Acorn Lodge Care Centre

Acorn Lodge Care Centre is a care home providing personal and nursing care to older people, including people living with dementia and mental health conditions. The service can support up to 98 people in a purpose built four storey building.

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

People were protected from the risk of potential abuse and harm. People were regularly observed and asked if they were feeling cared for within the home. Staff completed safeguarding training and knew how to report suspected abuse.

People's risks were assessed with systems in place to reduce the risk of harm people faced. This helped people live within the home and community with minimal restrictions. People were supported to be as independent as they could within the home and measures implemented to support people to take positive risks in their local community.

There were enough staff to provide care to people. Medicines were managed safely within the home. The home was clean and people’s rooms were regularly cleaned to reduce to risk of infection. People were able to decorate their rooms according to their personal preference.

Learning took place after accidents or incidents and staff told us they found these reflective sessions helpful to ultimately improve the quality of care for people living at the home.

People’s care needs were assessed before care began to ensure the home could meet their needs, with people and their relatives involved in this process. Consent to care and treatment was obtained before care began. Staff understood the principles of the Mental Capacity Act and to encouraged people to make their own choices as much as possible.

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.

Staff received appropriate training and support in order to perform their role. People were able to choose meals of their choice from a varied menu and the home provided meals to meet dietary requirements. The home worked well health professionals in order to provide people with good health outcomes and support for staff.

Staff treated people with kindness and respect. People’s privacy and dignity was respected and independence promoted. Diversity was celebrated and staff did not discriminate against people.

Care plans were personalised and met people’s individual likes and dislikes. Activities took place within the home and people could choose to participate within a group setting or receive one to one support from staff. Relatives were invited to join in the activities that were held within or outside the home.

Complaints were recorded and responded to by the management team and people felt comfortable to speak up if they had a concern. People’s end of life wishes were recorded and respected by the home.

Quality assurance systems were in place to monitor the quality of care being provided to people within the home. People, relatives and staff were asked to provide feedback on the quality of care to help drive improvement. Continual leaning and development was encouraged at the home for all staff to keep knowledge and skills up to date.

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 good (published 15 October 2019).

Why we inspected

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

Follow up

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

Acorn Lodge Care Centre is a care home providing personal and nursing care to 97 older people who may have dementia and or a mental health condition, at the time of the inspection. The service can support up to 98 people in a purpose built four storey building.

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

People's needs were met by enough and suitable staff who safeguarded them from the risk of harm and abuse. People’s healthcare associated risks were identified, assessed and mitigated. People received safe medicines support. People were protected from the risk of infection. Incidents were analysed, and lessons learnt to reduce recurrence.

People and relatives were happy with the service. People, relatives and staff told us the service was well-led and the registered manager was caring and approachable. Staff told us they felt well supported and worked well as a team.

People, relatives, staff and healthcare professionals’ feedback was sought and their opinions considered to improve the quality of service. The registered manager worked in partnership with other agencies to improve outcomes of care.

The provider had quality assurance systems in place to assess, monitor and evaluate the service. However, these were not always effective. We have made a recommendation about reviewing and updating the filing and record-keeping system.

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 January 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.

Why we inspected

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.

We carried out an unannounced focused inspection of this service on 13 and 26 November 2020. 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 good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. 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 Lodge Care Centre 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.

Acorn Lodge Care Centre is a care home providing personal and nursing care to older people who may be living with dementia or a mental health condition. The service can support up to 98 people in a purpose built four storey building.

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

People’s medicines were not always managed safely. For example, unclear documentation about medicines to be administered as required had meant that a person had received too much of one of their medicines putting them at risk of harm. The provider had asked a pharmacist to review this person’s medicines. During the inspection, the provider contacted the person’s GP about the error.

The home had identified the risks people faced and had comprehensive plans in place to mitigate against a range of issues that may cause harm, for example ones relating to epilepsy, pressure sores and people’s mental health. However, people’s plans did not always contain enough information about people living with diabetes for staff to follow.

