The Care Quality Commission
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  • Care home

Archived: Acre Green Nursing Home

Overall: Requires improvement read more about inspection ratings

Acre Close, Middleton, Leeds, West Yorkshire, LS10 4HT (0113) 271 2307

Provided and run by:
St Andrews Care GRP Limited

Important: The provider of this service changed. See old profile

All Inspections

13 July 2015

During a routine inspection

We inspected the service on 13 July 2015. The visit was unannounced.

Our last inspection took place on 18 and 23 February 2015 and, at that time we found the

service was not meeting the regulations relating to care and welfare of people who used the service; they did not have enough trained staff to meet the needs of the people in the home. Staff did not receive effective supervisions, medication was not given in a safe way and families were not supported to review care plans. The home had not made any applications for Deprivation of Liberty Safeguards (DoLs) and Mental Capacity assessments (MCA) were not completed for anyone who used the service. The home was not clean and the provider did not have effective systems in place to monitor the quality of the service. We asked them to make improvements. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. On this visit we checked and found improvements had been made in all of the required areas.

Acre Green provides accommodation and care for up to 50 older people. At the time of our inspection there were 36 people living in the home. The home is purpose built and there is car parking available. The home is divided over two floors and people living there have en-suite rooms. Both floors have communal lounges, dining rooms and bathing facilities. The home has a garden to the rear of the building which is secure.

At the time of our inspection there was a registered manager in 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.

During our visit we saw people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.

We found the service was meeting the legal requirements relating to Deprivation of Liberty

Safeguards (DoLS).

The service was meeting the requirements of the Mental Capacity Act 2005 (MCA). We felt staff had confidence in using the MCA to make best interest decisions for people who lacked the capacity to make decisions in relation to their care. We looked at two capacity assessments which had been completed in the home with family involvement.

Medicines were administered to people by trained staff and people received their prescribed medication when they needed it. Appropriate arrangements were in place for the ordering, storage and disposal of medicines.

We spoke with staff who told us about the action they would take if they suspected someone was at risk of abuse. We found that this was consistent with the guidance within the safeguarding policy and procedure in place at the home.

People told us the food at the home was good and that they had enough to eat and drink. We observed lunch being served to people and saw that people were given sufficient amounts of food to meet their nutritional needs.

We saw the home had a range of activities in place for people to participate in. Staff were enthusiastic and people’s relatives told us the activities had made a positive impact on the lives of their family members. This meant people’s social needs were being met.

We looked at five staff personnel files and saw the recruitment process in place ensured that staff were suitable and safe to work in the home. Staff we spoke with told us they received supervision every two months and had annual appraisals carried out by the registered manager. We saw minutes from staff meetings which showed they had taken place on a regular basis and were well attended by staff.

We saw the provider had a system in place for the purpose of assessing and monitoring the quality of the service. This showed through monthly and weekly audits that this was an effective system.

We found that staff had training throughout their induction and also received annual refresher training in areas such as moving and handling, Mental Capacity Act 2005, DoLS, safeguarding, health and safety, fire safety, challenging behaviour, first aid and infection control. The home had an action plan in place to ensure that staff were booked in for the relevant training when required. This meant people living at the home could be assured that staff caring for them had up to date skills they required for their role.

18 & 23 February 2015

During a routine inspection

The inspection was unannounced and took place over two days on 18 and 23 February 2015.

At the last inspection in September 2014 we found the provider was breaching four regulations. The breaches related to; care and welfare of people who used the service, meeting nutritional needs, cleanliness and infection control and assessing and monitoring the quality of the service provision. At this inspection we found the provider had made improvements in some areas but they were still in breach of three of the four regulations. We also found other areas of concern.

Acre Green is a purpose built home providing care for up to 50 people requiring personal and nursing care, some of whom may be living with dementia. All bedrooms are single occupancy with en suite toilet facilities. The home is arranged over two floors and both floors provide communal lounge and dining areas.

The home had a 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.

Staffing levels were not adequate to keep people safe and to allow them choice over their daily routine; we saw people’s preferences were not met. People were not given their medicines in a safe way. Appropriate hygiene standards were not maintained and this put people at risk of acquiring infections. Staff were recruited safely. Risk assessments were in place and the service had detailed personal evacuation plans for all the people who lived at the home.

Staff did not have effective support through appraisals, supervision and training to ensure they could effectively meet people’s needs. The service was not applying the Mental Capacity Act (MCA) (2005) and Deprivation of Liberty Safeguards (DoLS) effectively. The registered manager had not applied for a DoLS for someone who was under constant supervision. The registered manager and care staff could not tell us about the MCA and how to apply this to ensure people’s rights were protected. People told us they enjoyed the food and had been involved in changing the menus to accommodate their choices. However, we found people who needed more support to eat had to wait longer than those who were more independent. People were referred to health professionals as needed, and the home had good links with a local GP who visited every week to review people.

People looked well cared for and we observed good relationships and interaction between staff and people who lived at the home. People and their relatives spoke positively about the staff who looked after them. We were concerned about how people with pressure area care were looked after and we were unable to get a clear understanding from the registered manager about the support provided to people at the end of their lives.

People had their needs assessed before they moved into the home. Care plans were easy to follow and contained detailed information about how to meet people’s needs. Detailed risk assessments were also in place. However, people and their relatives told us they were not involved in reviewing their care plans. We were also told about difficulties people, their relatives and visiting professionals had communicating with some of the nursing staff. Activities were not individual to people’s likes and hobbies and people who were more dependent had less access to meaningful activity than people who were more independent. People knew how to make complaints and the provider was investigating two formal complaints at the time of our inspection.

