Acorn Heights Care Home

We found the following examples of good practice.

The management team had established robust infection prevention and control procedures which were understood and followed by staff. All staff had completed infection prevention and control training and training on the use of personal protective equipment (PPE). On the day of our visit, staff were wearing appropriate PPE and there were plentiful supplies of the items needed. All staff participated in the weekly testing programme. The home had a good standard of cleanliness in all areas seen.

Although visiting was subject to government restrictions, the management team had reviewed visiting policies to ensure any visits would be carried out safely and on an individual risk based assessment. Management and staff had found ways to enable people to maintain contact with their relatives which included the use of technology, window visits and outdoor patio visits. A warm and safe outdoor space was being developed to support visiting. There were strict procedures in place for essential visitors, which included a health and temperature check before admission to the home.

The atmosphere in the home was relaxed and calm. People were occupied with everyday tasks and activities such as craft activities, spending time talking to others or watching television.

The provider’s infection prevention and control policies and procedures were up to date and regular audits had been carried out. The provider had also developed a Covid-19 contingency plan, which set out the continuity of the service during the current pandemic.

We were assured this service met good infection prevention and control guidelines.

Further information is in the detailed findings below.

At our last inspection of 12 and 13 April 2017 our findings demonstrated there were six continued breaches of the regulations in respect of the assessment and management of risks, care planning, environment, Deprivation of Liberty processes, recruitment processes and quality assurance systems. Following the last inspection we asked the provider to complete an action plan to show what they would do to improve the service to at least good and by when.

Following the last inspection the clinical commissioning group medicines optimisation team and local commissioners of services had worked with the management team and staff to support them with improvements.

During this inspection we found that improvements had been made and all regulations were being met.

The registered manager had been in post since April 2017 and registered with the Care Quality Commission in August 2017. 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 Heights Care Home provides accommodation and care and support for up to 22 people, some of who were living with dementia or mental ill health. There were 22 people accommodated in the home at the time of the inspection.

Acorn Heights Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Acorn Heights Care Home is located on a main road close to the town centre facilities of Burnley. It is an older detached house with facilities on two floors. There is a small car parking area to the front of the home and an enclosed patio and smoking area to the rear.

During this inspection we found new quality assurance and auditing processes had been introduced to help the provider and the registered manager to effectively identify and respond to matters needing attention. The systems to obtain the views of people, their visitors and staff had been improved. People felt their views and choices were listened to and they were kept up to date with any changes.

The management team and staff had worked hard to introduce much needed changes and improvements. People and staff were happy with the improvements that had been made and considered the service was managed well. Communication had improved and people felt they had been involved in decisions and consulted about any changes.

People were happy with the personal care and support they received and made positive comments about the staff. They told us they felt safe and happy in the home and staff were caring. People were comfortable in the company of staff and it was clear they had developed positive trusting relationships with them. Staff understood how to protect people from abuse.

Records relating to people's care and support had improved. The information in people's care plans was sufficiently detailed to ensure they were at the centre of their care. People's care and support was kept under review and they were involved in decisions about their care. Risks to people's health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people's needs changed.

Improvements had been made to ensure the home was a clean, safe and comfortable place for people to live in. Appropriate aids and adaptations had been provided to help maintain people's safety, independence and comfort.

The recruitment of new staff had improved. A safe and robust recruitment procedure was followed to ensure new staff were suitable to care for vulnerable people. Arrangements were in place to make sure staff were trained and competent. People considered there were enough suitably skilled staff to support them when they needed any help. Staffing levels were monitored to ensure sufficient staff were available.

People's medicines were managed in a safe manner. People had their medicines when they needed them. Staff administering medicines had received training and supervision to do this safely.

People were supported to have 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. Staff respected people's diversity and promoted people's right to be free from discrimination.

People had access to a range of appropriate activities both inside the house and in the local community. People's nutritional needs were monitored and reviewed. People were given a choice of meals and staff knew their likes and dislikes.

People told us they were happy and did not have any complaints. They knew how to raise their concerns and compliments and were confident they would be listened to.

Sun Hill Private Residential Care Home provides accommodation and personal care for up to 22 people living with dementia or mental ill health. The home is an extended older type property situated in its own gardens in a residential area of Burnley. Public transport is easily accessible and the town centre is within walking distance. There were 17 people accommodated in the home at the time of the inspection.

