Archived: Acorn Retirement Home

Acorn Retirement Home is a residential care home providing nursing or personal care and accommodation to 15 older people. The service can support up to 18 people.

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

Prior to this inspection, the provider has been rated as ‘requires improvement’ in the question, ‘is the service well led?’ on three previous occasions. We found at this inspection, concerns remain regarding the governance of this service.

We have made a recommendation that the provider consult and familiarise themselves with the latest NICE guidance with regard to the administration of medication.

Concerns were raised during the inspection regarding the amount of weight lost by a person living at the service and the lack of monitoring of this person which would have prompted additional help being sought to meet their needs. This resulted in the inspector raising a safeguarding concern in relation to this person.

There were a lack of effective systems and processes in place to assess, monitor and improve the quality and safety of the service provided. Systems were not in place which would provide the registered manager with oversight of the service. Risks to people were not consistently managed. Daily charts were not completed consistently.

People were supported to receive their medication as prescribed by their GP. Accidents and incidents were reported on but there was a lack of analysis of this information taking place which would identify potential risks and assist the provider to put actions in place to address the risks.

People told us they felt safe and were supported by staff who knew them well. Staff had been safely recruited and were aware of their responsibilities to act on any allegations of abuse they may be aware of.

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 access a variety of healthcare services, but there was a lack of consistency in how people’s healthcare needs were managed and responded to.

Staff felt well trained and supported in their role. People were happy with the care they received and felt it met their needs.

People were cared for by staff who treated them with dignity and respect and encouraged them to maintain their independence.

Care plans were in the process of being reviewed and re-written. People were involved in the planning of their care and had no complaints about the service. People were support to take part in activities and access the community.

Rating at last inspection

The last rating for this service was Good (published 3 April 2019).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Acorn Retirement Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection. We have issued the provider with a warning notice regarding the concerns raised during the inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Acorn Retirement Home 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 18 people. There were 12 people living at the home on the day of the inspection.

The service had a registered manager who is registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager for Acorn Retirement Home is also the provider.

People’s experience of using this service:

• In the previous Inspection, we found a breach of regulations and we issued a warning notice, requiring the provider make the required improvements. This was a focused inspection to check their progress and if they had met the regulations.

At this inspection we found improvements had been made and the regulations were met. The effectiveness of the service had improved which meant that people’s outcomes were consistently good, and people’s feedback confirmed this, and this key question will now be rated as good. Improvements have also been made under well led, however, some further improvements were needed and the rating for well led remains as ‘requires improvement.’

• Improvements had been made and risk assessments were in place and were reviewed monthly. The provider had also developed the care plans since our last inspection. However, we found further improvements were required, for example, improvement was needed to record the actual date of reviews rather than the month; and all reviews needed evaluating so that an accurate assessment of risk was showing.

• We found that comprehensive information and guidance was not always available to staff because information was not consolidated into one main care plan.

• The registered manager told us further improvements were planned and care plans were being reviewed and further developed and new documentation introduced.

• People were supported by staff to stay safe and who understood the need to ensure they consented to the care they received. However, we needed assurance that the registered manager maintained up-to-date knowledge to ensure the service was developed in line with guidance and best practice.

• Staff received training that was appropriate to them in their role and supported them in providing care in the way people wanted.

• Staff liaised with other health care professionals to meet people’s health needs and support their wellbeing.

• Staff received training that was appropriate to them in their role and supported them in providing care in the way people wanted.

• Staff felt supported and said they could talk to management at any time, feeling confident any concerns would be acted on promptly.

• People spoke highly of the overall service and the management team. People had opportunity to feedback about their service.

Rating at last inspection: At the last inspection we rated the Acorn Retirement Home as ‘Requires Improvement’ (report published 09 November 2018).

Why we inspected: In the previous Inspection, we found a breach of regulations and we issued a warning notice. This was a focused inspection to check the provider’s progress and whether they had met the regulations.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found in inspections is added to reports after any representations and appeals have been concluded.

At our last inspection visit on 01 December 2016 we rated the service as 'requires improvement’. We found the provider was in breach of the regulations because audit systems in place had not always been effective at identifying where improvements were needed. We asked the provider to take action to ensure there were arrangements in place to address the issues we found and to ensure there were robust quality assurance systems in place to drive improvement within the home. When we carried out this inspection we found the provider had not met the regulations therefore the provider remained in breach of the regulation.

The home is registered to provide accommodation and personal care, for a maximum of 18 people and there were 14 people living at the home on the day of the inspection. A registered manager was in place. A 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 registered manager of this service is also the registered provider.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met.

Staff were available to people when required and demonstrated good knowledge about people living at the home. People were supported by staff to take their medicines and records completed by staff to record when medicines had been administered.

Staff understood the importance of ensuring people agreed to the care and support they provided. However there were no records of people being involved in some decisions about their care and the actions taken to keep them safe. The registered manager said all people had capacity to agree to their care and there were no restrictions on people’s liberty therefore no deprivation of liberty applications had been submitted to the local authority.

Staff told us training helped them meet the specific needs of the people living at the home and they attended regular training to ensure they kept their knowledge updated.

All people told us there was a choice of food, whilst some people enjoyed the meals provided others said menus could be repetitive. We saw the provider had taken action where comments had been made.

People were supported to access professional healthcare to support their wellbeing, for example, they had regular visits with their GP and any changes to their care needs were recorded and implemented.

People were relaxed around the staff supporting them. We heard and saw positive communication throughout our inspection and saw people smiling and responding positively to staff. Relatives we spoke with told us people enjoyed good relationships with staff. Staff showed us that they knew the interests, likes and dislikes of people and people were offered both personal and group activities.

