Acorn House Residential Home Limited

Acorn House Residential Home Limited provides accommodation and personal care for up to 20 older people. Some people were living with dementia. Accommodation is arranged over two floors. There were 18 people living at the home on the day of our inspection.

People's experience of using this service

People were interacting with one another and staff were engaging with people. One person said, “The staff are really good and kind, they listen to you, and I feel safe here”. A relative told us, “The staff couldn’t be more pleasant, we couldn’t sing their praises more”.

At the last inspection we found that risk assessments were not updated and there were not always risk management plans in place. At this inspection we found that improvements had been made. Risks to people had been identified. Risk assessments contained all the information needed to ensure risks were kept to a minimum and detailed action/s staff needed to take, if risk did occur.

At the last inspection we found that medicines were not always safely managed. Since the last inspection the provider had introduced new medicine dispensing technology and auditing procedures. This had addressed previous shortfalls in safe management of medicines.

At the last inspection we found that people were not always recruited safely. At this inspection we found that people were recruited safely. Recruitment procedures checks had been carried out to ensure that staff were of good character and had the skills and experience necessary to provide care.

The management had a clear understanding of their roles and responsibilities. The registered manager had implemented audits to assess, monitor and improve the quality and safety of the service. This had addressed previous shortfalls in this area.

Staff understood how to recognise signs of abuse and actions needed if abuse was suspected. There were enough staff to provide safe care. Safe recruitment checks were completed to ensure staff were suitable to work with people.

The registered manager and staff knew people well and quickly identified when people's needs changed. People who were unwell or needed extra support, were referred to health care professionals and other external agencies appropriately.

Care plans were held on an electronic database and accessed by tablets. The database contained up-to date and relevant information to ensure people were safe and their choices recorded. This enabled staff to safely support people and understand how people wished to be supported.

People received care and support that was personalised to their individual needs. Staff had training to meet these needs and identify areas of concern.

Infection Prevention and Control policies and procedures were being followed. The premises looked clean and tidy and we were assured that the service had controls in place to minimise the risks posed by COVID-19.

Regular activities took place to keep people stimulated and facilitate interaction between people and staff.

People's independence was promoted. The provider worked in partnership with other organisations to ensure people's individual needs were planned and met.

Rating at last inspection

The last rating for this service was requires improvement (published 29 January 2020). We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook a focused inspection to look at the key questions of safe, responsive and well-led only, following up on three previous breaches in regulation and areas identified for improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. Therefore, we did not inspect them.

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.

Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has improved 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 House Residential Home Limited 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 House Residential Home Limited provides accommodation and personal care for up to 20 older people. Some people were living with dementia. Accommodation is arranged over two floors. There were 17 people living at the home on the day of our inspection.

People's experience of using this service

Medicines were not safely managed. Multiple controlled drugs stock balances did not correlate with the number of medicines held at the home. Medicine administration record (MAR) charts showed that people were not always given medicines at the appropriate time without any explanation as to the reasons why. Medicines in the medicine trolley did not record open dates on them to ensure they remained effective to administer. Medicines audits carried out did not identify the shortfalls found at this inspection.

Risks were not always assessed and identified. Risk management plans did not always guide staff on how risks should be minimised. People’s behaviour charts were not completed when required. The provider's quality monitoring systems were not effective. Care plans were not always updated to show a change in people needs. Internal audits did not identify the issues we found at this inspection.

People said they felt safe and that their needs were met. People were protected against the risk of infection. Accidents and incidents were appropriately managed and learning from this was passed on to staff. There were enough staff deployed to meet people’s needs in a timely manner.

Assessments were carried out prior to people joining the home to ensure their needs could be met. Staff were supported through induction, training and supervisions. People were supported to eat a healthy and well-balanced diet. People had access to a variety of healthcare professionals, when required to maintain good health.

People's rights were upheld with the effective use of the Mental Capacity Act 2005. People were 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. Their needs were accurately assessed, understood and communicated.

Staff were kind and caring. People, including those living with dementia were offered stimulating activities on a regular basis. Information was available to people in a format to meet their individual communication needs. The service was not currently supporting people who were considered end of life, but relevant information was recorded in their care plans.

People’s independence was promoted. The provider worked in partnership with key organisations to ensure people's individual needs were planned.

Rating at last inspection

The last rating of the service was good (published on 4 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, dignity and respect, safe care and treatment, consent and good governance.

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

Follow up

We will ask the provider to complete an action plan to show what they will do and by when to improve to at least good. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner. We will also meet with the provider.

Acorn House Residential Home Limited provides accommodation and personal care for up to 20 older people. Some people were living with dementia; some people had mobility difficulties and sensory impairments. Accommodation is arranged over two floors. The home is situated on a busy road close to Chatham town centre. There were 20 people living at the home on the day of our inspection.

There was a registered manager employed at the service. 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. The registered manager was on maternity leave but visited the service during the inspection to take part.