The service did not have a registered manager in post. The previous registered manager left the service in November 2016 following enforcement action being taken by the Commission. 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. The recent manager had been in post since 3 April 2017 and an application to register her with the CQC had been downloaded.

At the previous comprehensive inspection on the 9, 10, 17 and 26 August 2016. We found the provider was not meeting fourteen regulations. We asked the provider to take action in relation to the management of medicines, assessment and management of risks, infection control practices, care planning and meeting nutritional needs, maintaining people's dignity and personal appearance, environment, staff training, complaints processes, Deprivation of Liberty processes, recruitment processes, staffing numbers, induction and supervision and quality assurance systems.

At the previous comprehensive inspection on the 9, 10, 17 and 26 August 2016 the overall rating for this service was 'Inadequate' and the service was placed in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timescale.

Following the inspection, the provider sent us an action plan which set out the actions they intended to take to improve the service.

On 7 December 2016 we undertook a focused inspection of the service to check on the provider's progress. At that time the local authority management team were supporting managers and staff at the home and we found a number of improvements were ongoing. However many of these changes were in their infancy and needed to be embedded into practice at the home. We therefore could not improve the rating for safe from inadequate because to do so requires consistent good practice over time.

From September 2016 regular quality improvement meetings had been held with the registered persons, CQC, the police, the safeguarding team, the police and commissioners of services. Following the inspection of 9, 10, 17 and 26 August 2016 the provider voluntarily suspended any further admissions to the home until commissioners and CQC were satisfied that significant improvements had been made. The medicines management team, infection control team and local authority commissioners and managers worked with the provider, managers and staff to support them with improving the service. A further quality improvement meeting was held in April 2017. Feedback from the meeting was positive regarding improvements made so far and an action plan was available to support further improvements. The local authority suspension on admissions was lifted. At the time of this inspection investigations by the local authority safeguarding team and the police were ongoing.

During this inspection we found improvements had been made and new systems had been introduced to make sure people were safe. However, due to the previous lack of clear leadership and changes in the management team there had been limited progress made in some areas. We found continuing shortfalls with regards to the assessment and management of risks, care planning, environment, Deprivation of Liberty processes, recruitment processes and quality assurance systems. The manager had already identified these areas for improvement. You can see what action we told the provider to take at the back of the full version of the report.

People told us they were happy living in the home and they felt safe. They said staff were kind and caring. We observed that staff promoted people’s independence and choices and valued and respected them as individuals.

Safeguarding adults' procedures were in place and staff understood how to safeguard people from abuse. We were aware safeguarding investigations were ongoing at the time of our visit. A representative from the safeguarding team told us the management team was fully cooperating with the investigation.

Whilst some risks had been assessed and documented, we found the assessments had not always been updated in line with changing needs. We found people's care plans had not been kept up to date and people were not routinely involved in the development and review of their plans.

Since our last visit the management of people’s medicines had improved and additional systems to improve safety had been introduced.

The accident and incident recording had improved although there was no clear analysis undertaken in order to identify any patterns and trends.

There were sufficient staff on duty to meet people's needs, however, we found shortfalls in the recruitment of new staff and noted essential checks had not always been carried out.

Staff had received appropriate training although the records were not accurate or reflective of the training that had taken place. The manager was in the process of ensuring all staff received a regular one to one supervision. All staff were able to attend meetings and provide feedback on the service. Staff spoken with told us they were well supported and had full confidence in the manager.

Appropriate Deprivation of Liberty Safeguard (DOLS) applications had been made to the local authority. However, there was no evidence to indicate people's mental capacity to make their own decisions had been assessed and recorded in line the requirements of the Mental Capacity Act 2005.

People were happy with the meals provided and told us they could have a choice. People had access to meaningful activities.

The manager and staff were observed to have good relationships with people living in the home. People were relaxed in the company of staff. There were no restrictions placed on visiting times for friends and relatives.

The way complaints were managed had improved. People had access to a clear procedure and were able to raise their concerns during meetings and during day to day conversations.