People and relatives said people had choices and felt staff listened to them. People and their relatives felt confident they could raise any issues should the need arise and that action would be taken as a result.

At the last inspection we found improvement was required in the provider’s audit systems because they had not always been effective at identifying where improvements were needed. This inspection found further improvements were required because although the provider had systems in place to check and improve the quality of the service provided these had not been robust in identifying areas for improvement and taking action in a timely way. Regulations state the provider should maintain accurate and complete records in respect of each person using the service. Audits had not identified some of the areas for improvement we identified in our inspection, such as up-to-date records of people’s risks and records recording peoples consent.

People, relatives and staff were positive about the service and the way it was managed for the people that lived there. The registered manager demonstrated clear leadership and staff were supported to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes.

You can see what actions we told the provider to take at the back of the full version of this report.

There was 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.

Risk assessments for people were not updated as people’s needs changed and guidance was not available for staff to refer to. People told us they felt safe and staff were aware of their responsibilities to report any concerns of potential harm or abuse. There were adequate numbers of trained staff to meet people’s needs although at times staff were busy. People received their medicines as prescribed.

People were asked for their consent before care and support was provided by staff. People told us staff had the skills and knowledge to care for them. People told us they had sufficient to eat and drink and had access to healthcare professionals when they needed.

People told us staff were kind and caring. People were involved in making choices about their day to day care. People’s independence was promoted and their dignity and privacy was maintained and respected by staff. People told us they enjoyed the activities available and were supported to maintain their interests. People were confident if they had any concerns or complaints, they would be listened to and the matter resolved.

People were supported by staff who understood their roles and responsibilities. Quality systems in place to monitor care provided were not effective. Improvements identified at the last inspection had not been fully implemented.

We found the provider was in breach of one regulation under the HSCA 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.

Acorn Retirement Home is a residential home that provides accommodation and personal care for up to 18 older people. At the time of our inspection there were 16 people living at the service, some of whom were living with dementia. A registered manager was 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 registered manager of this service is also the registered provider.

Risks to people were not always identified or actions taken to minimise these risks. People were not always protected from potential injury due to unsafe moving and handling practices. Staff could describe how to identify signs of potential abuse, however, concerns about people were not always effectively identified and reported to the Local Authority when required. People were supported by a staff team who had been recruited safely. People were happy with how they received their medicines.

People were supported by staff who had not received sufficient training and did not always have the required skills. People were not always enabled to consent to the care they received. Where people did not have capacity to provide consent, decisions were not always made in their ‘best interests’ in line with the Mental Capacity Act 2005.

People had access to sufficient quantities of good quality food and drink. People were not always enabled to make choices about their food and drink or provided with sufficient support where they were not able to eat independently. People had access to healthcare professionals when needed.

People told us that staff were kind and caring. People’s privacy and dignity was not always protected and their independence was not always fully promoted. People were supported to maintain relationships that were important to them.

People were not fully involved in the development of their care plans. Care plans did not always reflect people’s needs or the care they received.

People felt able to raise concerns and complaints where appropriate and we saw that the provider responded to concerns raised. The provider was developing ways of proactively obtaining people’s views about the service.

People and staff spoke highly of the management of the service. The provider was visible in the service and supported an open culture within the staff team. Quality assurance systems were not sufficiently developed to ensure that the quality of the service to people was continually improved and that care plans reflected people’s individual needs.

We found that the provider was in breach of three regulations under 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.

At this inspection Improvements were noted to records held at the home. Work had been undertaken to ensure care plans were up to date and in good order. We saw that more detailed information had been recorded to enable staff to provide personalised care to people. Activity records were completed which showed the activities undertaken by people who lived at the home on a daily basis.

We noted that there was a lack of risk assessments regarding falls, nutrition and the risk of developing a pressure area. We discussed this with the manager. The day following our inspection we were forwarded copies of risk assessments that were to be introduced for everybody who lived at the home.

We saw that menus recorded a choice of meal for people. We spoke with people who lived at the home and we were told that people had a choice in everything that they did. One person told us: "There is always a choice of meal, they tell you what you are having and you can always ask for something else". Another person said: "I choose to stay in my room but sometimes I like to go into the lounge".

The home's safeguarding policy had been amended to guide staff of the correct course of action if adult abuse was suspected or identified.

We found there were on-going improvements to the management of infection control. Hand washing facilities had been improved and staff training had been booked.

Improvements had been made to the quality assurance systems in place. Action plans recorded action taken to address issues identified during audits of the service or satisfaction surveys.

Some improvements had been made to records held at the home. We were told that work was on-going, however further improvements were required to ensure that records contained information to enable care to be provided in a safe and effective manner.

We saw that staff did not maintain people's privacy or dignity on all occasions. Everyone we spoke with said that they received appropriate care and support. Visitors said that their relative was safe and well looked after.

Staff spoken with said that they would report any potential or actual abuse to the registered person. The home's policy does not record the correct procedure for reporting abuse. Some of the staff practices observed could put people at risk of injury.

The home was not sufficiently clean and we saw some staff practices which could increase the risk of cross infection.

Staff appeared to be caring and kind. The registered person said that they, "Strive to obey the rules" and that their "Priority was to make sure everyone was safe and happy". People spoken with said that the staff were friendly but could be in a rush which they did not like.

We were told that the home had not received any formal written complaints. Everyone we spoke with said that they did not have any complaints but would speak with the registered person if they did. Some systems were in place regarding quality assurance but there was no records to demonstrate that action had been taken when issues were identified.

Not all records seen were fully completed or up to date.