8 Acres

Updated 2 March 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Three inspectors carried out this inspection over one day, one being a medicines inspector.

Service and service type

8 Acres is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection we reviewed the information we already held about this service including previous inspection reports, action plans and the provider information return. This is information providers are required to send us with key information about their service, what they do well and improvements they plan to make. This information helps support our inspections. We also reviewed notification and feedback through share your experience and whistleblowing concerns.

We sought feedback from the local authority and professionals who work with the service.

During the inspection-

We spoke with the service manager, the regional operational manager, a regional trainer, eight care staff, activity staff and two relatives on site. We looked around the site and spoke with five people using the service about their plans for the day and their experiences. We reviewed recruitment records and four care plans. We observed the care and support people received.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We spoke with the registered manager who was on leave at the time of inspection and requested information to be sent to us We spoke with a further five relatives and received feedback from a further six staff. We received feedback from social care professionals.

Updated 2 March 2022

About the service

8 Acres is a residential care home providing personal and nursing care to 18 people aged 18 or over, living with multiple needs including: physical and or learning disability or mental health need. At the time of the inspection the home was full supporting 18 people in individual bungalows and in the main house on site. Each accommodation had its own facilities including kitchen and en-suite and there was also access to communal spaces both indoors and out.

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

People have not always received a consistently good service or been supported by staff who were sufficiently familiar with their needs.

The COVID- 19 pandemic reduced people’s opportunities to do activities they enjoy and maintain regular visits from and to family. Opportunities for people to go out was increasing but the service was not fully utilising people’s commissioned hours or evaluating the benefit of different activities.

People were not fully supported to develop important life skills. Activities were restricted due to the availability and skill mix of staff and the limited transport available for people. More in house activities were being developed to try and provide additional stimulation which should not replace one to one support.

Communication across site and with external agencies and family was poor and record keeping was not robust. Two registered managers, two area managers and the service manager had all left within the last two years which had destabilised the service.

Some of the management team were new to post and both the registered manager and service manager were still within their probationary period. Additional skills training was being provided to enable seniors and team leaders to successfully fulfil their job roles. Staff competencies were not firmly embedded in all aspects of the service delivery.

Governance systems and management oversight had improved but there were continued breaches of regulation.

Training statistics were good, but training was not firmly embedded. Regular staff supervisions took place but spot checks on staff practice were not robust. Only one-night audit had taken place since the last inspection and there was insufficient oversight of people’s night support.

Repeated medication errors put people at risk of harm. Delays in either seeking appropriate health care or failing to effectively communicate changes in people’s needs placed them at unnecessary risk of harm. Day to day monitoring had improved from a management perspective but records needed to improve to increase accountability.

Vast improvement had been made in terms of people’s accommodation and the site in general which was being refurbished and remodelled.

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.

This service was not able to fully demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Reduced activities meant people were not having fulfilling lives and on- site activities were not fully developed. People’s records provided limited information about what people were doing or how activities were in line with people’s needs, wishes and care objectives. We saw the same routine activities being provided and could not see if they made a positive impact on people’s mental and physical health.

We were confident that the service was evolving and that leaders had the right attitude and were committed to empowering people using the service. Changes were being made to promote a more person -centred culture and ensure staff were all working to the same high standard. Daily management walkarounds provided an opportunity to monitor standards of care and give/ receive feedback. However, some of these changes were only just being made which meant over time, people need had not been prioritised.

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

The last rating for this service was Inadequate (published 27/07/2021) 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 but the provider was still in breach of regulations.

This service has been in Special Measures since the previous inspection 2 March 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 inspection was carried out 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 assurances that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements under the key questions of safe and well led to ensure all continued regulatory breaches are addressed.

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 8 Acres 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 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 staffing, medicines, and governance and oversight at this inspection.

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