Acorn Manor Residential Home

About the service

Acorn Manor is a residential care home providing personal care to 27 people at the time of the inspection. The service can support up to 30 people in one adapted building.

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

Apart from one discrepancy in the recording of one person's medication which had not posed any risk of harm to the person, medication was otherwise safely managed. We made the registered manager aware of this.

Environmental risks were not always identified and while there had been significant and ongoing improvement to the environment of the building; some areas had not been included on the refurbishment list where refurbishment was required.

While there were many quality audits in place, the quality of activities during the day of our visit had not been identified.

People were happy with the service provided. People either commented that they were pleased with the care they received and those who did not offer a view, were clearly relaxed with the staff team. Staff interactions were seen to be helpful and respectful. The management team operated an open-door approach and were accessible to people.

People and their families were kept up to date with events within the building through regular newsletters, Surveys seeking the views of people, families and other stakeholders such as staff were sought.

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

The last rating for this service was requires improvement (published 24 October 2019). The rating at this inspection has changed to good.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

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

Acorn Manor is a residential care home] providing personal care to 21 people at the time of the inspection. The service can support up to 30 people in one adapted building.

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

Quality audits were now more effective; however, checks had not identified insufficient hygiene standards within some bedrooms and bathrooms which we found during our visit. Cleaning audits were not always accurate as they suggested that areas had been cleaned when that was not the case. One piece of equipment was unsafe, and this was removed. This meant that people did not live in consistently clean or safe facilities. We alerted the registered manager to this and appropriate action was taken.

Other quality audits had been broadened to demonstrate effective governance of the service. While these were effective; their continued use is encouraged to ensure a good standard of governance within the service. The management of the service had been supplemented by the employment of a new registered manager and area manager. The registered provider demonstrated better oversight of the service.

There were sufficient care staff on duty to meet people’s needs. The service had limited availability of domestic staff to cover sick leave of one person with the result that some standards of hygiene were not always maintained. Since our visit, a new domestic member of staff had been recruited.

People now received safe care. Systems were in place to identify and report events that could place people at risk of harm. Risk assessments were more effective with any falls being analysed and reported appropriately. Medication was safely managed, and new staff recruited appropriately.

Arrangements to protect people during the Covid-19 had improved.

The service was now effective through better assessments for people as well as staff training. 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. The principles of the Mental Capacity Act were now followed, and the service now liaised with other health professionals when people faced risks from weight-loss, for example. Improvements to the decoration and layout of the building was ongoing.

The service was now more caring. Improvements in areas of governance, safety, person-centred care and COVID-19 prevention demonstrated an approach which better valued people as individuals and their welfare. Staff interacted with people in a positive and caring way. This view was reflected by relatives. People’s personal information was better protected.

Care plans were more person-centred. Support needs were clearly written to ensure that these could be met by the staff team. Use of a digital-based care plan system enabled real time recording of how people had been assisted. Activities were now in place and evidence provided of past activities undertaken by people.

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 inadequate (published 10 February 2021) and there were multiple 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 10 February 2021.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 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.

The overall rating for the service has changed from Inadequate to Requires Improvement. 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 Manor on our website at www.cqc.org.uk.

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

People did not receive safe care. The registered manager had not developed a way of checking the safety and quality of care provided and as a result many aspects of poor care had not been identified.

Arrangements to protect people during the COVID-19 pandemic were insufficient with no evidence that the registered provider had sought to keep in touch with updates and requirements needed to keep people safe. The premises were not always hygienic or well maintained.

People were not always safeguarded from abuse. The registered manager did not demonstrate an understanding of what constituted abuse or how to report it effectively. People were at risk of serious injury through a number of unwitnessed falls that were not analysed effectively and or referred to other agencies that could assist to minimise such occurrences. There was no reflective learning after incidents had occurred and the risk of re-occurrence was very likely.

Staffing levels were maintained although dependency tools used were unclear as to how numbers of staff on duty were matched to people’s needs. Medication management was safe.

The service was not always effective. Assessment information for people who came to live at Acorn Manor Residential Home was incomplete, lacking in detail and did not demonstrate a person-centred basis for care practice. One person us “I have been independent in the past, but no-one has looked at what I can do for myself”. Staff training had been completed but was not effective. Staff did not follow the principles of the Mental Capacity Act and had basic understanding of the needs of those who lived with dementia.

We have made a recommendation about the best practice and following guidance related to the mental capacity act.

The design of the building did not fully reflect good practice to cater for the needs of people living with dementia. Liaison with other professionals was incomplete, for example, there was limited evidence of follow up with falls teams to gain support for people who were at risk of regularly falling and becoming injured. People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service was not always caring. The independence of people was not always taken into account and sensitive information was not always kept secure. People were not provided with the contact details of other agencies that could support them, for example, advocacy services.

The service was not always responsive. People were not provided with effective formats of information reflecting their communication needs. People told us that they did not feel involved in decision-making and had not seen their care plans. Care was not person-centred as generalisations were made about people who were living with dementia and/or other health conditions. The complaints procedure was not transparent to people. Activities were not always in line with peoples assessed social interests.

Staff interactions with people were caring and positive. People’s comments included. “It is not what I expected. The home is not the problem; it is just a new way of living” and “Staff are kind and they are always around if I need them”.

Relatives we spoke with had had limited opportunity to visit their loved ones during the pandemic and therefore their views were based on information that they had received from the registered manager and staff in terms of their loved one’s experiences within the home. They told us that “I have been assured that [name] has settled in", "The manager and staff have been really helpful when[name] went to live there” and “Yes I am more than happy with the care”

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

Rating at last inspection

This service was registered with us on 17/07/2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns about infection control, the management of accidents and incidents, and the governance of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report.

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 coronavirus and other infection outbreaks effectively.

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

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 person-centred care, safe care and treatment and governance at this inspection.

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.

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 residential care home providing personal care to 26 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

We found the provider needed to make some improvements to the home environment so that social distancing measures could be consistently followed. The provider also needed to ensure up to date policies were in place to support the implementation of COVID-19 contingency plans and risk assessments.

The service pre-booked times for friends and relatives to visit. At the time of the inspection, visits took place through windows at the service. There was time between visits to allow for cleaning. Visitors were asked to wear a face mask during their visit. Alcohol gel was readily available.

People were admitted to the service immediately following a negative COVID-19 test result. They were isolated on transition into the service for 14 days and staff supported them with all their needs within their bedroom. This included personal care, social support and ensuring their food and drink needs were met. People living with dementia who were unable to isolate had a risk assessment in place.

The service had increased the cleaning schedules and routines to reduce the risks of cross infection. Residents commented positively on this and one told us, "The home is lovely and clean."

The registered manager was appointed infection control lead at the service to ensure people's safe discharge from hospital followed up to date national guidance. The registered manager liaised with relatives to ensure they understood the reasons for why their loved one would have a period of isolation in the home on arrival.

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

Rating at last inspection

This service was registered with us on 17 July 2020 and this is the first inspection. The last rating for the service under the previous provider was requires improvement, published on 19 February 2020.

Why we inspected

The inspection was prompted in part due to concerns received about infection control and the use of PPE. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the Safe section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Acorn Manor 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.