Archived: Acacia Nursing Home

Acacia Nursing Home was last inspected in February 2018, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. We identified significant concerns with the safe care and treatment of people including medicine management, choking risks and pressure care. People who lacked capacity were not having decisions made in line with current guidance. Staff levels and training were not adequate to keep people safe. There was a lack of governance by the management to monitor the quality of care people were receiving. Legal notifications had not been received by the Care Quality Commission as required.

Following the inspection, we restricted admissions to the service and required the provider to send us a monthly report of how they were improving the concerns we found. The provider sent monthly audits to demonstrate the progress they thought they had made. We also placed the service in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During this inspection, in August 2018, we found some improvements had been made. Most people who lacked capacity now had decisions made in line with statutory guidance. Staff had improved amounts of training. There was improvement around fire safety in the home and people were at less risk of choking. The management had started to work on the culture of the home and improve the environment. Recruitment systems for new staff had improved.

However, significant concerns were still found with the management of medicines, pressure care and the management of the home. Staff levels were not safe enough to meet people’s care and health needs. Accidents and incidents had been logged yet patterns of concerns had not been investigated. Quality assurance systems had not identified shortfalls found during this inspection. Where they had identified issues, they had not always been followed. One safeguarding had not been identified and not all significant events had been notified to the Care Quality Commission in line with their statutory requirements.

Acacia Nursing 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 can accommodate up to 39 people. There were up to 24 people living at the home during this inspection because two people had time in hospital. The building is purpose built and has a courtyard garden in the middle. There are three floors with communal spaces such as lounges and dining rooms on each floor. At this inspection everyone had their own individual bedroom.

One of the directors was acting as the manager at the time of this inspection. This was because a manager was absent who was currently completing the process of becoming the registered manager. 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 service continued to not be well led and some shortfalls identified during this inspection had not been identified by the quality assurance processes. There was still some disorganisation by the management and systems in place to audit the service people were receiving were not always acted upon. The provider had still not completed all statutory notifications in line with legislation to inform external agencies of significant events. There continued to be issues locating some documents and providing information in the required time frames.

People remained unsafe at the home because people did not receive care and treatment in line with their health needs. There were risks of infections spreading because practices found around the home did not always keep it clean. Some risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. However, when people had a new health risk, systems had not been put in place to mitigate them. Medicines were still not managed safely.

Staff had received most of the training to have the skills and knowledge required to effectively support people. However, when people were identified as at risk of seizures no training had been provided and medicines competency checks for nurses had not been completed. People told us their healthcare needs were met and staff supported them to see other health professionals. Most people who required special diets and drink now had their needs met. One person with a special diet had not been reviewed since moving into the home. Meal times were not always treated as a social opportunity and special thickening agents were left unsecure in people’s bedrooms.

There were not enough staff to meet people’s needs consistently and keep them safe. People were not always protected from potential abuse because systems had not always identified when this had occurred. Staff understood how to recognise signs of abuse and knew who to report it to. The recruitment procedures were in place to protect people from unsuitable staff supporting them.

Some staff had developed incredibly positive relationships with people. Most people’s privacy and dignity had been respected. However, there were many times interactions between staff and people were task based. Staff did not always offer choice to people.

There were no permanent activity coordinators at the time of the inspection. Despite this activities were provided in communal spaces on the ground floor. However, there were times people’s personal interests had not been considered. People in their bedrooms lacked activities. There continued to be mixed opinions about whether complaints were investigated and responded to in a timely manner. No records of actions taken to prevent reoccurrence had been made.

Most people and their relatives told us, that permanent staff were kind and patient. People’s care plans had been improved to make them personal. However, they still contained inconsistencies and there was sometimes a lack of specific information to guide staff to people’s needs and wishes. People continued to not always be supported to have all areas of their life considered prior to their death.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, a breach of the Care Quality Commission (Registration) Regulations 2009 was also identified. All of these breaches were repeated from the previous inspection in February 2018. You can see the action we took at the end of the report.

The overall rating for this service is ‘Inadequate’ and the service therefore will remain in ‘special measures’.

When Acacia Nursing Home was last inspected in June 2017, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. We identified the provider had failed to ensure that all risks had been mitigated to people living at the service because records had not been accurately maintained. In addition, we found the provider had not fully implemented effective systems to monitor the quality of care people received. Legal notifications had not been received by the Care Quality Commission as required.