There were systems in place to assess and monitor the quality of the service, which included feedback from people, their relatives and staff, however we found a number of shortfalls across the operation of the service. The provider and the manager told us they were committed to making the necessary improvements and were working to an action plan with clear timescales. This showed us there was an upward trend towards improvement of the service.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timescale.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We undertook this focused inspection on 7 December 2016 to check on the provider’s progress. 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 Sun Hill Private Residential Care Home on our website at www.cqc.org.uk.

Meetings had been held with the registered persons, Care Quality Commission (CQC), the safeguarding team and commissioners of services. At the time of this inspection there were a number of safeguarding concerns which were currently under investigation by the local authority safeguarding team and other agencies. At the time of this inspection there was a suspension on any further admissions to the home until commissioners and the Care Quality Commission were satisfied that significant improvements had been made.

During this inspection visit we found a number of improvements were ongoing. However many of these changes were in their infancy and needed to be embedded into practice at the home. We therefore could not improve the rating for safe from inadequate because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Sun Hill Private Residential Care Home provides accommodation and personal care for up to 22 people living with dementia or mental ill health. The home is an extended older type property situated in its own gardens in a residential area of Burnley. Public transport is easily accessible and the town centre is within walking distance. There were 17 people living in the home at the time of the inspection.

The manager who was registered with the commission was not available 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.

In the absence of the registered manager there was an acting manager in day to day control of the service. The provider was also available at the home and had expressed his commitment to improving the service. The acting manager and provider were being supported by a management team provided by the local authority. The local authority team was working at the home in an advisory capacity to help the registered manager and provider make needed improvements.

We found that positive changes were being made to the systems and processes in the home in order to improve the service. However it was clear that many of these improvements were in their infancy and considerable work had to be undertaken to embed these processes into the day to day practice at the home.

People’s care plans were being reviewed and updated to include information about their likes, dislikes and preferences and routines. We were told people or their relatives would be formally involved in decisions about care and support.

Risks to people’s health, safety and welfare had been recognised and recorded and would be included and kept under review as part of the new care plan format.

Improvements had been made to ensure people’s medicines were managed safely. Advice and support had been provided by the local authority medicines management team and this was being implemented.

Information about people’s capacity to make choices and decisions about their lives and any restrictions on their freedom that were in place were being recorded clearly in their care plans. Staff had received training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards to help them to understand the processes.

People told us they were happy with the facilities available in the home. During this inspection we found the cleanliness of the home had improved. Areas of the home remained in need of maintenance and redecoration. However we saw improvements were underway.

The service had new recruitment and selection policies and procedures. We were told new staff were being recruited although we were unable to monitor progress with recruitment and induction practices as new staff had not been employed using this process.

Whilst sufficient staff were available we were told agency staff were still needed to cover shifts. During the inspection we found staff were available to respond to people’s needs in a timely way.

A training plan was available and additional training was underway to ensure staff had the skills and knowledge to meet people’s needs in a safe way.

People told us they enjoyed the meals. People’s dietary preferences and nutritional risks were being recorded.

The complaints procedure had been reviewed to make it clearer for people to understand. There had been no complaints or concerns raised since our last inspection. We were unable to monitor this.

Quality assurance and auditing processes were being reviewed and new systems were being introduced to help the provider and the manager to effectively identify and respond to matters needing attention. Adequate financial resources had been made available to support the day to day management of the home.

Sun Hill Private Residential Care Home provides accommodation and personal care for up to 22 people living with dementia or mental ill health. The home is an extended older type property situated in its own gardens in a residential area of Burnley. Public transport is easily accessible and the town centre is within walking distance. There were 22 people accommodated in the home at the time of the inspection.

At the previous inspection on 12 September 2014 we found the service was meeting all the standards assessed.

During this inspection we found fourteen breaches of the current regulations relating to the management of medicines, assessment and management of risks, infection control practices, care planning and meeting nutritional needs, maintaining people’s dignity and personal appearance, environment, staff training, complaints processes, Deprivation of Liberty processes, recruitment processes, staffing numbers, induction and supervision and quality assurance systems.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timescale.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service was managed by a 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.

Whilst people and their visitors told us they did not have any concerns about the way they or their relatives were cared for, this was contrary to our findings during the inspection.

Staff were aware of the action they would take if they witnessed or suspected any abusive or neglectful practice. However, not all staff had completed training on safeguarding vulnerable adults.