Staff were recruited safely and there were enough staff working at the service to meet people’s needs in a timely fashion. Staff understood how to safeguard people from abuse.

There were a range of infection prevention and control measures in place to minimise the risk of the spread of infection.

People and their relatives told us they felt safe and the service was well-run. Staff told us the registered manager was approachable and had input into how the service was run. The provider monitored the service using a range of control audits however, the medicine audits were not effective enough to pick up the issues we found during the inspection.

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 17 October 2019) and there were two breaches of the regulations. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement in the safe and well led key questions. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11 September 2019. 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 good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as 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 Lodge Care Centre on our website at www.cqc.org.uk.

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.

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

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

We found the following examples of good practice.

The provider had established appropriate visiting arrangements to help prevent the spread of infection. Visitors booked appointment slots and were supported to wear personal protective equipment (PPE) and their temperature was checked before they met people living at the service to minimise the risk of the spread of infection.

The provider ensured people using the service, including those on end of life care, could maintain links with family members and friends. People were supported to have visits at a social distance from their relatives and friends in a designated area in the garden, during the summer and early Autumn. Family members unable to visit the service could stay in touch with people by phone and video calls. The provider took into account people’s communication needs during these contact sessions.

The provider had established appropriate measures to test people living at the service and staff members for COVID- 19 and was following government guidance on testing. Bank staff with allocated shifts at the service were also tested as part of the provider’s testing regimen.

The provider ensured staff received training and support to help prevent the spread of infection. All staff had received training on infection control, social distancing and the proper use of PPE. Staff and bank staff members were assigned to work on a particular unit only to help minimise the risk of cross infection. The provider had taken steps to promote staff wellbeing.

Further information is in the detailed findings below.

Acorn Lodge Care Centre is a care home providing personal and nursing care to 93 people older people who may have dementia and a mental health condition, at the time of the inspection. The service can support up to 98 people in a purpose built four storey building.

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

People’s healthcare associated risks were identified and assessed. However, the risk assessments did not always include mitigating factors to ensure safe care. People were not always safely supported with their medicine management needs. The provider's auditing and monitoring systems were not always effective in identifying issues to ensure the safety and quality of the service.

People told us they felt safe living at the care home and with the staff. People were supported by enough and suitable staff who knew how to keep them safe from the risk of harm and abuse. People told us their medicine management needs were met. People were protected from the risk of infection. People’s accidents and incidents were recorded, and lessons were learnt to prevent them from occurring again.

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’s needs were assessed before they moved to the care home. People’s needs were met by staff who were well trained and received regular support and supervision. People’s dietary needs were not always met effectively. We have made a recommendation in relation to people’s nutrition and hydration needs.

People were supported to access ongoing healthcare services and staff supported them to live healthier lives. The premises were adapted to meet people’s physical needs. However, the premises were not dementia friendly. We have made a recommendation in relation to dementia friendly environment.

People and relatives told us staff were caring and treated them with dignity and respect. People were involved in making decisions regarding their care. People were supported to remain as independent as possible. People received care and support without discrimination.

People’s care plans were detailed and regularly reviewed. However, these were not always personalised. We have made a recommendation in relation to personalised care plans. People were offered a range of group activities and outings. People and relatives’ concerns were addressed in a timely manner. People’s end of life care wishes explored and met by nurses who were trained in end of life care.

People, relatives and staff told us the management team was approachable and available. Staff told us they felt valued and well supported. The provider did not always effectively engage with their stakeholders. We have made a recommendation in relation to stakeholders’ engagement. The service worked well with other organisations to improve people’s experiences.

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 17 September 2018) and there was one breach 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 some improvements had been made but were not enough and the provider was still in breach of regulations.

The last rating for this service was requires improvement (published 17 September 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, and good governance at this inspection.

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

Acorn Lodge Care Centre can accommodate 98 older adults who may have dementia in a purpose built four storey building. At the time of this inspection, 94 people were using the service.

