Archived: Little Acre Care Home

Little Acre is a residential care home providing personal care for up to 14 people aged 65 and over. At the time of the inspection there were 14 people living there at the home, some of whom were living with dementia.

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

People and their relatives said the service was very caring. Staff highly valued each person and people genuinely mattered to them. Staff developed kind and compassionate relationships with the people they supported.

People were treated with dignity, respect and sensitivity. They were supported to retain as much independence as they could.

Staff were gentle, patient and respectful towards people. They spent lots of time with people and helped them to enjoy the things they wanted to do. The atmosphere in the home was very friendly, calm and welcoming.

People said they felt safe at the home. There were enough staff to support them whenever they needed it.

The home was clean, warm and comfortable. Staff knew how to protect people from avoidable harm. People at risk of falls or poor health were provided with the assistance and equipment they needed.

Staff said they had good training and support to care for people in the right way. Staff worked well with other health agencies and people were supported to access health services.

People said the meals were very good. Staff encouraged people to eat and drink enough and they had lots of choices about their meals.

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; but the policies and systems in the service did not always support this practice. The service did not always work within the principles of the Mental Capacity Act and best interest decisions were not always correctly recorded. We have made a recommendation about this.

People had interesting activities to take part in and were supported to be part of their local community. The service continued to be managed in a way that promoted individualised care for each person.

The provider and management team were open and approachable. They encouraged a caring, friendly culture amongst the staff team.

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 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection we looked at all the areas where the home had breached the regulations described above, and other areas to ensure that we carried out a fully comprehensive inspection of the services provided. We found that there had been significant improvements across all areas and the home was no longer in breach of the regulations.

Throughout this period the provider worked closely and co-operatively with CQC and the local county council commissioning and adult social care teams.

Little Acre Care Home is registered to provide accommodation for people who require personal care. The home can accommodate up to 14 older people, some of whom may have dementia. Accommodation is provided on the ground floor of a bungalow style property. All of the rooms are for single occupancy; 13 of the rooms provide en-suite facilities with the remaining room having close access to a communal bathroom. The home had one vacancy at the time of our inspection.

There was a new registered manager employed at the service since the last 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.

All of the people we spoke with during our visit to the home told us that they were “very happy” with the home and the support they received from staff. Everyone, including visitors and staff said they really liked the new registered manager. They found him “a breath of fresh air” and also said that both he and the owners were very approachable.

One person said; “I think it is excellent here, I looked at a few homes before I came here and I can’t fault it. This really is my home now.” Another said, ”The girls are very nice. I am safe and I comfortable and all my needs are catered for. What more can you wish for.” A third person said, “I’m very content. I couldn’t wish for better. I go to bed when I like and have a sleep in if I want. I can have cooked breakfast and the food is beautiful.”

Healthcare professionals told us of the staff, "They worked beyond the duty of care and always go the extra mile." Another said, "Definitely one of the best groups of staff I have ever worked with, they all really care, and the place is very person centred."

The ethos of the home was one of an extended family. Staff valued each person as an individual, people mattered and staff developed exceptionally positive, kind, and compassionate relationships with the people they supported.

Staff were very knowledgeable about people’s needs and about them as a person. This was a real feature of the home. One person said, “I love this home because its small and you get the personal touch. All the staff know me so well. I’ve known some of them and their families for years. This keeps me in touch with what’s going on. You can't buy that!” Another said, “This place really is my home. I do what I want as if I was at home.”

Training was now a positive feature of the home and staff were very upbeat about increased opportunities for learning. Staff were well supervised and supported to ensure they provided high quality care that was tailored to each person in order to promote people’s well-being and engagement.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Staff had received training and had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were encouraged and supported to make choices where they were able about all of their daily lives.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Medicines were handled safely and people received support with their medicines as they needed in a safe and timely way.

Healthcare professionals spoke very highly of the home and how they managed people’s health related conditions. One said, “I trust them to make the right decisions. If they call me I know I’m needed. The staff are excellent at communicating and managing quite complex health matters.” Another said, “I always get excellent handovers from staff who are very knowledgeable about the people they care for.”

People received exemplary end of life care at the home in line with best practice guidance. They were treated with dignity, kept peaceful, and pain free and staff supported families and those that mattered to the person to spend quality time with them.

The accuracy, quality and detail recorded in people's risk assessments and care plans had significantly improved. Risk assessments were in place that accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Records were now in place that reflected the care that staff provided.

Menus were varied with a wide choice of home cooked, nutritious food. Staff supported people who required help to eat and drink and special diets were catered for.

A wide range of both group and individual activities and entertainment were available for people. People said they had a really good choice of what to do with each day.

The environment was warm and homely. Improvements and redecoration were on-going and refurbishment was carried out sensitively to promote the orientation and independence of people who lived with dementia.

Infection control measures in the home were good. The staff team had been suitably trained and had access to personal protective equipment. The home was kept clean and orderly while still keeping a homely feel.

People were confident to speak to staff about any concerns if they needed to. Staff and people who used the service said the new registered manager was very approachable. People had the opportunity to give their views about the service. Feedback from people living in the home and from staff was acted upon in order to ensure improvements were made to the service when required. A recent quality assurance review was highly complimentary about the service they received.

People told us the service was well organised and managed. The registered provider set high standards and the new registered manager had set up systems that monitored the quality of the service to check these were maintained.

