Acorn Lodge Nursing Home

Acorn Lodge Nursing Home is a residential nursing home which provides personal and nursing care for up to 85 people. At the time of the inspection 72 people were living at the home.

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

Some records were not always accessible, accurate or up to date, including body maps for the application of creams and patches, we brought these to the attention of the manger who took immediate action.

We have made a recommendation about recording practices.

Moving and handling training was safe. Competency checks had been completed and appropriate equipment was in place to assist staff when moving and handling people. People were safeguarded from abuse. Staff were safely recruited and staffing levels were adequate. The home was clean and tidy, though some cleaning records had missing signatures. Staff used appropriate personal protective equipment (PPE).

Person centred care was being provided and people had their own care plans which were reviewed. People's communication needs were recorded, and complaints were logged and responded to. The service was supporting visits from family and loved ones in line with relevant guidance, and activities were taking place in the home. End of life wishes were discussed, though at the time of inspection not all staff had received end of life training. During the inspection the provider sourced appropriate training for staff to complete.

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 15 October 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced focussed inspection of this service on 20 and 21 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to check if they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, responsive and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Acorn Lodge is a care home which provides accommodation and care for up to 85 older people across four separate units. One unit specialises in providing care to people with dementia. During our inspection the service was providing care to 73 people.

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

On the inspection we identified concerns about safety and governance. These amounted to breaches of legislation, although we did not identify anyone had suffered harm as a result. The provider and manager commenced immediate action to resolve the issues identified.

People had not always been safely assessed by a competent member of staff to use appropriate equipment for moving and handling transfers. The provider had addressed some of these issues before the inspection and work was ongoing. Two bath hoists were not fitted with appropriate lap belts. People told us there were sometimes not enough staff on duty. We have made a recommendation about the call bell system.

People and relatives were complimentary about staff's skills, who had been provided with training to help increase their awareness of people's needs. People's needs were assessed, and staff were provided with guidance to help inform their practice. Overall, people were complimentary about the range of food available and people who needed assistance to eat and drink were supported with sensitivity and patience.

Everyone we spoke with said the staff were caring. People told us they were happy and regarded the service as their home. People's privacy and dignity were maintained, and they were treated with respect, kindness and compassion. People were involved in discussions and decisions about their care.

Staff cared for people the way they preferred. However, these details were not always captured in people’s care plans. Formal complaints were recorded and responded to appropriately. People were supported by Acorn Lodge as they came to the end of their lives. However, more detail was required in care plans to consider and support people's wishes. We have made a recommendation about end of life care training.

Quality assurance systems were in place to assess, monitor and improve the quality and safety of the services provided. However, audits had not identified risks to people’s safety and shortfalls in person-centred planning. The management team were receptive to our feedback and started to make the required improvements immediately. They were committed to making improvements at the home, and ensuring effective systems were in place.

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.

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

Rating at last inspection

The last rating for this service was good (published 5 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safety and governance. Please see the action we have told the provider to take at the end of this report.

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 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 Lodge is a privately owned care home. It offers nursing and residential care and support for up to 85 older people, some of whom have a diagnosis of dementia. There are four units, but at the time of our inspection one unit was closed as the home was undergoing some refurbishment, and this unit was in the process of renovation. When we inspected Acorn Lodge there were 61 people living there. The home is located in located in Failsworth, close to Oldham and the city of Manchester and is a large purpose built care home with a secure garden. All rooms are single and some have en-suite facilities.

There was no registered manager in post at the time of inspection. The former registered manager had left in November 2015. A new manager had been in post for three months and had submitted an application to register with CQC. 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.

When we spoke to people who used the service they told us they felt Acorn Lodge was a safe place and that they felt secure. We saw that there were systems were in place to protect the safety and welfare of the people who used the service. When we spoke to staff at Acorn Lodge, they demonstrated a good understanding of safeguarding adult procedures, and we saw that recruitment procedures were sufficiently robust to help ensure that people were protected from the risk of unsuitable staff being recruited.