This inspection took place on 16, 17 and 23 July 2018 and was unannounced. At the last inspection in April 2017, the service was rated as Good. During this inspection, we found one breach of the regulations and the service is now Requires Improvement. This is the first time the service has been rated Requires Improvement.

The service did not 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.

Staff were knowledgeable about safeguarding and whistleblowing procedures. Safe recruitment checks were made before new staff began employment. There were enough staff on duty to meet people’s needs. Building checks were carried out in line with building requirements. Risk assessments were carried out to mitigate the risks of harm or abuse people may face. People were protected from the risks associated with the spread of infection. The provider analysed accidents and incidents and used this as a learning tool to improve the service.

People’s care needs were assessed before they began to use the service to ensure the provider could meet their needs. People and relatives were confident staff had the skills to work with their family member. Staff were supported with training opportunities, supervisions and appraisals. People were supported to eat a nutritionally balanced diet and to maintain their health. The provider understood their responsibilities under the Mental Capacity Act (2005). Staff understood the need to obtain consent before delivering care.

People and relatives told us staff were caring. Staff described how they developed caring relationships with people. Relatives were kept updated on the wellbeing of their family member. Staff were knowledgeable about equality and diversity. People were supported to maintain their independence and their privacy and dignity was promoted.

Care plans were personalised and contained people’s preferences. Staff understood how to deliver a personalised care service. The service was meeting people’s accessible communication needs. People were offered a variety of activities in accordance with their preferences. The service had a complaints procedure and kept a record of complaints. People’s end of life care preferences were recorded.

Relatives and staff gave positive feedback about the leadership in the service. The provider had a system to obtain feedback about the service in order to make improvements. People had regular meetings so their views about the service could be heard. Staff had regular meetings to keep updated on service development and to contribute their views on the running of the service. The provider had several quality audit systems to identify issues to improve the service. The manager worked in partnership with outside agencies to share examples of good practice.

We have made one recommendation about the continued monitoring of staff suitability.

At our previous inspection on 5, 6, 7 and 8 April 2016 a breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to notifications.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breach found. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Acorn Lodge Care Centre’ on our website at www.cqc.org.uk’

There was a registered manager in post at the time of our 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.

Acorn Lodge Care Centre provides accommodation for up to 98 people who require nursing or personal care. At the time of our inspection 95 people were living in the home.

At our previous inspection we found that the provider did not always notify the CQC of notifiable incidents.

At this inspection, we found that improvements had been made.

The provider was aware of the type of incidents that they were required to notify the Care Quality Commission (CQC) of and had reviewed their notifications procedure with the management team. A new log record had been created to correlate safeguarding incidents with their notification reference.

Acorn Lodge Care Centre provides accommodation for up to 98 people who require nursing or personal care. At the time of our inspection 95 people were living in the home.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and their relatives told us they felt safe using the service and registered nurses and healthcare assistants had a good understanding of how to protect people from abuse. Staff were confident that any concerns would be investigated and dealt with. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns.

People’s risks were managed and care plans contained appropriate and detailed risk assessments which were updated regularly when people’s needs changed. Staff worked with all people across all floors to ensure they were aware of the needs of each person. The service had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service. Sufficient numbers of staff were employed to keep people safe and meet their needs.

People who required support with their medicines received them safely from staff who had completed in-depth training in the safe handling and administration of medicines, which was refreshed annually. Staff completed appropriate records when they administered medicines and these were checked after each medicines round on the same day to minimise medicines errors.

There was a comprehensive induction and a six month probation period for new staff. Staff members also took part in a training programme to support them in meeting people’s needs effectively. New staff shadowed more experienced staff before they started to deliver personal care independently and received regular supervision from management. They told us they felt supported and were happy with their input during the supervision they received.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were aware of the importance of asking people for consent and the need to have best interests meetings in relation to decisions where people did not have the capacity to consent. The provider was aware when people had restrictions placed upon them and notified the local authority responsible for assessment and application.

