrong here � I do what I want to do�, �its ok � not my scene�, �I like it here� and �it�s not too bad�. One person said that they helped lay the tables and wash up the breakfast things each day.

A visitor reported that the staff were �polite and respectful� to the person they knew. All of the individuals we spoke to said that they were treated with dignity and respect by care staff. We observed some positive interactions between staff and people using the service when we spent time in the main lounge of the home.

Comments about the staff included �the staff are very good�, �they are nice�, �not bad�, �no complaints�, �there�s nothing wrong with the staff� and �these girls are smashing�. A relative of one person said �the staff are kind and caring � that�s the main thing�.

�There�s nothing wrong with the food�, �the food�s nice�, �it�s ok � you get what you are given�, �it�s nothing special � you can choose what you have�, �usually not bad� and �not bad� were all comments we received about the food provided.

Reports under our old system of regulation (including those from before CQC was created)