We found there were sufficient numbers of staff to meet people’s needs in a timely way. The provider had recently recruited some staff and worked hard to reduce sickness levels. Rotas showed that shifts were covered and there was less reliance on the use of agency staff. One care worker told us, “Sickness has gone down and morale has gone up. Staff are smiling and are happier”. All staff had access to a computer based eLearning package to improve their skills and knowledge.

At our last inspection we found that the service was not managing medicines in a safe way. We found at this inspection that the service had reviewed medicine protocols, and there were systems to ensure that medicines were managed, stored and administered safely.

Where risk was identified plans were put into place to minimise harm. Care plans were detailed and subject to regular review. Attention was paid to people’s dietary and nutritional needs, and the service supported people to make lifestyle choices around their food. People who used the service told us they had sufficient to eat and drink.

We saw that arrangements were in place to assess whether people were able to consent to care and treatment, and people were offered choices about how their care was delivered.

Where health needs were identified, the staff at Acorn Lodge liaised with appropriate health professionals, such as doctors, district nurses and dieticians to ensure that health needs were not neglected.

We saw examples of kind and caring support, and one person who used the service told us, “The staff really make an effort to get to know us, and they are so kind. Nothing is too much trouble.”

Systems were in place to ensure that people at the end of life received appropriate care in accordance with their wishes, and were supported with the relevant healthcare as needed.

Care plans documented people’s interests and what they enjoyed doing. Staff were encouraged to help people to maintain their interests. The service had looked at innovative ways of supporting people to maintain an active life, including setting up a small shop which was run by and for the people who used the service

The service had a complaints policy, and complaints were taken seriously. People told us that they knew how to make a complaint and were satisfied that their issues were addressed.

All the people we spoke with were positive about the manager. One visitor told us, “There is a massive improvement in staff morale since the new manager started, a real positive difference”.

The service had good systems to audit service provision and used information to improve performance.

The inspection was undertaken by two inspectors. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

This summary is based on a visit to the home where we spoke to the manager and observed staff interactions with people using the service. We looked at records and talked with seven visiting relatives, eight people using the service and seven members of staff. We also spoke with a visiting health care professional.

The full report contains the evidence to support this summary.

Is the service safe?

Overall the people we spoke with at the inspection visit were positive about the care provided by the home. Visitors who we asked told us they thought their relatives were safe. One visitor said 'I have never seen any incidents of inappropriate behaviour [from staff]' and 'I have never seen anyone not treated as an equal'. Another visitor told us 'I've got some sleep since [relative] has been here'.

People told us they were confident they could complain if they needed to.

Staff who we spoke with told us they believed people using the service were protected from abuse or exploitation.

There was documentary evidence that most staff had received training in the safeguarding of vulnerable adults. This was confirmed by staff who we asked. Staff also told us they understood the need to be vigilant and, to whistle blow if necessary.

We undertook a tour of the building. This included communal areas and a selection of people's bedrooms. No obvious hazards to people's health and safety were seen. Staff were provided with disposable gloves and aprons to help minimise the risk of cross infection. Infection control and health and safety audits were undertaken.

Is the service effective?

Each individual's care needs were assessed and reviewed. A care plan was developed on the basis of the assessment.

People who used the service told us they were involved in the development of their care plan. One person said 'The staff listen to me about how I want to be cared for'.

Staff who we spoke with understood the importance of delivering care in a 'person centred' way. One member of staff told us 'People are individuals, what works for one person may not work for another. It's important to get to know what works for the person in getting a positive response'.

There was evidence that people were referred to community based health care professionals if their support was necessary.

Is the service caring?

Observations of interactions between staff and people who used the service indicated a calm and respectful atmosphere. Staff were seen to focus on the individual and take time to explain what they were doing.