At the last Care Quality Commission (CQC) inspection on 01 April 2015, the service was rated as good in all of the domains and had an overall good rating. Since the last rated inspection, the provider had changed their registration so that they could provide care and support for people living with dementia as well as older people. This was the first inspection since the changes had been made. The owners of the home had also changed.

At this inspection, we found the service remained Good but required improvement in the effective domain.

People and their relatives provided positive feedback about the service they received, staff and the management team.

The decoration of the home did not follow good practice guidelines for supporting people who live with dementia. We made a recommendation about this.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which included steps that staff should take to comply with legal requirements. Staff had limited understanding of the MCA and DoLS, however staff gave people choices throughout the day and helped them to make decisions. We made a recommendation about this.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The providers and registered manager understood their responsibilities under the DoLS. The registered manager had systems in place to monitor DoLS and had taken action to meet DoLS conditions.

People continued to be safe at Acorn House Residential Home. People were protected against the risk of abuse. People told us they felt safe in the service. Staff recognised the signs of abuse or neglect and what to look out for. The provider’s own safeguarding policy required updating to provide staff with accurate information about which local authority to report abuse to. We made a recommendation about this.

Medicines were managed safely and people received them as prescribed. Staff knew how to protect people from the risk of abuse or harm. They followed appropriate guidance to minimise identified risks to people's health, safety and welfare. There were enough staff to keep people safe. The providers had appropriate arrangements in place to check the suitability and fitness of new staff.

Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. Care plans did always not detail people’s abilities so it was not clear what people could do for themselves. People’s interests and hobbies had not always been incorporated into the care plans to enable staff to provide person centred activities to keep people stimulated and active.

Staff received regular training and supervision to help them to meet people's needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

Staff were caring and treated people with dignity and respect. They ensured people's privacy was maintained particularly when being supported with their personal care needs.

The complaints procedure was available to people and their relatives in a variety of formats.

Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

The report is based on our observations during the inspection, talking with six people who lived in the home, four staff who worked in the home, and reviewing records, policies and procedures. We also talked with the manager and provider.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The home was well maintained and clean, improvements had been made to the internal decoration and some carpets had been replaced.

There were suitable levels of staffing to meet people's needs.

Medicines were safely stored, administered and recorded.

Is the service effective?

There was a range of activities available to people. The home had booked an external activities company to come to the home to do motivational activities.

People were listened to. People told us that they had requested changes to the meals they were offered. They told us that these changes had been made. We saw that the requests had been discussed with the kitchen staff.

Sensory training had been booked to provide staff with further information and guidance.

People who required specialist equipment had been assessed by an occupational therapist to ensure they had the right equipment to meet their needs. The home had followed guidance provided by specialists.

Is the service caring?

People were supported by kind and attentive staff. We observed staff speaking with people in a respectful manner and respecting people's privacy.

People told us that they were very happy living in the home. People were involved in making decisions, For example, people chose their meals and what activities they would like to do.

Is the service responsive?

Assessments and care plans had been updated to reflect people's needs and were person centred. The home had responded to people's physical and sensory needs and had made referrals for specialists to provide advice and guidance.

Complaints procedures were clearly displayed, the home had received one complaint since we last inspected, this had been dealt with swiftly and had been resolved.

Is the service well led?

An experienced manager was in place. People told us the manager was easy to talk to. Staff told us they were well supported by the manager. The manager had developed good systems and had made significant changes to the home.

The provider had worked with the manager to ensure that the home was regularly checked. Any concerns or issues found in the checks had been dealt with. Repairs and maintenance had been carried out in a timely manner.

Our inspections of 27 May 2014 and 17 June 2014 were conducted by two inspectors at each visit. We visited the home a second time as we had received concerning information through our whistle blowing procedures. When we inspected on the 27 May 2014 a new manager was in post. When we inspected on the 17 June 2014 the new manager had left without giving notice. The owner told us that they were advertising for a new manager. A deputy manager had been put in place to manage the home.

There were 16 people living in the home at the time of our first visit and 13 people were living at the home at the time of our second visit. Some people had communication difficulties. This meant they were not always able to tell us about their experiences. This report is based on our observations during the inspections, talking with people who used the service, one relative, staff and reviewing records.

During these inspections we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that people who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The provider and staff were aware of their responsibilities for keeping people safe and clear guidance was available for staff.

We saw that care plans reflected people's choices. We saw that one person had returned from hospital with significantly increased care needs. Their care plan had not been updated to reflect the changes.

We found that the building had not been suitably maintained and posed a potential risk to people. We also noted damaged furniture which could injure people who lived in the home. Some windows in the home required maintenance work as frame holding the secondary glazing in place had broken.

We saw that there was not enough staff on duty in all areas of the home to keep people safe from harm.

CQC monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. While no applications have been submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how they should be submitted.

We have asked the owner to make improvements and meet the requirements of the law in relation to keeping people safe from harm.

Is the service effective?

People told us they were happy with the care that they received at the home. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs. We saw that people's needs had been assessed and they had been involved in planning for their care where possible. Best interests meetings were held when people lacked the capacity to make decisions about their care.

