Acorn Park Lodge

About the service

Acorn Park Lodge is a residential care home providing personal care to up to 9 people. The service provides support to people with a learning disability and / autism. At the time of our inspection there were 8 people using the service.

Right Support:

The model of care did not maximise people’s choice, control and independence. The care model did not consistently focus on people’s strengths or promote what they could do. This meant people did not have fulfilling and meaningful everyday lives. Limited information was available about people’s aspirations and goals and how staff could support them to achieve these. Staff did not ensure people received an interactive and stimulating service.

The environment appeared to be clean but there were limited records to evidence when the service was cleaned. Maintenance tasks had not been undertaken in a timely way.

Medicines were not always administered as prescribed or recorded accurately. Actions to improve medicines safety had not stopped medicines errors occurring.

People were not consistently supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support good practice.

People could access specialist health and social care support according to their needs but healthcare professionals raised concerns about accuracy of records, availability of equipment and consistency of staff available.

Right Care:

Staff had received safeguarding training but had not always raised concerns promptly.

Staff were caring but did not always treat people with dignity or respect.

Individualised communication tools had not been used to empower people to have control over their service.

People’s care plans reflected their range of interests, but these were not always provided for. This limited their wellbeing and enjoyment of life.

Staff training was not all up to date. Systems to ensure there were always staff available with the correct training and skills to keep people safe, had not been used effectively. Relatives did not think there were always enough staff available.

People’s records contained information about how they liked to spend their time. We were told that people were supported to do more but records and our observations showed people were not supported on a daily basis to undertake activities or pursue interests that were tailored to them.

People’s care plans and risk assessments did not include information about all risks relating to people’s needs. Information about people’s needs was not always shared across all documents.

Right Culture:

The service did not reflect best practice. Not all areas for improvement had been identified. When areas requiring improvement had been identified, action had not always been taken. When action had been taken, this had not always been embedded into practice.

People did not lead confident, inclusive and empowered lives. Staff were not always proactive in supporting people to live a quality life of their choosing and did not consistently follow best practice.

The lack of permanent staff at the service affected the quality of care people received.

Relatives and staff raised concerns about the lack of support from senior managers.

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 (published 20 May 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service is now rated inadequate. This service has been rated below good for the last 3 consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 May 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and the governance of the service.

We planned to undertake a focused inspection of the service covering the Key Questions Safe, Effective and Well-led, to check they had followed their action plan and to confirm they now met legal requirements. As a result of information gathered during the inspection process, we decided to also inspect the Key Questions Caring and Responsive.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Acorn Park Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to person centred care, staffing, safe care and treatment and the governance of the service.

We required the service to report to us on a monthly basis detailing the improvements they are making to the service.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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 park Lodge is a residential care home providing personal care to up to nine people. The service provides support to learning disability and autistic people. At the time of our inspection there were nine people using the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of underpinning principles of “Right Support, Right Care, Right Culture.

Right Support,

Staff supported people to have choice and control in their everyday lives. Their ability to do this had been impacted by staffing shortages in the service which meant people were not always able to attend planned events and sometimes had to share support. People were not always supported by enough staff on duty who had been trained to do their jobs properly. People did not always receive their medicines in a safe way.

Right Care,

People received care and support that was person-centred. However, people had not been consistently supported by staff that knew them well due to the staffing shortages at the service. Care and support plans were reviewed to reflect people's changing needs.

Right culture,

Staff told us that due to the number of changes of managers at the service this had impacted on the support and training that staff received and on the operation of the service. Relatives and health and social care professionals told us there was a lack of consistent leadership in the service and felt this had impacted on the care that people received along with poor communication from managers and the provider.

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

Concerns had been raised by staff, relatives and health and social care professionals regarding the number of changes of manager at the service and how this impacted on peoples care, and the oversight of the service. At the time of the inspection, there was no manager registered with the Care Quality Commission (CQC). The provider acknowledged that this had impacted on the service and had recruited a manager to start with the service.

The provider had, prior to the inspection, identified issues in respect of lack of consistent manager who had an oversight of the service. They had also identified issues with medicines systems due to the number of errors. They had put in place action plans to address these issues and shared them with us. However, this was still in the early days of implementation and further time to embed this was needed.

The provider had acknowledged that more support and greater oversight of the service was needed, and communication needed to improve, particularly with staff and relatives. The provider had made steps in addressing this; however, this was still in the early days of implementation and further time to embed this was needed.