The provider’s systems to monitor and assess the quality of service provision were not effective. They had not identified any of the issues we found during our inspection. The provider asked people to comment on the quality of care through surveys but results were not analysed or acted upon. People gave us mixed feedback about the support provided by the registered manager. Communication was not effective and we did not see evidence of regular meetings between the manager and staff, or people who used the service and their relatives.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which has since been replaced with 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.

22 September 2014

During a routine inspection

This inspection was carried out by an inspector, an expert by experience and a specialist advisor. Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff, senior managers, our observations and from looking at records. We spoke with 13 people who used the service, 6 relatives and 5 staff.

The manager was not present at the time of the inspection so most of the inspection was conducted with the deputy manager.

Acre Green comprises of two separate units. One unit provides care and support for people in a residential setting and the other nursing care. At our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

We found people were not always cared for in a clean, pleasant and hygienic environment. There were systems in place to manage infection control and prevention however, these were not effective.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Policies and procedures were in place and under review to ensure people's rights were protected.

Is the service effective?

Care records showed people had regular contact with health and other professionals. Specialist dietary, mobility and equipment needs had been identified in care plans when required.

People said they liked the staff and felt safe with them providing their care and support. However, several people spoken with expressed concerns about the way the service was managed. In particular people felt there were times when there was insufficient staff on duty. As a consequence of this they felt they did not always receive adequate assistance with personal care.

Training records showed most staff in the home had completed mandatory training and other appropriate training to meet people's care and support needs. This included training on caring for people living with dementia.

Is the service caring?

Most people told us they were treated with dignity and their rights were respected. However, we saw on occasions that people were not asked for their consent before any care interventions. For example, we saw people were not asked for their consent when putting aprons on people during meal times or when being assisted by staff with moving and handling.

We observed some very positive interaction between people who used the service and staff. However, there were occasions where we saw people being ignored. This might have been because staff were busy with other people.

Overall, people's family members were complimentary about the staff and the care and support their relative received.

We observed staff speaking respectfully and in a friendly manner with people who used the service. People also made remarks such as, 'It would be nice if they had time to have a bit of a chat, they're all nice, but they're so rushed and stressed, they can't.'

One person at the home told us care 'The care staff take care of me and are nice.' However they did comment of the different approach of the management staff in the home.

Is the service responsive?

There was a coffee morning on the ground floor during the inspection. However in discussion with people who lived in the home about activities a number of people said they would like to do more.

Records we looked at showed people knew how to make a complaint if they were unhappy. We looked at complaints records to see how they were dealt with. We found they had been investigated thoroughly and people were, in the main, responded to in a timely manner.

Is the service well led?

Senior managers from the organisation carried out a monthly audit to check standards and the quality of care being provided. We saw there were action plans developed when any shortfalls were identified.

The provider had systems in place to identify and assess risks to the health, safety and welfare of people using the service. However, though these did not reflect practise and peoples experience seen during the inspection.

Our overall impression was of a staff team that were mostly willing and caring, but at the inspection we were told they were not receiving effective support, direction and leadership from the manager and senior management team. Shortfalls demonstrated this situation had an impact on people who used the service.

This lack of effective leadership was also reflected in the frustration expressed by many people about a lack of response to expressed needs around significant factors in their care, for example the state of the mattresses and armchairs and staffing levels raised by people who used the service and staff working in the home.

18 December 2013

During a routine inspection

We found people were offered choices and had been involved in agreeing and reviewing decisions about their care. There were systems in place to obtain and record people's consent in all aspects of their daily lives. Where appropriate, the wishes of people with regard to future care and treatment had been recorded.

People said, 'I am always involved with decisions concerning my care', 'I like it here and they make things happy for me; they take notice of what I want.'

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People told us they were happy with the care and support they received. Comments included, 'I like to have my music on it's nice that I can play it and sit in my room and listen to it', 'There's plenty going on I can choose what I want to do', ' I like everything about it here' and 'Staff are brilliant, they give us loads of choices and are very friendly. '

The people we spoke with said the environment was clean and in good repair. We looked at some of the communal areas of the home, bathrooms, some people's bedrooms and the laundry area. We found all the areas to be clean and satisfactorily maintained.

Staff were required to attend mandatory training courses including moving and handling, health and safety and safeguarding vulnerable adults. Training records showed appropriate training was being delivered.

The provider had a policy on obtaining feedback from people who used the service. This included information from sources such as residents and relatives meetings, complaints and survey questionnaires.

We saw records of the checks and audits the Manager and Regional Manager carried out to make sure the home met the required standard. These included checks of care plans, staffing, the environment, quality of records and the catering facilities.

19 December 2012

During a routine inspection

At the time of our visit we spoke with seven people who lived at Acre Green and three visiting relatives to gain their views of the service. People told us how they were able to express their views and were involved in making decisions about their care and treatment. One person explained 'The staff talk to me about my care and check it's alright with me.' This was confirmed when we reviewed four sets of care planning documentation of people living in the home. We saw they had been signed by the person to confirm they agreed with the planned care. Another person said 'I can choose what I want to do. The staff ask me what I want to do and respect my choice. Like what time I decide to go to bed.' People spoken with said they were happy living in the home and would not hesitate to raise concerns if they had any.

Four of the six members of staff spoken with said they had concerns about staffing arrangements in the home. One member of staff commented 'There is a fast turn over of nurses. They don't seem to stay.' During our visit we also spoke with a visiting health professional who told us 'The permanent nurses are good, but it is a problem when an agency nurse is on duty when I visit as they don't know the people as well.' The provider may find it useful to note that people may be put at risk due to the lack of continuity of nursing staff with responsibility for the ongoing management of people's care needs.