Archived: Acacia Care Centre

We found the following examples of good practice.

¿ The service had a clear admissions policy to ensure people were admitted to the service safely.

¿ The provider ensured there was sufficient stock of Personal Protective Equipment (PPE) in place including masks, gloves, aprons and hand sanitiser. Infection control polices had been updated to reflect the current national guidance and staff were wearing this appropriately.

¿ The service had infection control champions who performed training and checks on staff wearing Personal Protective Equipment.

¿ There was a testing programme in place for staff and people living in the service. This was to

ensure if any staff or people had contracted COVID-19 and were asymptomatic, this was identified and acted upon in a timely way.

¿ The registered manager performed regular audits and had identified furniture that needed changing to allow easier cleaning. Cleaning of the home had been increased and a new steam cleaner had been purchased to clean carpets.

¿ New visiting arrangements were being made in a spare bedroom which had direct access from the garden. The room was being emptied, deep cleaned and adapted so family members could safely see their loved ones.

¿ The laundry room had a separate entrance and exit to minimise cross infection. The service had implemented sealed garment bags to return clean clothing to people’s rooms.

¿ The service had supported one member of staff to change their hours of work to minimise the staff use of public transport.

¿ The registered manager performed daily walks round the home to support and monitor staff. They conducted daily senior staff ‘flash’ meetings in order to identify problems and rectify issues quickly. Staffing had been restructured in order to restrict staff to zones. Spare rooms had been utilised for PPE and linen storage to minimise staff movement.

¿ Ornaments and frequently touched items had been removed and the home utilised small seated areas around the home for people to use, rather than having everyone in one area in order to reduce the risk of cross infection.

We inspected on 10 April 2018 and the visit was unannounced. This meant the staff and the provider did not know we would be visiting.

Acacia Care Centre provides nursing, personal care and accommodation for up to 58 older people. On the day of our inspection there were 41 people living at the service. At the last inspection in January 2016, the service was rated ‘Good’. At this inspection, we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had 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.

People told us they felt safe living at Acacia Care Centre. Relatives we spoke with agreed they were safe living there. The staff team understood their responsibilities for keeping people safe. They were aware of what to look out for and what to do, if they suspected that someone was at risk of harm.

People's needs had been identified and the risks associated with their care and support had been assessed and reviewed. There were arrangements in place to make sure action was taken and lessons learned when things went wrong to improve safety across the service.

Appropriate checks had been carried out when new members of staff had been employed to check they were suitable to work at the service. Staff members had received an appropriate induction into the service and relevant training had been provided. This enabled them to properly support the people using the service.

People told us there were enough staff members to meet their current needs. They told us the staff team were kind and caring and they were treated in a respectful manner. They told us their care and support was provided in a way they preferred and their consent was always obtained. The staff team supported people to make decisions about their day to day care and support. They were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) ensuring people's human rights were protected.

Plans of care had been developed and the staff team knew the needs of the people they were supporting well. People received their medicines as prescribed and there were appropriate systems in place to audit the management of medicines.

People were provided with a clean and comfortable place to live and there were appropriate spaces to enable people to either spend time with others, or on their own. The staff team had received training in the prevention and control of infection and the necessary protective personal equipment was available.

People were supported to maintain good health. They were supported to access relevant healthcare services such as doctors and community nurses when needed and they received on-going healthcare support. Nutritional assessments had been carried out and people were supported to maintain a healthy, balanced diet. For people who had been assessed to be at risk of not getting the food and drink they needed to keep them well, appropriate records were kept so this could be monitored.

A formal complaints process was displayed and people knew who to talk to if they had a concern of any kind. Complaints received by the registered manager had been appropriately managed and resolved.

People were appropriately supported at the end of their life. They were supported to develop an end of life plan of care and the staff team had received training to enable them to provide the care and support people wanted and wished for.

Relatives and friends were encouraged to visit and they told us that they were made welcome at all times by the staff team.

Staff meetings and meetings for the people using the service and their relatives had been held. These provided people with the opportunity to have a say and to be involved in how the service was run. Surveys had also been used to gather people's feedback.