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 caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found

Is the service safe?

People told us that they were comfortable at the home. They told us that they had access to call bells so that they could summon help quickly when needed.

One person we spoke to told us, 'Staff are respectful and if I had any problems or concerns would speak to the manager or owner.'

We observed staff helping people with their mobility. We noted that assistance was given appropriately and safely. Staff explained the use of equipment and the procedures. This helped to reduce any anxieties service users might have had.

The staff we spoke to confirmed that they had received training with regard to adult protection and abuse. They were able to tell us about the signs of abuse and the processes that were in place to report any suspicions or allegations of abuse. Staff told us that they would not be afraid to speak out if they had concerns about the treatment of people who used this service.

We saw that CCTV had been installed in the hallway and communal lounge at the home. We were told that the camera in the hallway was in use as part of the security systems in place at the home. The camera in the lounge was described by the manager as 'a second pair of eyes.' We raised concerns with the manager and the owner about this camera and the implications it presented about people's privacy.

We found that restrictions had been placed on people who used this service and that there were times when they had been kept under close confinement within the home. Records showed the use of alarms and pressure pads but the records did not include how or why these decisions had been made. It was impossible to tell whether these arrangements were the least restrictive and had been placed on people in their best interests.

We spoke to the owner and registered manager about their responsibilities under the Mental Capacity Act 2005 with regard to the Deprivation of Liberty Safeguards.

We noted that the home was generally clean, tidy and odour free on the day of our inspection visit. There were areas of the home that were not as clean as they might have been and posed a risk to the control and prevention of infections.

We found that the provider had not always recruited new staff safely. Records showed that some required recruitment checks had not been carried out. This put people at risk of being supported by unsuitable staff.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving people in the planning of their care.

Is the service effective?

We found that people who used this service had received an assessment of their care and support needs but this had not included a detailed assessment of their nutritional requirements. More work was needed with this aspect of people's care needs to help ensure they received appropriate support and interventions when risks had been identified.

Care plan summaries provided useful information about care needs 'at a glance' for care staff, but these documents had not always been updated as people needs changed. This was particularly evident in the care plans of two people who had been identified for 'end of life" care.

The people we spoke to during our visit to the home told us that they were satisfied with the care and support they received and indicated that their needs were met. We observed that people who used this service all appeared well groomed and well cared for.

Risks and support needs had been identified but there were no clear and detailed strategies recorded to help ensure staff managed these safely and appropriately. We observed staff supporting people with their mobility. In the examples we saw we noted that support was given safely and appropriately.

Is the service caring?

The people we spoke to during our visit to the service told us that they were satisfied with the home and the service they received.

One person told us they were, 'Highly delighted with my care and treatment. The carers come in and help me when I need them. The staff are always polite and helpful.'

We were told by someone else, 'It's lovely here. I have regular baths and the food is good. I have a call bell in my room and the staff come quickly if I need them.'

The staff we spoke with were very knowledgeable about the care and support needs of the people who used this service. Staff could tell us about the needs of service users and what was recorded in their care plans.

We observed that staff were caring, attentive and treated people with respect. People were addressed by their preferred name, staff explained procedures to people during moving and handling transfers and checked that people had everything they needed to hand.

We noted that people were able to make choices about their daily lives. For example, what they had to eat and drink, the clothes they would like to wear and where they would like to spend their time.

We noted that people appeared well groomed and adequately supported with their personal care needs.

Is the service responsive?

We found that people who used this service had not received an assessment of their nutritional needs and support. There was some evidence of people having their nutritional intake and body weight monitored. More work was needed with this aspect of people's care needs to help ensure people received appropriate support with their nutritional requirements.

We spoke to the provider about the gaps in the care planning process. They told us that staff knew the needs of service user's. They told us that they, and the manager, 'Speak to the residents every day' so they knew about any changes to needs.

No one raised any current concerns or complaints with us. People told us that if they had any problems or concerns they would speak to the provider or the home manager directly. One of the people we spoke to told us of about an unpleasant incident they had experienced in the past. They told us that the provider had dealt with the matter to their satisfaction and that 'everything is alright now.'

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and involving people in the planning of their care.

Is the service well led?

We saw that there was an annual development plan for quality assurance and a business plan to help ensure any planned improvements for the home stayed on track.

No one raised any current concerns or complaints with us. Only one person told us that they had previously made a complaint about the service. They confirmed that the provider had listened to their concerns and that they had been dealt with appropriately.

There was information available to confirm that systems were in place to assess and monitor the quality of service provision. However, they needed to be developed further and implemented consistently across the service to help demonstrate they were effective.

The provider had procedures in place to help ensure a safe and good quality service was provided. However, we found that these were not always followed. For example, there were gaps in the staff recruitment processes. We found that restrictions had been placed on people with no recorded evidence of best interests assessments.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

People told us they were happy with the care and support they received and were pleased with their accommodation.

'I love my room as it is on the front of the house and I have a lovely view'.

'I like to spend time in my own room and the staff pop in to make sure I am alright'.

Some people in the home had limited verbal communication, therefore we spent time observing people's behaviour and their interactions with staff. We did not observe any overtly negative or harmful interactions between staff and people in the home.

People told us the food was "good" and told us that they were always given a choice and asked what they liked and wanted.

On our walk around the building we saw that bedrooms were well maintained and people had been able to personalise their rooms with their own pictures and personal items.