The provider wrote to us following this inspection in August 2017 to tell us the actions they would undertake to achieve compliance with the regulations. During this inspection, we found the provider had failed to undertake these actions. In addition to this, we found additional breaches to the Health and Social Care Act 2008.

Acacia Nursing 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 is able to accommodate up to 39 people. At the start of the inspection there were 35 people living at the home and one person was in hospital. The building is purpose built and has a courtyard garden in the middle. There are three floors with communal spaces such as lounges and dining rooms on each floor. At this inspection everyone had their own individual bedroom.

There was no registered manager in post at the time of this 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. At the time of the inspection recruitment was being undertaken to employ a new registered manager. Whilst they were doing this one of the directors, a qualified nurse, was acting manager. They were supported by a deputy manager and nurses. During January 2018 there had been a manager in post recruited by the provider to be the registered manager. They had resigned prior to this inspection.

The home was not well led and shortfalls identified during this inspection had not been identified by the directors. There was a disorganised approach from management and lack of systems in place to audit the service people were receiving. The provider had not completed all statutory notifications in line with legislation to inform external agencies of significant events. The provider was not clearly displaying their current inspection rating for the service as required. Many documents could not be found or did not exist at the time of the inspection.

People were not safe at the home because people did not receive care and treatment in line with their health needs. There were risks of infections spreading because the management did not have clear systems in place to manage infections. Some risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. However, not all risks had been identified and those that did lacked guidance for staff to follow. Medicines were not managed safely.

People who required special diets and drink did not always have their needs met and when people were eating in communal areas meal times were not always treated as a social opportunity. Staff had not always received training to have the skills and knowledge required to effectively support people. People told us their healthcare needs were met and staff supported them to see other health professionals.

People were not always protected from potential abuse. Staff understood how to recognise signs of abuse and knew who to report it to. However, there were times action had not always been taken or in a timely manner. The recruitment procedures in place had not always been followed to protect people from unsuitable staff supporting them. There were not enough staff to meet people’s needs consistently and keep them safe.

Staff had developed positive relationships with people. There were mixed opinions about whether people liked living at the home. People’s privacy and dignity had not always been respected and staff did not always offer choice to them.

Activity coordinators liaised with people about the activities they would like. However, there were times people’s personal interests had not been considered. There were mixed opinions about whether complaints were investigated and responded to in a timely manner.

Most people and their relatives told us, that staff were kind and patient. People’s care plans were sometimes generic and lacked personalised details to help guide staff to their needs and wishes. People were not always supported to have all areas of their life considered prior to their death.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, a breach of the Care Quality Commission (Registration) Regulations 2009 was also identified. Three of these breaches were repeated from the previous inspection in June 2017. You can see the end of the report for the actions we took.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The inspection team inspected the service against two of the five questions we ask about services: is the service well led and safe. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At the last inspection in August 2018, the service was rated inadequate. We had found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. These were all repeated from the February 2018 inspection. We identified significant concerns with the safe care and support of people including ongoing medicine management and pressure care issues. Staffing levels and training were not adequate to keep people safe. There was a lack of governance by the management to monitor the quality of care people were receiving. Legal notifications had not been received by the Care Quality Commission as required.

Following the inspection in February 2018, we imposed some conditions on the provider’s registration to drive improvement in the home. After the August 2018 inspection, we continued to restrict admissions to the service because there had been little improvement. The provider was still required to send us a monthly report of how they were improving those concerns we had found. There had been a delay in us receiving the latest report and this was provided during the inspection. The service remained in special measures due to a lack of improvement between February 2018 to August 2018.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection, there had been small improvements with the provider notifying us of significant events and with medicine management. However, substantial concerns were still found which placed people at significant risk of harm or actual harm. Most staff, including senior staff, told us they felt people were not safe at the home. Staffing levels were potentially dangerous at times including a high use of agency staff and there were periods of time people were not supported to keep them safe. People with specific health conditions were not having their needs met including pressure care and those at risk of seizures. The management continued to fail to identify and improve the service people received. Some concerns which had been resolved between February 2018 and August 2018 had returned. Staff were no longer being recruited safely. People who were at risk of choking were not always being supported safely.

Acacia Nursing 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 can accommodate up to 39 people. There were 26 people living at the home during this inspection. The building is purpose built and has a courtyard garden in the middle. There are three floors with communal spaces such as lounges and dining rooms on each floor. At this inspection everyone had their own individual bedroom.