Comments from people who used the service and visitors included: 'I have always found the care good here'; 'I'm very happy with the care my relative has. The staff are marvellous'; and '[staff are] always very helpful. Always willing to help if we ask'.

Is the service responsive?

We did not look specifically at the service's complaints procedure. However, people using the service and visitors who we asked during our visit said they believed they would be listened to if they had a complaint. One visitor told us that the manager was 'helpful' and 'looks into issues'. Another person told us 'I know staff listen to me'.

We saw that there was an effective quality monitoring (QM) and quality assurance (QA) system. This meant that the service was able to identify and respond to any shortfalls in the service, as well as recognising the strengths of the service people received. The QM and QA system included reporting on actions which would further improve the service.

Satisfaction surveys had been distributed, but not many had been returned. The manager held monthly meetings where relatives could attend to express their views.

Is the service well led?

For several years this service has fluctuated between compliance with the required standards and non compliance with them. This is indicative of the management structure's failure to provide good and consistent leadership over time. Since the last inspection the service provider had engaged a management company to assist in the management of the home. A new manager had also been recruited with the intention of continuing after the management company withdrew.

At the time of this visit the new manager was still consolidating their position. It was too soon after their appointment to assess fully if they would be able to maintain consistently good leadership at this service. However, everyone who we spoke with who expressed a view, spoke positively about the impact of the new manager. Staff talked about the manager as being pro-active and approachable. Staff told us they were more involved in the care planning and that things were 'really improving'. Comments from visitors included 'The new manager is helpful' and '[the new manager] seems respected by staff. She is very fair and very interactive'.

People using the service and visitors who we spoke with were generally positive about the service provided. Comments included 'staff are alright. They do their best and treat you as an individual'; 'any questions I have they will answer straight away, or if they don't know they will find out'; 'it's really good here'; 'I feel looked after. I get a good standard of care' and 'as for Mum's care I can't speak highly enough of it here'.

Records relating to people consenting to their treatment were not well maintained. Staff did not always appear to recognise the limited nature of a family member's right to provide legal consent to care and treatment.

Staff were not always aware of the content of written care plans.

There were infection control policies and procedures in place. However, these were not always understood or followed by all staff.

The building was clean, tidy and well maintained.

There were usually enough staff on duty to meet the needs of the people living at the home.

Checks were carried out on staff before they starting working at the home to ensure they were suitable to work with vulnerable people. However, in some cases the recruitment procedures were not applied rigourously enough.

Many of the people living at the home had complex health care needs such as dementia. This meant that they were unable to tell us about their experiences of receiving a service. However, we spoke with six people who lived at the home and visitors to four people. People told us that it was 'alright' living at the home. One person said they received 'good care' and the staff were 'respectful'. Another person said the staff were 'helpful' and 'knew what they were doing'.

We saw that people received respectful and supportive care from staff. The three care staff we spoke with demonstrated a good understanding of providing individual support to people.

We saw that people's health, care and nutritional needs were monitored and supported. People told us that the food was 'lovely', 'pretty good' and 'I enjoy all my meals'.

People told us that they had been asked their opinion of the service they received.

Equipment was available to meet the needs of people and staffing levels in the home were reviewed and monitored to make sure people received the care they needed.

We spoke with four people staying at the home and with visiting relatives for two people. Two people said 'The staff work very hard'. One person said 'Everything is lovely' when asked about the care. Visitors for two people with complex care needs said they were satisfied with the care their relative received. One visitor said, 'The girls [staff] are excellent'.

People told us that they were involved in their care and visitors told us that they were kept up to date about their relative's progress. We heard from people and visitors that they felt confident to raise any concerns or complaints with staff and the manager.

We looked at the care records for three people. We saw one care file needed updating and another care record contained very generalised information. We observed one person had to wait about 20 minutes for assistance and another person was moved in a wheelchair without footplates potentially putting the person at risk from injury.

We found that the management of medication was safe. One person told us it was their preference that staff administered their medication.

We saw that records of new staff recruitment were appropriate.