Archived: Five Acres Nursing Home

Updated 18 February 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 13 January 2016 and was unannounced. The inspection was undertaken by a team of two inspectors and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert used for this inspection had experience of a family member using this type of service.

Prior to this inspection we had received some information of concern. We therefore reviewed all the information we held about the service, including data about safeguarding and statutory notifications. Statutory notifications are information about important events which the provider is required to send us by law. We spoke with the local authority and a healthcare professional to gain their feedback as to the care that people received.

During our inspection, we observed how the staff interacted with the people who used the service, how people were supported during meal times and also during individual tasks and activities. Some people communicated with us by gestures and facial expressions or spoke a few words, rather than by fluent speech. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with five people living at the service and one relative. In addition we spoke with; the provider, the manager, a registered nurse, the activities co-ordinator, the housekeeper, three care staff, and a member of catering staff.

We looked at 6 people’s care records to see if their records were up to date and reflected their care needs. We also looked at other records relating to the management of the service, including staff recruitment, medication charts and quality audit records.

Updated 18 February 2016

Five Acres Nursing Home is registered with the Care Quality Commission (CQC) to provide care for up to 32 older people, who may be living with dementia. At the time of our inspection there were 20 people living in the home.

Following our previous comprehensive inspection, on 19-21 May 2015, we gave this location an overall rating of ‘inadequate’, and placed them into special measures. We found that there were no effective systems in place to manage and monitor the prevention and control of infection or ensure that the premises and equipment used was safe and cleaned to an appropriate standard. In addition, the registered person did not have effective systems in place to ensure there were sufficient quantities of medicines available which meant that medicines were not managed safely. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found that the registered person had not protected people against the risk of an unsafe and inadequately maintained environment. There was a lack of appropriate signage and decoration for the people living at the service. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person had failed to operate systems to ensure records were managed safely and effectively. Systems were not effective in terms of assessing, monitoring and improving the quality and safety of the services provided. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not treated with care, dignity and respect, which was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person had not taken steps to ensure that care and support was provided with the consent of the relevant person. Where consent could not be gained because people lacked capacity, the registered person had not acted in accordance with the Mental Capacity Act 2005. This was a breach of regulation 11of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person had not taken steps to meet people’s nutritional and hydration needs, which was a breach of regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that the registered person had not displayed ratings from the previous inspection of this service. This was a breach of regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person had not taken steps to notify the Care Quality Commission of requests made to supervisory bodies to deprive people of their liberty. This was a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (Part 4).

We also received some information of concern, which led to an additional focussed inspection on 02 July 2015. During that inspection we also found that the registered person had not sent statutory notifications to the Care Quality Commission. This was a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (Part 4).

The provider submitted an action plan to tell us how they would meet these regulations and the timescale they intended to have met them by. We carried out this inspection on 13 January 2016, to see if the provider had made the necessary improvements to meet these breaches of regulations, and to see whether or not they should remain in special measures. We found that the provider had implemented systems to meet these regulations and, as such, the service is no longer in special measures.

The service did not have a registered manager in post; however there was a manager who had been at the service for several months. They informed us that there were plans for them to change their role to become the clinical lead. We found that another manager had been recruited and were due to start a few weeks after our inspection. The current manager told us that the new manager would register with us as soon as possible after commencing 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.

During this inspection, we found that people felt safe at the service and were cared for by staff who were trained in safeguarding principles. Staff were knowledgeable about abuse and were prepared to raise any concerns they had. There were systems in place to assess and manage risks, and risk assessments were updated on a regular basis, to ensure they were accurate. Staffing levels had improved and the provider had carried out recruitment to improve continuity of care. Systems for the storage, administration of medication had been improved to ensure that this could be done safely and there had also been significant improvements to the infection control practices at the service.

Staff training had improved and we saw that staff members received regular training and refresher sessions, to ensure that their skills were up-to-date. Staff also received support from the manager, including supervision and appraisal meetings. People’s consent to their care was sought, and systems for the implementation of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards had been developed. People had access to sufficient food and drink and were supported to see healthcare professionals when necessary.

Staff treated people with kindness and compassion and promoted their privacy and dignity. They spent time engaging with people in conversation and exchanging jokes. People were provided with information about their care, and there were plans in place to improve the recording of people’s involvement in their care.

People’s care plans were reviewed regularly, to ensure they were an accurate reflection of people’s needs and wishes. The activities programme at the service had been improved and there were plans to extend this father in the future. Policies and procedures for feedback from people and their family members were in place, and the manager sought out people’s views to help develop the service provided.

There was clear leadership at the service. Staff and people were aware of who the manager was and were positive about the impact that they had at the service. The manager was aware of the requirement to send notification to the Care Quality Commission, and had done so where necessary. They had also implemented a number of checks and audits to ensure there were effective quality assurance systems at the service.

At the last comprehensive inspection this provider was placed into special measures by CQC. Although we identified a number of areas that still required improvement we were satisfied with the progress that had been made and determined that the provider was no longer in breach of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3). The overall rating for this service is ‘Requires Improvement’. This means that the service no longer requires to be in ‘Special measures’.