Archived: Acocks Green Nursing Home

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five questions that we always ask;

Is the service safe?

We saw that people were cared for in an environment that was maintained and suitable to

meet their needs. All the people we spoke with told us they felt safe living there. One person told us, "Staff are very kind and patient feel very safe'. Another person said, 'Staff are good, lots of patience'. Staff spoken with told us they had regular training updates. This meant staff had the skills to keep people safe. We saw that equipment was available to minimise risks for people when providing care. This meant people's needs were met safely.The deputy manager told us no applications had been made under the Deprivation of Liberty

Is the service effective?

We saw that people's individual needs had been assessed and that there were enough suitably trained care staff to care for people. We saw that there was more stability in the care staff team compared to the time of our previous inspection. The provider informed us that agency staff were only used in an emergency and that they would ask for staff who had been there before to ensure continuity of care. This meant that people would receive care and support from some staff they knew and that knew them.

All the people that we spoke with told us they were happy with the care and things at the home had improved. One person told us, 'I have seen lots of improvement, I am happy here and it's a lot better.' We saw that staff knew people well and were attentive to their needs whilst supporting them to be independent. One person told us," I could not ask for better staff to help me. They are all lovely.''

Is the service caring?

All the people we spoke with and our observations told us that the staff were caring. One person told us, "There are no rules, they look after you really well''. Another person told us, "They (staff) help me when I need help but they always ask if they can do anything." Another person said, 'Staff are nice.' We saw that staff attended to people's needs with sensitivity so that their dignity.

All the people we spoke with told us and we saw that staff respected their privacy and dignity and that they were given choices about their care. We saw that people were well presented in individual styles. Records confirmed and people told us they were supported to attend healthcare appointments and referrals were made to other health care professional when required. This meant people were happy with their care and the provider took the appropriate action to involve other health care professional to ensure people's health and welfare was monitored.

Is the service responsive?

We saw that staff were attentive to people's needs and spoke with people respectfully. We saw that staff asked people if they wanted drinks and encouraged them to make choices. All of the people that we spoke with told us that staff asked them if they would like to be supported with personal care tasks such as bathing. One person told us, "The staff always ask and wait for me to give them an answer. I have never been made to do anything that I have not agreed to." One staff member told us, "I always ask people, what they want me to do' 'This meant that staff were able to provide care that met people's needs according to what they wanted on a daily basis.

All the people we spoke with told us there were no restrictions on family members visiting the home showing that the service was responsive to people's needs and enabled them to maintain relationships with people

Is the service well led?

The service had had a number of changes in the management team over the past year. A number of manager's had been brought in by the provider to improve the service. There was no registered manager in post at the time of the inspection; however an application had been submitted to us to register the acting manager.

There was a system in place to ensure that the quality of the service was monitored. We saw that some audits undertaken by the provider were not always effective and analysed so that actions could be taken to address trends and areas for improvement.

We saw that records in the home required improvement to ensure that care was provided the way that people preferred and needed at all times. We saw that people's care records were not person centred and were repetitive in relation to how people spent their day. This meant the provider could not be assured that people living there lead a meaningful life and their social needs were met.

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five questions that 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?

We saw that medicines were managed safely and people generally received their medicines as prescribed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes and hospitals. No applications had been made and we did not see anyone's liberty being restricted but we noted that not all the staff had got a good knowledge of the Mental Capacity Act or DOLS. This meant that people's rights may not be safeguarded.

Staff were alert to the signs of or potential for abuse of vulnerable adults and knew what actions to take in the event of an occurrence. One person told us, '(I'm) quite happy with everything, I feel safe and staff are fine.' A relative told us, 'I feel mum is safe.'

Whilst the provider had made efforts to improve the standard of care records further improvements were needed to ensure that all needs and risks were identified and issues of concern were acted on.

Is the service effective?

We saw that people's individual needs had been assessed and that there were enough suitably trained care staff to care for people. We saw that there was more stability in the care staff team compared to our previous inspection. This meant that people received care and support from some staff they knew and that knew them. However, we saw that there was still a high dependency on agency nurses. We saw that care staff and nurses were not always knowledgeable about people's needs and this meant that there was a risk that people's clinical needs were not planned and delivered in an individualised way. One person told us, 'Nurses don't always know your needs.' We saw that this was the case during our inspection and some visiting professionals also commented that this was the case.

We saw that systems were in place for passing on information between shifts and to the manager were not effective. This meant that the required information was not passed to the right person so that follow up actions could be taken.

We saw that systems for monitoring weights, falls and incidents were not effective. This meant that people were at risk of not having their needs adequately met.

Is the service caring?

We saw that generally all the staff were caring towards people and wanted to meet the needs of people living in the home. This was apparent when they talked about them and we saw interactions throughout the day that confirmed happy relationship between staff and people who used the service.

All the people we spoke with and all but two of the relatives told us they were happy with the care provided. One relative told us, '(The staff are) Striving to make things a lot better.' Another relative told us they were generally happy with the care but they also told us they were not happy with the quality of food their relative had received for breakfast on the day of our inspection and another told us they were considering an alternative placement.

