Background to this inspection
Updated
23 September 2020
The inspection
This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice and breaches in relation to the assessment, planning and management of risk to people. Three key questions were inspected; 'Is the Service Safe?' 'Is the Service Effective?' and 'Is the Service Well-Led?'
As part of CQC’s response to the coronavirus pandemic we also looked at the infection control and prevention measures in place at the home.
Inspection team
The inspection was carried out by one inspector.
Service and service type
The 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
We gave 24 hours' notice of the inspection. Due to the COVID-19 pandemic we wanted to review documentation remotely and make arrangements to speak with people and staff. This helped minimise the time we spent in face to face contact with the staff team.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We also requested information from the registered manager prior to this inspection. All this information was used as part of the inspection plan. On this occasion the provider was not asked to complete a provider information return prior to this inspection.
During the inspection
We spoke with the registered manager and a support worker. We observed interactions with the person living at The Acres. Through our discussions and a review of records, we looked at how people using the service were kept safe through the management systems in place. We also explored how staff were trained and equipped to support people’s individual needs.
After the inspection
We continued to seek clarification from the provider to validate evidence found. On the second day of the inspection we spoke with two members of staff and a relative of the person living at the home. Feedback received has been added to the report. We also sought feedback from the local authority. No concerns were raised with us.
Updated
23 September 2020
About the service
The Acres is a small residential home providing personal care to one person with a learning disability at the time of the inspection. One person had left the service just prior to our inspection. The service can support up to four people. Each person had their own bedroom, two of which were en-suite, and shared the lounge and kitchen. There was a waking night member of staff overnight in case of an emergency.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. It is a small home which is not identifiable as being a care home. People are supported to be part of their local community.
People’s experience of using this service and what we found
People were not safe living at the service. Risk assessments had not been robust enough to prevent one person leaving the home unsupported. Staff had not followed the agreed care plan to engage and distract this person when they were anxious. Action had not been taken when there was a ‘near miss’ incident when the same person was seen leaving the home by staff and then encouraged to return.
A new manager had been appointed in September 2019. The nominated individual and quality manager were taking more of a ‘back seat’ role, with the manager taking responsibility for managing the service.
The manager had re-written care plans and risk assessments, introduced a more robust quality monitoring system and regular staff meetings and supervisions.
People’s needs had not been adequately assessed before they moved to the service to ensure The Acres was able to meet their needs and they were compatible sharing with the people already living at the home. The manager told us they would lead all future pre-admission assessments.
Staff felt well supported by the manager, who was approachable. Staff completed training to meet people’s needs, although we noted some of this had only been arranged after people had already joined the service.
People were supported to maintain their health and nutrition. People received their medicines as prescribed.
Relatives were positive about the staff team supporting their relative, saying they were kind and caring.
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 service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
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 1 December 2018 and this is the first inspection.
Why we inspected
This was a planned inspection based on when the service was registered with us.
Enforcement
We have identified breaches in relation to managing the known risk of one person trying to leave the home unsupported, the lack of robust pre-admission assessments, the lack of engagement by staff to distract one person when they were anxious and not taking sufficient action following an incident to reduce the risk of the same thing happening again.
Please see the action we have told the provider to take for these breaches at the end of this report.
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.