There were staff vacancies at the time of this inspection. Regular agency staff were being used to cover these absences whilst a recruitment campaign was on going. Duty rotas confirmed that there was a mix of permanent and agency staff on duty so that people were supported by some members of staff that were familiar to them on each shift.

All necessary recruitments checks had been completed. New staff completed an induction.

The provider had effective safeguarding systems in place and core staff had a good understanding of what to do to help ensure people were protected from the risk of harm or abuse.

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.

People were supported to access healthcare services, core staff recognised changes in people's health, and sought professional advice appropriately.

Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Government guidance about COVID-19 testing for people, staff and visitors was being followed.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 April 2021).

At our last inspection we found breaches of the regulations in relation to medicines, the premises and governance. The provider sent an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection, we found the provider remained in breach of regulations.

Why we inspected

We carried out this inspection to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have found breaches in relation to safe care and treatment and governance at this inspection.

Please see the action we have told the provider to take at the end of the full version of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Acorn Park Lodge is a residential care home registered to provide personal care for nine people with a learning disability. At the time of the inspection eight people were using the service.

Acorn Park Lodge is a detached three storey property situated within walking distance of the centre of Redruth, Cornwall.

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

The service did not have safe systems in place for the management of people’s medicines. Audits had been ineffective and the allocation of two staff to participate in the dispensing of each person’s medicines had failed to prevent errors from occurring. All staff were in the process of having their training in the management of medicines refreshed and updated at the time of our inspection.

The service was short staffed on the first day of our inspection and two people, who each required support from one member of staff, were having to share a staff member. Rotas demonstrated the service had been regularly operating at below planned staffing levels and on the second day of our inspection two agency staff were on duty to ensure people received the care they needed. Relatives comments included, “The home itself is understaffed for what they need and they are not always the right sort of staff”, while staff said, “Staffing is one short today as [Staff member name] is covering [another care home]. I have had times where we have been down to our safe number which is six staff but it has never been below that. Over Christmas it was quite tough, we were at least one staff short every other day.”

Staff were using Personal Protective Equipment correctly and there were appropriate systems in place for the testing of staff, visitors and people living at the service for the Covid-19 infection. However, the time staff had allotted specifically for cleaning had been reduced during the pandemic and high contact areas of the service were not being cleaned regularly.

Some areas of the interior of the premises required redecoration or repair and regular cleaning of communal areas had not been completed on the second day of our inspection. One person’s en-suite bathroom was soiled and in need of cleaning. This issue was raised with managers but was not promptly addressed. Significant quantities of debris and building waste had been allowed to build up outside the premises.

The service had safe recruitment procedures in place and staff training had been regularly refreshed and updated. However, staff had not received regular supervision and we have made a recommendation about this issue.

People’s care plans were informative but had not been regularly updated and their relatives had not been involved in care plan review processes. Internet connectivity was poor in the service and had impacted on staff ability to use the providers digital record keeping system.

Staff understood people’s individual communication needs and supported people to engage with a range of activities both within the service and in the local community.

The registered manager had been absent from the service for a number of months and the provider had not made effective arrangements for the management of the service during this period of absence. Quality assurance systems were ineffective and had failed to ensure compliance with the regulations.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting did enable people to have choice and control over their lives. People were supported to leave the service when they wished and were able to spend time on their own if they chose to.

Right care:

• People and their relatives were complimentary of the care provided and during our inspection we observed examples of staff providing support with care and compassion. However, we did observe one example of poor staff practice which was shared with the registered manager for further investigation.

Right culture:

• The registered manager’s absence and lack of effective oversight of the service by the providers local senior leaders had impacted on the culture of the service and the quality of support provided. This issue had been identified by the provider in the month prior to our inspection and additional management support introduced. Since our last inspection the service had become part of Achieve Together, a large national learning disability provider. Relatives and staff reported that both the quality of care provision and the culture of the service had deteriorated following this change.

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

Rating at last inspection

The last rating for this service was outstanding (report published 23 May 2018).

Why we inspected

The inspection was prompted in part in response to information received from a whistle-blower about staff culture and the quality of care being provided. We planned to undertake a focused inspection to review the key questions of safe, caring, responsive and well-led only. However, during the inspection we identified concerns in relation to the environment of the service which meant it was necessary to expand the inspection to become a comprehensive inspection of the service.

We have found evidence that the provider needs to make improvements. Please see the full report for more information.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of medicines, the environment and hygiene practices, record keeping and oversight of the service.

You can see what action we have asked the provider to take at the end of this full report.

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.