Is the service responsive?

We saw that the service had listened to people when they had a trial period when the main meal of the day was provided in the evening rather than at midday. As a result of people's comments the main meal was returned to being served at midday.

We saw that complaints were looked into and people were responded to in a timely manner. We saw that activities were not enjoyed by everyone taking part on the day of our inspection. No actions were taken to ensure that people were supported to take part. At lunchtime we saw that not everyone received the level of encouragement to eat as they needed. This meant that sometimes the service was responsive but improvements could be made.

Is the service well led?

The service had had a number of changes over the past year in the management team at the home. A number of manager's had been brought in by the provider to improve the service. However, none had remained in place for a length of time to ensure continuity of service improvement and ensure that new systems were embedded so that the required improvements were achieved. There was no registered manager in post and no applications had been received to register one although we were told during our inspection that an application had been submitted. This meant the provider was in breach of their condition of their registration. We may take further action if the provider continues to be in breach of their conditions of registration.

There was a system in place to ensure that the quality of the service was monitored. This included regular audits of issues such as falls and people who had lost weight. We saw that there was not adequate analysis of the causes or trends to enable appropriate actions to be taken to address the causes of the identified trends.

We were told that the acting manager had sent surveys to relatives to gain their views about the service but they had only recently been received back and therefore no analysis had been undertaken. There were other systems in place to gather people's views such staff and relative meetings and we saw that actions were taken as a result of issues raised.

We saw that records in the home required improvement to ensure that care was provided safely at all times. Not all records seen were accurate in relation to people's care. Records were not always kept locked away securely.

On 18 September 2013 we issued a warning notice to the provider as they were not monitoring and assuring the quality of the service people received. At this inspection we saw that sufficient improvements had not been taken to assure the quality of the service. We saw that there had been another change in the leadership at the home. This meant that the required improvements had not been made.

On occasions people's needs were not adequately met in a well-planned and individualised way. One person told us, "They are supposed to bring a drink in the morning but some days they don't.'

There were adequate numbers of staff available in the home but there were high levels of agency staff in use. One agency staff told us that they did not get sufficient information to meet people's needs. A relative told us, 'We keep getting new people; they don't know what (the resident) needs or how to use the equipment.' This meant that people were not receiving continuity of care.

People were provided with choices and support at mealtimes so that their nutritional needs were met.

We saw that some improvements could be made to the management of records to ensure that staff had up to date information about people's needs.

Two relatives told us they were happy with the care provided. Five relatives said they were happy about some aspects of the care. One of them told us staff sometimes refused to support their relative and two others told us that they did not feel listened to and one said, "We are offered the earth but nothing changes."

Two people living in the home said they wanted to leave. People were concerned at the regular changes in the staff team. One person told us, "They keep losing staff". This meant people were not always happy with the service they received.

People were supported to have choices and nutritious food to eat. People told us that the standard of the food had improved. This meant that people were happy with the food they received.

There were sufficient staff on duty to meet people's basic care needs but people were bored as there were no meaningful activities to occupy them. One person said, 'Not a lot going on, do a jigsaw to keep active, would like something else to do but no one to do things with at the minute. Suppose I am lucky other people just sit there.'

There was not a robust system in place to monitor the quality of the service and to ensure that improvements were made and sustained.

Both relatives told us they were happy with the care being provided. One relative said; 'Care wise very happy. Mum gets the care she needs.' Another relative told us they were happy with the care and, 'If I raise any issues they get dealt with.' Some people told us that they were bored. Three of the people said they were happy with their care. This showed that people were happy with some aspects of the care provided.

We saw that some people were not supported with their food and drink in a timely manner. This meant that people were waiting for drinks during the day and that sometimes their food and drinks were cold by the time they received support.

People were not always protected from harm due to the way information was passed on and due to some staff practices.

People did not always get the support they needed in a timely manner and that met their emotional and social needs. Interactions between staff and people were generally task orientated.

There was not a robust system in place to monitor the quality of the service and to ensure that improvements were made and sustained.

Before this inspection, we received information of concern about staffing levels, and the care people were receiving.

We looked at records of the care given to people. The records indicated that people did not always receive the care they needed. One relative told us that, 'X presses the buzzer but no one comes.' We saw that emergency call bells were not always responded to when activated during our visit. This meant people did not always get the help they needed in a timely way full stop

We saw that tables were placed in front of people some people restricting their movements.

On the day of our visit we saw that people were supported to eat their food when needed and people received their meals in a timely manner. One person told us, 'The meat is good.'

We saw that the staffing levels meant that people were not always assisted to get up at the time they wanted. Staff confirmed when we spoke with them that it was quite late when they assisted people to get up. This meant there were not sufficient staff available to enable people to be supported to get up at the time they wanted.

At this inspection we looked at the improvements that had been made in relation to this.

People's care records had been improved so they reflected the care that people were getting.

The environment had been improved so it was a nicer place for people to live in.

Staff had received some training and support so they had the skills they needed to meet people's needs.

Systems in place to monitor the quality of the service provided to people living there had improved. So risks to people were identified and dealt with.