Acorn Lodge

Acorn Lodge is a residential care home providing personal and nursing care for up to 40 older people, the majority of whom were living with dementia. At the time of the inspection, 23 people were living at the home. The home accommodates people in one adapted building.

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

Additional staff were required to support people with activities. All other aspects of care were provided when people needed. We found that paperwork was not always up to date or accurate and analysis of accidents and incidents was required. We have made recommendations around this.

Relatives felt their family members were safe at the service and that staff treated people well. Staff were knowledgeable around the risks associated with people’s care and any clinical concerns were addressed appropriately.

The service was clean, and staff adhered to appropriate infection control measures. Relatives felt involved in their family members care and were complimentary about the communication from staff about their loved ones.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was Requires Improvement (published 21 October 2019). At this inspection we found concerns that related to the robustness of records, the deployment of staff and the requirement to have a registered manager.

Why we inspected

We received concerns in relation to risks associated with people’s care and the management of people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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 Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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 Lodge is a residential care home providing personal and nursing care for up to 40 people, the majority of whom have a diagnosis of dementia; some have mental health needs and frailty of old age. At the time of the inspection, 37 people were living at the home. The home accommodates people in one adapted building.

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

Activities were not designed specifically for people living with dementia. Care was not always delivered in a person-centred way by staff. Some actions had been taken to arrange the environment in a way that was dementia-friendly.

Care people received was not consistently good. People were not always treated with dignity and respect.

There was a strong smell of urine in one part of the home which was persistent throughout the day. After the inspection, the manager sent us a copy of cleaning schedules and how the problem was being addressed.

Audits had not identified the issues that were found at inspection. Personal information about people was not always kept confidentially. Whiteboards in people’s bedrooms charted detail about people’s continence needs and whether they should be resuscitated or not. After the inspection, the manager informed us that these whiteboards had been removed pending a decision on how information should be managed in people’s bedrooms.

Records relating to Lasting Powers of Attorney and the authority to make decisions with regard to property and finances or health and welfare were not always accurate. During the inspection, the inaccurate records were removed from people’s care plans.

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.

The management team understood their responsibilities in relation to providing the regulated activity. Staff felt supported by the management team. People and their relatives were complimentary about the home and the care provided.

Staff completed a range of training to enable them to support people in line with their care and support needs. They had regular supervisions and attended staff meetings.

People enjoyed the food on offer. They had access to a range of healthcare professionals and services. People were safe living at the home. Risks were identified, assessed and managed safely with guidance for staff which was followed. Staffing levels were sufficient to meet people’s needs. Medicines were managed safely.

Care plans provided detailed information about people, their likes, dislikes and preferences. People’s wishes for the end of their lives were recorded in their care plans. Complaints were managed in line with the provider’s policy.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The rating at the last inspection was Good (published 5 January 2017).

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 Caring, Responsive and Well-Led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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 Lodge has a registered manager who has been in post for many years. However at the time of the inspection they had been absent for some time. 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 ensured that suitable management arrangements were in place during the extended absence of the registered manager. The person in charge was a director of the company and they were being supported by another director, both were registered nurses.

People and their relatives spoke highly of the care provided at the home. Their comments included, “Staff here are very nice indeed,” and, “I am treated with kindness and respect.” A relative told us, “We are very lucky, the staff here are lovely, so patient and kind.” People said they felt safe. Staff had a clear understanding of their responsibilities with regard to keeping people safe. There were clear safeguarding and whistleblowing arrangements in place and risks to people were recognised, assessed and managed to ensure people were protected.

People had confidence in the staff and told us they were well trained. One relative told us, “I think the staff here are well trained and they work well together. You can approach the nurses at any time and they always know what is going on.” There were enough staff to care for people safely and the provider had a robust system for recruitment to ensure that staff were suitable to work with people. Staff understood the principles of the Mental Capacity Act and people’s rights were protected. Staff told us they felt well supported and that they had access to training. They were receiving regular supervision and demonstrated that they were knowledgeable about the needs of people they were caring for.

People told us they enjoyed the food at Acorn Lodge and they were receiving enough to eat and drink. One person said, “The food is very nice and we can have a choice, if you want something different they will make it for you”. Staff were aware of people’s nutritional needs and preferences and ensured that people who had specific needs received the support they needed. People were able to access the health care services they needed. Staff had made good links with the local community and sought advice and support from health care professionals when needed.

Staff had developed positive relationships with people and knew them well. People and their relatives told us that people’s dignity was respected and that staff helped people to remain as independent as possible. One person said, “The staff help me to get washed and dressed but they still encourage me to do bits for myself while I still can.” People’s information was kept securely and staff understood the importance of maintaining confidentiality.

Staff provided care that was personalised to the individual needs of people. Their needs were reviewed regularly and risk assessments and care plans were updated following any changes in people’s needs. A relative told us that staff provided personalised care. They said, “I think it’s because the staff have made them feel that it’s their home, they know how they like things to be done and that makes the difference.” People were supported to follow their interests and told us they enjoyed the activities that were organised. People who were living with dementia were provided with a range of occupations to stimulate and interest them and staff spent time chatting and interacting with people.

People, their relatives and the staff spoke highly of the management of the home. One person said, “I would say the home is well managed, very firmly managed in fact.” Another person said, “I’m very happy with how it’s run, nothing to complain about at all.”

There were robust management systems in place that ensured the quality of the service was monitored and actions were taken to ensure continuous improvement. People and their relatives told us that they knew how to make complaints, they felt comfortable to raise any issues with staff and they were confident that actions were taken to respond to their concerns. Despite the absence of the registered manager good leadership was evident. People, their relatives and staff were included in developments at the home and communication was good.

We saw that people felt comfortable in approaching staff and asking for assistance. We also saw that staff made attempts to engage people in conversations and activities throughout our visit.

We found that peoples' care was not always delivered in a way that repected people privacy and dignity. We found that people had planned care that mostly met with their needs. However, we found that where one person was being deprived of their liberty, this had not been assessed and planned within legislative guidelines.

We found that the service was clean and that infection control was taken seriously. We also found that the service had a complaints procedure in place which was being followed when the home received complaints.

People experienced care, treatment and support that met their needs and protected their rights. One family member told us 'It's really nice and friendly here. They treat mum as a person.' Another said 'The staff are always working so hard and they are very patient and kind.'

Through reviewing arrangements for staff training, talking to staff and reviewing care plans we found that people were protected from the risk of abuse. The provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

Looking at records and talking with staff demonstrated that people were safe and their needs were met by competent staff who were trained and supported.

The provider had systems in place that sought people's views and took account of comments. This meant the provider had an effective system to assess and monitor the quality of the service.