There was now a registered manager at the home. 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 had recently returned to work after a period of being absent. This meant there was a period between the August 2018 inspection and this inspection where one of the directors, who was a nurse, was acting as the manager.

The service was not well led. There was a lack of communication between management. People, relatives and staff did not always feel listened to. Shortfalls identified during this inspection had not been identified by the quality assurance processes. Documents which should be readily available during the inspection were not always. There was still disorganisation by the management and systems in place to audit the service people were receiving were not always acted upon. The provider failed to have a monthly audit ready until the second day of inspection.

People were at significant risk of harm because they did not receive care and treatment in line with their health needs. Risks were found for people in relation to pressure area care and some people had suffered harm since the last inspection. Some people were placed at potential risk of choking and aspiration. Although small improvements had occurred with the storage of medicines we found medicines were not always managed safely.

Staff had not received training to have the skills and knowledge required to effectively support people. New staff did not have adequate training to keep people safe if they had not previously worked in care before and come with experience. Although thickening agents were now being stored securely, some people who required special diets and drinks did not have their needs met. At times, people were placed at risk of choking and aspiration.

There were not enough staff to meet people’s needs and keep them safe. Most permanent staff told us they were planning to leave or had a leaving date. There was a high use of agency staff. People were not always protected from potential abuse because systems had not ensured measures were put in place when allegations had been made. Staff understood how to recognise signs of abuse and knew who to report it to. The recruitment procedures were not ensuring people were protected from unsuitable staff supporting them.

People’s care plans had some improvements to make them personal. However, they still contained inconsistencies and there was sometimes a lack of specific information to guide staff to people’s needs and wishes. Guidance which was in place was not always known about by staff or followed.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some of these breaches were repeated from the previous inspections in February 2018 and August 2018.

Following this inspection, we identified significant risks to people’s safety and welfare. The local authority and other agencies took action to keep people safe and support people to move to other care homes. The provider decided they would close the home. The home is now closed.

You can see the actions we took at the end of this report.

Acacia Nursing Home is a care home which is registered to provide care including nursing and accommodation for up to 41 older people. The provider was applying to CQC to reduce this to 39 people due to recent renovations at the home; 27 of the bedrooms were going to be for people with dementia and 12 bedrooms were going to be for people with general nursing needs. At this inspection there were 33 people living at the home with one of these people in hospital during the inspection. The current provider started running the home from September 2016 and specialise in supporting people with dementia. There were people with various stages of dementia living in the home during the inspection with limited verbal communication skills. The home had a number of people who wished to live a more independent lifestyle within the safety and security of the care home.

The building is purpose built and has a courtyard garden in the middle. There are three floors with communal spaces such as lounges and dining rooms on each floor. At this inspection everyone had their own individual bedroom. The provider has some people completing periods of respite as part of a pilot scheme with a local hospital.

There is 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.

People were not always kept safe at the home because staff did not have access to the most recent records for some due to a transfer to electronic care plans. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. However, the ones in use by staff were not always complete or the most up to date version. People were not always protected from abuse because external agencies had not always been informed and actions taken had not been recorded.

Most medicines were managed safely and stored appropriately including those requiring additional security. However, some improvements were needed for when a medicine was mixed in with food or drink and some people’s medicine stock being transferred to other services.

The home had not always been well led. People told us the management was supportive and had made positive improvements to make the home a happier place. The registered manager and provider had some systems to monitor the quality of the service and made some improvements in accordance with people’s changing needs. However, some concerns found during this inspection had not been identified by the registered manager or provider. They had not completed statutory notifications in line with legislation to inform external agencies of significant events.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. However, when people lacked capacity the statutory principles had not always been followed. People who required special diets had their needs met and meal times were treated as a social opportunity. Staff had the skills and knowledge required to effectively support people. People told us their healthcare needs were met and staff supported them to attend appointments.

People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People, or their representatives, were involved in decisions about the care and support they received. People who had specific end of life wishes had their preferences respected by staff to help provide a dignified death.

Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. A programme of activities was in place to provide a range of opportunities. People were encouraged to suggest activities and trips which would respect their hobbies and interests. Complaints were fully investigated and responded to in a timely manner.

We made a recommendation about making decisions for people who lack capacity.

We have found one breach in the Care Quality Commission (Registration) Regulations 2009 and two breaches in 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.