We saw people being asked to give their consent to care and staff were aware of people’s capacity to make choices and decisions about their lives. However, this was not always clearly recorded in the care plans. The registered manager had an awareness of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards although procedures had not always been followed at all times.

Significant improvements were needed to ensure people’s medicines were managed safely. Risks to people’s health, safety and welfare had not always been recognised or recorded. This meant staff may not respond quickly to any increased risks or changes to people’s health.

People told us they were happy with the facilities available in the home. However, we found some areas of the home had a unsatisfactory level of cleanliness. We noted some improvements had been undertaken but other areas were in need of maintenance and redecoration.

The service had recruitment and selection policies and procedures which needed to be reviewed to reflect current guidance. Staff had not always been recruited safely and had not received the training and support they needed to help them look after people properly.

We received mixed views about the availability of staff. People and visitors to the home told us there were sufficient numbers of staff available whilst staff told us there were insufficient staff at times. At the time of our inspection, we found staff were responsible for additional duties and were not always available to respond to people’s needs. Staff told us they had a stable team and they worked well with each other.

People told us they enjoyed the meals. We noted the mealtimes were relaxed with chatter throughout the meal. People’s dietary preferences and nutritional risks were not always recorded. Professional advice and support had been sought when needed but for one person this had not been done in a timely manner.

People told us they had no complaints and were aware of how to raise their concerns if they needed to. The information available to people and the process of managing people’s concerns needed to be improved.

Whilst people told us they were happy with the care and support provided and they felt safe and comfortable, the information in people’s care plans was not sufficiently detailed about their likes, dislikes and preferences and routines. Some people told us they were kept up to date and involved in decisions about care and support.

The number of shortfalls we found indicated the quality assurance and auditing processes had not been effective as matters needing attention had not always been recognised and addressed. This meant the provider had not identified risks to make sure the service ran smoothly. Adequate financial resources were not available to the registered manager and there was no improvement or business plan in place to address the issues identified at the home. As a result people’s health, safety and welfare was placed at risk of significant harm.

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?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Suitable policies and procedures were in place and staff had been trained to understand their responsibilities under the DoLS Codes of Practice.

Care records and our observation of staff provided evidence of good practice in applying the least restrictive options to promote and maintain an individual’s independence.

People told us they felt safe and we saw that there were systems in place to make sure staff learned from events such as accidents and incidents, and complaints and concerns,. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

The service took into account people's care needs when making decisions about the numbers of staff and their qualifications, skills and experience required to cover the rotas.

We looked at a sample of people's care plans and saw evidence to show where possible, people had been involved in developing their care records. This meant they received care and treatment in a way they preferred.

Is the service caring?

People's care needs were assessed by the staff along with people who used the service and/or their family members or representative. People were involved in developing their own care records. We saw that they reflected their current needs and we saw they were up to date.

We saw people being supported by staff who demonstrated empathy and listened to what the person wanted.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People who used the service told us they were happy living at the home.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People's care records showed that where concerns about their wellbeing had been

identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health and social care professionals, including doctors, district nurses, social workers and mental health professionals.

People we spoke with knew how to make a complaint if they were unhappy. The service worked well with other agencies and services to make sure people received care they needed.

The registered manager was able to access all the information we asked for on the day of our visit in order for us to make our judgements.

Is the service well-led?

Sun Hill Private Residential Care Home had a statement of purpose that covered resident’s rights, privacy, dignity, independence, choice and complaints.

Staff told us they were clear about their roles and responsibilities. We reviewed the

minutes from staff meetings which showed that the management team had consulted with staff before implementing changes in the service. This helped to ensure that people were provided with a good quality service.

The service had an effective quality assurance system and records reviewed by us

showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

People said they enjoyed the meals and there was a choice of menu. People's weight was monitored and when necessary advice was sought from other healthcare professionals.

We found that the home was clean, tidy and free from offensive odours.

Members of staff told us they received the training and support they needed in order to provide safe and appropriate care for people using the service.

We noted that systems were in place to monitor some aspects of the quality of the service provided. However, this did not include care planning or infection control.

At this inspection we found that people were being given their medicines as prescribed by the doctor and they lived in a safe and comfortable environment.