Staff were aware of people’s dietary needs and food preferences and provided support to those who required it during mealtimes. People had regular access to healthcare services as a GP visited six times a week and recorded information in a visit book. Registered nurses and healthcare assistants told us they contacted other health and social care professionals, such as occupational therapists and speech and language therapists, if they had any concerns about people’s health. We saw evidence of this in communication books and people’s care plans.

People and their relatives told us staff were kind and compassionate and knew how to provide the care and support they required. All staff understood the importance of getting to know the people they worked with and showed concern for people’s health and welfare in a caring manner.

People were spoken with and treated in a respectful and kind way and staff respected their privacy and dignity, and promoted their independence. People were also supported to access independent advocates where necessary. Where appropriate, people and their families were involved in decisions about end of life care and staff were aware of respecting people’s wishes and providing support at a sensitive time.

People were involved in planning how they were cared for and supported. An initial assessment was completed from which care plans and detailed risk assessments were developed. Care records were person centred and developed to meet people’s individual needs and reviewed if there were any significant changes. People and their relatives were actively encouraged to express their views and were involved in making decisions about their care and whether any changes could be made to it.

People were supported to follow their interests and encouraged to take part in a range of activities to increase their well-being and reduce social isolation. Those who were unable to take part in group activities had plans in place to receive one to one support. There was evidence that cultural requirements were considered when discussing this and making sure these needs were met.

People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received. The provider listened to all complaints and made sure people were confident their complaints would be taken seriously. There were also surveys in place to allow people and their relatives the opportunity to feedback about the care and treatment they received.

The service promoted an open and honest culture and the registered manager and senior staff team were transparent in their discussions with us during the inspection. Staff spoke highly of the atmosphere at the service and the support they received from management. Staff were confident they could raise any issues or concerns, knowing they would be listened to and acted upon.

There were effective quality assurance systems in place to monitor the quality of the service provided and understand the experiences of people who used the service. The registered manager followed a monthly, quarterly and annual cycle of quality assurance activities and learning took place from the result of the audits. However the registered manager failed to notify the CQC about a safeguarding incident which is a legal requirement of the provider’s registration.

We identified one breach of the Regulations in relation to notifiable events. You can see what action we told the provider to take at the end of the full version of this report.

We saw that the manager was working directly with staff to assist people with more complex needs, which meant staff were supported to provide individualised care that reflected people's choices and best practice.

People using the service and their representatives told us they were happy with the quality of the care. One person using the service told us, "they look after me well". We saw positive interactions between people who use the service and staff. However, there were incidences when staff did not consistently promote people's right to their privacy and dignity.

The five care plans we looked at showed that people's capacity to make decisions about their care was assessed and we saw staff seek people's verbal consent as they supported people with their daily care.

The care plans contained more detailed information about people's needs and wishes, including risk assessments to promote their safety and minimise risk. The involvement of families with planning and reviewing care was demonstrated in the care plans. Staff demonstrated better knowledge of people's backgrounds and interests. The recording of care provided had improved in many of the care plans we looked at.

Staff had received training and guidance in regard to safeguarding people and how to support people in a non-institutionalised manner.

The staffing levels were sufficient for people to receive individualised and safe care.

Systems were in place for the service to seek the views of people and improve upon care through the use of audits and observations by the manager and clinical lead nurse.

Most people we spoke with told us they were happy with the quality of the care and support they received. One person using the service told us, "everyone is nice to me and they are so kind. I like to chat so the staff come in and give me all the news. It really cheers me up." The relative of another person said, "here they understand people's behaviour and I can't fault them. There is not one nurse we don't like, they are all very kind."

People were consulted about the care and treatment they received, although some of the care plans needed to be updated in order to show that people and/or their representatives were consulted when their health and social care needs changed. Most of the care plans we saw did not show that staff knew about people's lives and interests, in order to provide individualised care.

Safe systems were in place for the management of people's medications.

Staff were provided with mandatory training and other relevant training, although the level of dementia training did not reflect the needs of people using the service.

Appropriate measures were in place to monitor the quality of the service, including actions to seek the views of people using the service and their representatives.