Archived: Acorn Manor Residential Care Home

Acorn Manor is a residential care home that was providing personal care to 15 people at the time of the inspection. The home can accommodate up to 40 people over two floors with all communal facilities being on the ground floor.

People’s experience of using this service and what we found

The provider had not ensured they always took steps to effectively monitor and improve the safety and quality of the service people received. The provider had not fully implemented good practice recommendations made by external agencies in relation to the environment and equipment and to minimise the risk to people's health and safety.

Some areas of the service had not been well maintained and were in poor state of repair. These issues increased the risk of infection and of harm occurring.

The fire service has issued an enforcement notice which the provider must complete by the 2 March 2020.

We have made a recommendation about the adaptation of the environment to meet the needs of people living with dementia.

The provider no longer employed an activities organiser and the range of activities on offer to people was limited. People enjoyed the visiting entertainers and had a choice of where they spent their time.

Some improvements had been made to the governance of the service. Audits had been introduced, health and safety checks had been undertaken and people's confidential information was stored securely. Staff spoke highly of the registered manager and the changes that had been introduced.

Improvements had been made to the assessment and care planning processes. Each person had a care plan in place. People's needs had been assessed and a care plan implemented describing the support people needed. People's care had been planned with them, and where appropriate, their family members involvement.

People's mealtime experience had improved. People were receiving the support they needed to eat and drink. People's dietary needs and preferences were catered for and people enjoyed the variety of homemade meals and the snacks on offer.

The support staff received had improved. Staff had received the induction, training and supervision they needed to carry out their role. There were sufficient numbers of suitably qualified and safely recruited staff on duty to meet people's needs.

People were treated with dignity and respect by kind and caring staff that knew them well. People and their relatives were happy with the care people received. They had the opportunity to give their views and felt able to raise any concerns they may have.

People received their medicines when they needed them and referrals were made to healthcare professionals when people needed their support and advice.

There were systems in place to protect people from the risk of abuse and people felt safe living at the service. Accidents and incidents were recorded and monitored by the registered manager for themes and trends and action was taken to reduce the risk of re-occurrence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate with multiple breaches of the regulations (published July 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection some improvements had been made but the provider remained in breach of regulations.

This service has been in Special Measures since 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the safe, effective, responsive and well-led sections of this full report.

Enforcement

We have identified breaches in relation to the safety of the premises and equipment and the overall governance of the service. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Acorn Manor is a residential care home providing personal care to 20 people at the time of the inspection. The service can support up to 40 people.

The care home accommodates up to 40 people over two floors with all communal facilities being on the ground floor.

People’s experience of using this service and what we found

The service was not well led. The provider and registered manager lacked oversight of the service and the required improvements had not been made since the last inspection.

Systems in place to monitor the quality of the service were not effective and failed to highlight or address concerns identified during this inspection.

The service failed to ensure that staff had the skills and competence to carry out their roles. Staff had not undertaken the required training.

The service failed to manage and mitigate fire safety risks. We referred the service to the local fire authority.

The provider failed to maintain the environment to ensure it was safe for people living in the service and improvements were required to meet the needs of those people living with dementia

Peoples needs were not always met in a timely way and areas of the service were unsupervised for long periods of time placing people at potential risk of harm.

Care plans and risk assessments were not always in place to provide staff with the information they required to provide person-centred care. Staff were able to tell us about people and how they preferred their support to be carried out. People said their needs were met well.

People's medicines were administered safely but were not stored in line with manufacturer’s requirements.

Staff and relatives told us there were adequate and meaningful activities for people. They were also very complimentary about the quality and variety of food they received.

Staff respected people's privacy and dignity and interacted with people in a caring and compassionate way. Personal information belonging to people was not stored securely.

People were supported to have maximum choice and control of their lives and staff supported support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement with multiple breaches of the regulations and an inadequate rating of the safe domain (published 11 January 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvement had not been made and the provider remained in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider still needs to make significant improvement.

The overall rating for the service has changed from Requires Improvement to inadequate. This is based on the findings at this inspection.

Enforcement

We have identified breaches in relation to the safety of the service, staff training, care planning, support with nutrition and hydration, records and overall governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Acorn Manor 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 care home is registered to accommodate up to 40 people. At the time of the inspection there were 15 people living at the home.

The home is required to have 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. At the time of this inspection, the home did not have a registered manager. The home had an interim manager in place that would not be registering with the Care Quality Commission. A new manager had been appointed and a start date was awaited.

At this inspection we found breaches of Regulation 12, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Fire safety systems were not followed and a fire risk assessment was not in place. Staff were not recruited safely and had not received training and support in line with best practice guidelines. The registered provider had not identified areas of concern for development and improvement. You can see what action we told the provider to take at the back of the full version of the report.

We made a recommendation that all care plans and risk assessments were reviewed to ensure all information about people and guidance for staff remained up to date.

Staff recruitment systems were not robust and staff files did not always hold up to date references and a DBS. The DBS carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults, to help employers make safer recruitment decisions. Staff had not all undertaken an induction or completed essential training required for their role. Staff had not consistently received supervision and support. This meant people were supported by staff that may not have the right skills and knowledge for the role.

The registered providers’ policies and procedures had not been written in accordance with best practice guidelines and held out of date information. This meant staff did not have access to up-to-date guidance to successfully support people.

Quality audit systems had not been consistently completed which meant areas for development and improvement had not always been identified and actioned.

Fire safety procedures had not been regularly undertaken to ensure staff were competent in the event of an emergency. Fire safety refresher training had not been completed.

Staff felt confident and knew what they needed to do if they had any safeguarding concerns at the home. They were able to describe what abuse may look like and described the actions they would promptly take.

People's needs were assessed before they moved into the home and this information was used to create individual care plans and risk assessments. Guidance was in place for staff to follow to meet people's individual needs. People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process. Care plans needed to be reviewed and updated at the time of our inspection.

Medicines were managed safely in accordance with best practice guidelines. The registered providers medicines policies had not been written in line with National Institute for Health and Care Excellence (NICE) guidelines as required. NICE use the best available evidence to develop recommendations that guide decisions in health, public health and social care. Medicine administration records (MARs) were fully completed. Staff that administered medicines had received training and had their competency assessed.

Staff supported people with their food and drink needs. When people had been identified as having specific assessed dietary needs staff had guidance available to support them.

Staff had developed positive relationships with the people they supported. People told us staff were kind and caring.

People and their relatives told us they felt confident to raise any concerns they had. However, the complaints policy was not up to date and held inaccurate information.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we find. We saw that the registered provider had guidance available for staff in relation to the MCA. Staff had not all received up-to-date training but demonstrated a basic understanding of the act. The registered provider had made appropriate applications for the Deprivation of Liberty Safeguards (DoLS). Care records reviewed included mental capacity assessments and best interest meetings