We carried out a review of the data available to us about Acer Court Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Acer Court Care Home, you can give feedback on this service.
We found the following examples of good practice.
Acer Court Care Home ensured current government guidelines in relation to COVID-19 were being followed by staff and visitors to reduce the risk of infection to people living at the home. This included comprehensive checks for visitors and staff on arrival to the home.
Acer Court Care Home had an online booking system for visits so that visitors could book a visit directly without needing to contact the home. Visitors were still able to contact the home directly to book if they did not want to use the online system.
Acer Court Care Home had a full-time visiting coordinator who focussed on supporting people who lived there and friends and family with visits.
Acer Court Care Home supported people who lived there to remain connected with friends and relatives through visits, video calls, phone calls and letters.
People’s experience of using this service and what we found
Systems and processes were in place to ensure people were kept safe. Risks were monitored and managed with robust instructions to support staff to identify risk. Staffing levels were managed, but not always deployed appropriately. Consideration was given to ensure the right staff skill mix was in place. Medicines were managed in a safe way. People received their medicines as prescribed. Infection control was followed in line with legislation. Accidents and incidents were managed with corrective action taken and lessons learned.
We recommend the deployment of staff is regularly reviewed to ensure enough suitably qualified staff is available to meet people's needs.
People's needs were assessed, and this was reflected in their care plan. Staff were fully supported and received training that provided them with the skills to do their job. People were kept nourished and hydrated as meals and snacks were of a high standard. The provider had connections with the community and had a positive working relationship with other agencies and healthcare professionals. Individual needs around people’s mobility and wellbeing was met. Acer Court had a lovely warm friendly and homely environment, which was calm and relaxing for people. There were clear systems and processes to support people to access healthcare services. The managements and staff understood the principles of the Mental Capacity Act 2005. They ensured best interest and decisions for people were met. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People were cared for by staff that demonstrated and promoted dignity and respect. People were supported to make decisions and staff respected their diverse needs. Where required people had access to information to help them have their voice heard by accessing an advocate or representatives to support them. People were encouraged to lead an independent lifestyle.
People received exceptional personalised care from staff who were knowledgeable and skilled to care for them. Visiting professionals felt staff focused on people’s individual care needs. Staff and the management team worked with passion and dedication and went above and beyond to achieve excellent outcomes for people. The service was creative and innovative in supporting people to live well independently, by using technology to support this. People were encouraged to keep in touch with family and make friends. There was a welcoming committee run by people in the home that supported people to settle into the home without disruption. Staff and the management team were passionate and dedicated to achieving positive outcomes for people. There was an open and transparent culture when dealing with complaints. End of life care was discussed with people and their wishes documented.
There was a clear positive culture throughout the staff team. People felt the home was well managed. We received overwhelming positive comments about the management of the service. The provider had good clear vision and values of how the service would run. Staff were passionate about providing high quality care. The service had received a number of awards for good practice in caring and employment. People and relative meetings were held regularly, and people could voice their opinions. There were good links with the local community that suits people preferences and choices. The registered manager was extremely proud of a process they had helped to develop and provide joined up care. Quality assurance was robust and a strong focus on continue learning. The registered manager and staff worked well with external healthcare professionals.
Why we inspected
This was a planned inspection based on the previous rating.
The last rating for this service was Good (published 23 June 2016).
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Acer Court on our website at www.cqc.org.uk.
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.
Accommodation for up to 78 people is provided in the home over three floors. The service is designed to meet the needs of older people. There were 70 people using the service at the time of our inspection.
A registered manager was in post and she was available during the 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.
People felt safe in the home and staff knew how to identify and respond to potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe. Sufficient staff were on duty to meet people’s needs. Staff were recruited through safe recruitment practices. Safe infection control practices were followed, however; medicines were not always safely managed.
Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate. The adaptation, design and decoration of the service could be improved to support people living with dementia.
Staff did not always protect people’s dignity and treat them with respect. Staff were generally kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.
People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.
People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the registered manager and that appropriate action would be taken. The provider and registered manager were aware of their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.
Acer Court is registered with the Care Quality Commission to provide accommodation for up to 75 older people with varying support needs, including dementia care. The service is delivered over three floors. We inspected the service on 16 and 17 December 2014.
This inspection was carried out to see if improvements had been made to the service in relation to the care and welfare of people who used the service, staff support and supervision, safeguarding people from abuse and how the quality of the service was monitored. The provider sent us an action plan detailing how they were going to make improvements. When we carried out this inspection we found that actions had been completed and improvements had been made.
Since the time of our last inspection a new manager has been appointed and they had applied for registration with us. 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.
