Background to this inspection
Updated
3 February 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on the 13 December 2017 and was unannounced.
Prior to the inspection we reviewed information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.
Prior to the inspection we spoke with the local authority quality monitoring and safeguarding teams. They raised some concerns regarding medication which we followed up on this during the inspection.
The inspection was carried out by two adult social care inspectors and an expert by experience with experience of caring for older people. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
During the inspection we spoke with 12 people using the service and five people’s family members. We looked at the care records for three people and the recruitment records for four members of staff. We also looked at other records relating to the day to day running of the service, for examples audits and maintenance records.
Updated
3 February 2018
The inspection took place on the 13 December 2017 and was unannounced. At the last inspection in 2015 the service was rated as ‘good’ overall, but ‘requires improvement’ in the well-led domain, due to a lack of stable leadership. At this inspection there was clear and stable leadership in place. There were no breaches of Regulations identified at this inspection.
Acorn Hollow 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 registered to provide nursing care and support for up to 48 older people. At the time of the inspection there were 43 people living at the service. The service is spread over two floors. The ground floor accommodates people with more complex nursing needs, whilst the first floor accommodates people with less complex needs.
There was a registered manager working at the service who had been registered with the CQC since October 2011. 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.
Staff had completed training in areas needed for them to carry out their roles effectively. This included training in areas such as moving and handling, safeguarding and life support. In one example the registered manager and another member of staff had provided cardiopulmonary resuscitation (CPR) to a visitor who had become unwell. This had resulted in this person’s life being saved. This demonstrated that staff had the skills necessary to deal with emergency situations.
People were protected from the risk of abuse. Staff had completed training in safeguarding vulnerable adults and were aware of the processes for reporting incidents. There was a whistleblowing policy in place which was displayed on the staff noticeboard. Staff were aware of this.
Recruitment processes were safe and there were sufficient numbers of staff in post to keep people safe. New staff had been required to provide two references, one of which was from their most recent employer. They had also been subject to a check by the DBS to ensure they did not have a criminal history. We reviewed staffing rotas which showed consistent numbers of staff were in place. This helped ensure people’s needs were being met in a safe manner.
People were supported to take their medication as prescribed. Medication Administration Records (MARs) were being signed by staff as required and medication was being stored securely, in line with legal requirements. People confirmed that they received their medication as prescribed.
People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Information regarding people’s mental capacity was included in people’s care records and Deprivation of Liberty Safeguards had been applied for by the registered manager as required.
Risk assessments were in place to keep people safe. These were reviewed to ensure they stayed accurate and up-to-date and provided staff with the information they needed. This helped ensure that risks to people were safely managed.
Accidents and incidents were monitored and appropriate action taken in response to these to prevent them from occurring again in the future. For example where people were at risk of falls protective measures had been implemented, such as using movement sensors or bed rails to protect people.
Care records were in place which clearly outlined people’s needs and provided details to staff around what support they needed to provide. These were reviewed and updated on a routine basis to ensure the information remained accurate.
Positive relationships had been developed between people and staff using the service. People commented that staff were kind and caring, and we saw examples where staff engaged with people in a compassionate and friendly manner.
People confirmed that there were activities for them to participate in, such as day trips and arts and crafts. There was a 'wellbeing co-ordinator' in post who was in charge of organising activities. During the inspection they spent time doing group activities or one-to-one sessions. There were links with the local church who held regular services at the home. This helped to protect people from the risk of social isolation.
Audit systems were in place to monitor the quality of the service and to generate improvement. People and their relatives had the opportunity to give feedback regarding the service, and action was taken in response to their views.