The home had not followed the guidance given by a dietician and had not contacted the dietician to advise that they were concerned about a person's reducing food and fluid intake.

One person told us that they were not able to join in with activities as the home did not cater for their needs as they had a visual impairment. We saw that the home did have some activities for people who had a visual impairment. The home had not included information about people's sensory impairments within assessments undertaken.

We have asked the owner to make improvements and meet the requirements of the law in relation to meeting the needs of people who live in the home.

Is the service caring?

People were supported by kind and attentive staff. We observed positive interactions between staff and people living at the home. We saw that people enjoyed spending time in the company of the staff who supported them. Two of the people who lived at the home told us that the staff were 'Lovely'. One person told us 'Acorn is a very nice place' and another person said 'I like it very much'. They described the staff as 'All very nice girls'. We spoke with five people who lived at the home. They were positive about their experiences.

At our inspection on the 17 June 2014 we had serious concerns about the care and welfare of some of people who lived in the home. We found one person who was left in bed with no access to staff for up to an hour at a time. The person was too frail to sit themselves up and use the call bell.

We saw that care plans reflected people's choices. For example, one person's care plan showed that they preferred to get up at 07:15 in the morning. The daily records showed us that this person had been supported to get up at this time each day.

Is the service responsive?

We saw that the home had taken steps to ensure that people's views were sought and actions were taken as a result of what people told the provider. People were asked about what activities they would like to have at the home and we saw that changes had been made in response to suggestions from people who lived at the home.

Some processes were in place to monitor the quality of the service and audits had been introduced to ensure that regular checks were made on different aspects of the service.

We found some areas of the home had not been cleaned satisfactorily. We also found that infection control guidelines had not been adhered to which put people at risk of infection.

We have asked the owner to make improvements and meet the requirements of the law in relation to reducing the risk of exposure from a healthcare associated infection and identifying, assessing and managing risks relating to health, welfare and safety of people who live in the home.

Is the service well-led?

At our inspection of 2 December 2013 we found that people were not protected against the risks of abuse or unsafe care and treatment. This was because the provider had not taken steps to address safeguarding concerns at the home in a timely manner. Potential fire risks in the home had not been assessed so that action could be taken to minimise them. The culture at the home did not ensure that people were confident about raising concerns due to the manner of a previous senior staff member. Appropriate systems were not in place for gathering, recording and evaluating information about the quality and safety of the care, treatment and support that the service provided.

At our inspection of 27 May 2014 we found that the provider had taken steps to address concerns in relation to their understanding of safeguarding procedures and they had attended appropriate training. A fire risk assessment had been carried out and the provider had ensured that all recommendations had been acted on. Systems had been introduced to monitor the quality of the service and we saw that residents and relatives had been provided with a forum to make their views known. However, some systems that had been introduced were not effective as they had not identified issues that we found during our inspection. For example, infection control audits had not checked dining room chairs.

Staff we spoke with told us that the provider and senior staff at the home were approachable and we saw evidence that they were regularly meeting with staff. Staff told us they were clear about their roles and responsibilities. We saw that systems were in place to manage complaints appropriately.

We have asked the owner to make improvements and meet the requirements of the law in relation to assessing the quality of services provided by the home.

We spoke to seven people who lived in the home. They were all positive about the support that they received from the care staff at the home. One person said, 'Staff treat me like a human being' and another person said that, 'Staff treat me well and do the best that they can in a difficult situation'. We saw that when staff spoke to people they were polite and respectful.

Care plans varied in the level of detail that they contained, but generally contained most of the information that staff required to support people with their personal, and health care needs.

People were not protected against the risks of abuse or unsafe care and treatment. This was because immediate action had not been taken to safeguard people when staff voiced concerns about the care and treatment of people who lived in the home.

Potential fire risks in the home had not been assessed so that action could be taken to minimise them. In addition, people could not be assured that they would be safely evacuated in the event of a fire.

The culture in the home did not ensure that people were confident about raising complaints or assure them that if they do so, that their concerns would be acted on.

Appropriate systems were not in place for gathering, recording and evaluating information about the quality and safety of the care, treatment and support that the service provided.

Care plans did not all contain information about people's assessed needs or give clear instructions to staff so that they knew how to look after people safely. Comprehensive risk assessments had not always been carried out detailing the steps that had been taken to minimise the risks to people who lived in the home.

There were safe procedures in place for the administration of medication. We saw that medication was given to the right person at the right time.

The home did not regularly monitor the service so that it could identify if any improvements needed to be made for the benefit of the people who lived in the home.

Most of the people that we spoke to were satisfied with the support that they received. One person told us,' If you have got a complaint, it is dealt with quickly'. However, two of the ten people that we spoke with did not feel that the home listened to and responded to their concerns. 'I've told the staff about it but nothing ever gets sorted in this place', one person told us. Therefore, not everyone who lived in the home felt that they were listened to and that their concerns were acted upon.