This inspection was carried out by three inspectors on day one and two inspectors and a specialist advisor on day two. The specialist advisor was a person who had specialist knowledge in relation to supporting people with dementia care needs.
People who used the service told us that they felt safe living at Acer Court. Throughout the inspection we saw staff treat people appropriately and with dignity and respect. We saw that staff were kind and caring when supporting people.
People told us that there enough staff to meet their needs. They said that staff responded to requests promptly and that they did not have to wait very long for call bells to be answered.
People who used the service told us that they were able to make choices about how they were supported and felt fully involved in making decisions that affected them. When people were unable to do this we saw that the provider worked with appropriate people to ensure that decisions made on their behalf were in the person’s best interest.
People told us that they liked the food at Acer Court. We saw that the monitoring of food and drink intake had improved since our last inspection. As a result staff could show that people received a varied and balanced diet.
We saw there were systems and processes in place to protect people and keep them safe. We spoke with staff who understood their role and responsibility in relation to offering safe and effective support. Systems were in place for staff to identify and manage risks and take actions when people’s needs changed.
Staff were recruited through safe recruitment practices and on-going monitoring had improved to ensure staff felt valued and effectively supported. Staff received training that was specific to meet the needs of the people who used the service.
Medicines were managed safely and people received their medication when they should.
People told us they knew who to speak to if they wanted to raise a concern and we saw that there were processes in place for responding to concerns. Staff knew the complaints procedure and people who used the service told us that they would be comfortable to make a complaint. A small number of relatives told us that they had not always been satisfied with how issues had been managed. Most told us that this had now improved. We found that communication had not always been effective however improvements had been made in this area. Some relatives told us that further improvement was still required. The regional manager (who was assuming day to day responsibility for the running of the home) acknowledged this and the newly appointed manager was aware of issues and had plans to address them as a priority.
There were effective systems in place to monitor and improve the quality of the service provided and these were now being used. Action plans, in response to audits and incidents, were now being shared with staff and senior managers to demonstrate improvements and identify areas where more work was required. This made staff more accountable for their actions.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The Deprivation of Liberty Safeguards are a code of practice to supplement the main Mental Capacity Act 2005 Code of Practice. We looked at whether the service was applying the DoLS appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these were assessed by professionals who are appropriately trained to assess whether the restriction is needed. The regional manager told us that no one currently using the service was having their liberty deprived. They were knowledgeable about criteria for requesting assessments and staff were mindful as to what constituted a deprivation.
The inspection team who carried out this inspection consisted of three inspectors. The inspection was unannounced, which meant the provider did not know we would be visiting.
During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?
Due to the complex needs of some people living at Acer Court Care Home they were unable to talk with us. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We used this to observe people in the lounge. We also carried out observations in other lounges in the service and observed lunch being served in all three dining rooms.
Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.
If you want to see the evidence that supports our summary please read the full report.
Safe
The service was not consistently safe.
People told us they felt safe and secure and we found staff had knowledge of when and how they should report any concerns about the safety of people using the service.
However, we found that some concerns and incidents had not been properly investigated by the registered manager and had not been shared with the local authority for consideration under their safeguarding adult's procedures. We found that where allegations against staff had been made, steps had not been taken to monitor and improve staff care practices. We also found a lack of systems in place to protect people from harm from other people using the service who had a history of aggressive behaviour. This meant action had not been taken to protect people from abuse or the risk of abuse.
We gave the information of five people who used the service to the local authority during our inspection. This was because we did not feel their care had been managed safely.
People consistently told us there were not enough staff on duty in the home and our observations supported what they told us.
Effective
The service was not consistently effective.
We found that although staff were given training, there were some staff whose training had lapsed. We found there were gaps in training in relation to supporting people with complex needs related to dementia.
People all had an individual care plan which was designed to set out their care needs. However, we found the plans did not always inform staff of people's current needs and abilities. This meant that people could not be sure that their individual care needs and wishes were known and planned for.
We saw that some people who had lost weight had not been referred to a dietician. This meant people were not always protected against the risks of inadequate hydration and nutrition.
Caring
The service was not consistently caring.
We saw that some staff showed patience and gave encouragement when supporting people. We received positive comments from people who were more independent. One person said, 'I am very happy here. I feel well cared for.' We observed staff interacting with people and we saw they were kind and respectful to them.
However, we found evidence that some people had not always been treated kindly and compassionately. We carried out this inspection in response to concerns raised regarding the care provided by some staff to a person who used the service. The investigation into these concerns was ongoing at the time of our visit. We are currently working with other agencies to investigate alleged poor care practice within the home.
Responsive
The service was not consistently responsive to people's needs.
Although people commented positively on the care they were given by staff, people's health needs were not always monitored and responded to appropriately.