The registered manager and management team monitored the service being provided to make sure people received the safe care and support they required. The staff team felt supported by the registered manager and the management team. They felt able to speak with them if they had an issue or concern of any kind and they felt listened too.

Further information is in the detailed findings below.

During the inspection we gathered information to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe. One person said, 'I feel safe and secure in here.' Relatives we spoke with also told us they felt their family members were safe.

We observed the care for 20 minutes in the dining room at lunchtime. We saw people received appropriate and safe support.

We looked at the care records for four people who used the service. We saw care plans on many different subjects. These mostly contained detailed information and were centred around people's individual needs. However, we found that some care records were not accurate or not completed when required. We found, for example, that staff were not completing repositioning charts during the day for a person when this was needed.

People who used the service told us they felt that the care home was kept clean. One person said, 'Yes I think the home is very clean. They clean my room every day.'

People who used the service did not raise any concerns about the management of their medication. One person said, 'I always get it on time.' However, we found some discrepancies where information on the medication administration records did not match with the remaining quantity of medication.

We asked the provider to tell us what they would do to meet the requirements of the law in relation to the management of medicines.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw a DoLS policy was in place. The manager also understood their responsibilities regarding DoLS. However, some staff we spoke with did not have an understanding of DoLS.

We found there were enough staff to meet people's needs.

Is the service effective?

People who used the service told us they were happy with the care they received. One person said, 'I do feel safe and looked after.' Relatives were very positive about the care and support their family members received.

Staff generally had a good understanding of the needs of people who we discussed with them.

Is the service caring?

People who used the service told us staff were caring. One person said, 'They [staff] are very caring and they're very friendly.'

Relatives also provided positive feedback regarding this. One relative said, 'I think it is fantastic, the staff really do care.'

We saw that staff communicated warmly with people as they supported them and staff were caring and kind.

Is the service responsive?

A relative told us the service was responsive and staff involved other agencies regarding their family member's care.

We saw that staff responded to people's needs in a timely manner. When it became apparent that one person using the service was becoming distressed, staff quickly intervened to support them.

We saw that staff took prompt action to involve healthcare professionals in people's care and treatment when this was required. We saw a letter from a dietician with recommendations made regarding a person who used the service. The letter had included information about the appropriate amount of fluid each day. However, this information was not reflected in the eating and drinking care plan.

We asked the provider to tell us what they would do to meet the requirements of the law in relation to records.

Is the service well-led?

Three people who used the service told us they felt the service was well-led. One person said, 'I think it's a good service.' However, we found that the systems in place to regularly assess and to manage risks relating to the health, welfare and safety of people who used the service were not always effective.

We asked the provider to tell us what they would do to meet the requirements of the law in relation to assessing and monitoring the quality of the service provision.

People we spoke with told us they were happy with the care they received. One person said, 'I feel staff care for me well, I am happy here.' Another person said, 'I am cared for very well, I have nothing to complain about.' However, we saw that sometimes people's assessed needs were not always planned for and sometimes care was not delivered in line with people's care plans. This meant people did not always receive safe appropriate care.

People were not always protected from harm due to some people who displayed their illness through their behaviour. Some people with a dementia related illness regularly entered the bedrooms of other people and this sometimes placed people at risk. People who displayed behaviour were not always monitored as detailed in their care plan.

We saw there were not always sufficient numbers of staff available to meet the needs of people using the service. Staff were supported and trained to deliver appropriate care and support.

We found mixed evidence as to whether people were involved in their care and treated with respect. We saw some excellent care being provided, but were concerned about how two members of staff assisted people to eat and drink. We shared these concerns with the acting manager.

People had their right to consent or refuse treatment upheld and we saw that there were assessments in place where there was any doubt about people's capacity to make their own decisions. This meant the service complied with the law.

We found people's care and welfare needs were assessed, planned and delivered safely and in a way which meant their needs were met.

There were sufficient staff to meet people's needs. A relative commented, "I come five days a week for an hour and a half and I think there are enough staff on duty. They have time for the service users; they sit beside people and comfort them.'