When complaints had been raised, we saw these had been investigated and responded to. However records did not show whether people raising the complaints were happy with the response. Where there were trends in complaints, there was no analysis or learning from these to try and avoid further complaints of this nature.
Well led
The service was not consistently well led.
We found concerns in relation to the care and support people who used the service were receiving. Throughout our inspection it was clear that systems were not robust enough to ensure people received a service that provided consistent good quality care.
The home did not have effective systems to assure the quality of the service they provided. The way the service was run had been regularly reviewed but action had not always been taken to improve the service or put right any shortfalls found. Information from the analysis of accidents and incidents had not been effective in identifying changes and improvements to minimise the risk of them happening again.
We found that the service was not learning from experience because there was a lack of oversight when analysing or evaluating events to establish cause; identify any trends or themes and continually review practice. Whilst in some cases investigations were being, or had been, undertaken in relation to the conduct of some staff, there was no system in place to develop solutions and risk reduction actions to protect people and ensure future lapses were minimised.
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 safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well led?
Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records. We also spoke with the manager.
If you wish to see the evidence supporting our summary please read the full report.
Is the service safe?
During our visit we spoke with 15 people who received a service and observed how staff supported people in each part of the home. We saw examples of good care and support during this time. Everyone that we spoke with said they felt safe.
We saw that care plans were in place to identify how people's needs should be met. However it was difficult to find information on the three care plans that we reviewed in detail. For example we saw how changes had been recorded in the 'update' section of the plan but this was not reflected in the main text. This could lead to confusion and the registered manager acknowledged this. We also found that, on one file there was no information about health professional visits. One person, who was identified as being at risk of falls, had not had that risk assessed or safeguards recorded to reduce the likelihood. This meant that care and support had not been appropriately documented to ensure a safe and consistent approach. An external complaint investigation had made similar findings.
Is the service effective?
People who received a service told us that their needs were met in ways that they preferred. Everyone we spoke with said they were satisfied with the service that they received. One person said, 'We have everything we need'.
Is the service caring?
People were supported by staff who cared about their work. We heard staff speak with people in a calm and reassuring way. They responded to requests for support in a timely manner. Staff offered people choices to help them remain in control of their lives as far as they were able. For example, at lunch time, they showed people both meal options. This enabled them to make an informed decision.
Is the service responsive?
We found that the registered manager had responded to feedback about the service provided. For example they had set up a support group for relatives. The registered manager also told us about residents' meetings where people who received a service were able to share their views on the running of the home and make suggestions for improvements. For example they had suggested newspapers and a stereo in the lounge over recent months. These suggestions have been actioned.
Although we found that care plans were in the process of being redesigned and updated we found that some care needs were not being recorded or assessed appropriately and this had previously been identified following a complaint from a relative in July 2013.
The registered manager did not have records to reflect actions taken following investigations into alleged poor practice. This meant that they could not show how staff had been supported following the incidents or how practice had been improved and monitored.
Is the service well-led?
We saw how the registered manager did regular reviews and audits of systems and processes. They told us that they had effective monitoring tools that reassured them that they provided a good service. The manager also told us how the service provider worked with them to monitor and assess the quality of the service.
Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received an appropriate service at all times. Staff felt well supported by senior staff although supervision arrangements were informal. We could not see how the registered manager had followed up on staff performance issues when they had been bought to their attention. The registered manager was clear about their responsibilities in relation to reporting incidents to relevant agencies however they could not show us how they had followed procedure on all occasions.
We revisited the service over two days on 10 September 2013 and the 11 September 2013 and found improvements had been made.
We spoke with eighteen people who use the service. They told us staff always asked their permission before they provided care and treatment.
We also spoke with three relatives and six members of staff during our visit.
Where people did not have capacity to consent we found appropriate assessments had been completed.
People told us they were happy with the care and treatment they received. One person said, 'Staff are lovely, they are always nice to us.'
We found people who use the service received a choice of nutritious food and hydration and were supported with eating and drinking.
People told us they received their medication safely and staff were knowledgeable about people's needs and what medication they were on.
We found there was sufficient staff to meet people's needs.
People told us they received enough information regarding the service. They said they knew who to tell if they wished to raise a concern. We found complaints were investigated in line with the services policy and procedures regarding complaints.
People told us they were happy with the care provided by the service. They all felt safe. All people told us they received their medication when they needed it and they were happy that they could raise any issues of concern.
We found that people were treated with dignity and respect and were involved in their own care. We found that people did not always experience care, treatment and support that met their needs and protected their rights.
We found that people were safe but medicines were not always appropriately administered. We found that there were arrangements in place to assess the quality of the service being provided.