Acorn Lodge Care Home

We found the following examples of good practice.

The premises were clean and hygienic. Cleaning schedules were in place, including for high touch points.

Personal Protective Equipment (PPE) and appropriate handwashing and sanitising facilities were available to staff.

The staff and residents were taking part in regular COVID-19 testing and people's temperatures were taken daily.

The local authority provided training on the wearing of PPE and pictorial guidance was on display. There were pictorial hand washing signs at sinks for people using the service

People were supported to stay in touch with their families through telephone calls and electronic devices.

The registered manager had systems in place to ensure that, cups, cutlery, plates and laundry were cleaned using a separate process.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 9 Regulated Activities Regulations 2014 - Person centred care

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Regulation 18 Regulated Activities Regulations 2014 - Staffing

Regulation 19 Regulated Activities Regulations 2014 – Fit and proper persons

Regulation 18 Registration Regulations 2009 – Notification of other incidents

Regulation 19 Registration Regulations 2009 Fees

Regulation 7 HSCA RA Regulations 2014-Requirements relating to registered managers

Following the last inspection the service was placed in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. We received an action plan from the provider. During this inspection, the service demonstrated to us that significant improvements have been made and is no longer rated as inadequate overall or in any of the key questions. The service is no longer in special measures.

Acorn Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 accommodates up to 15 people who have a learning disability in one adapted building. At the time of our inspection there were eight people using the service.

The care service has been developed in line with the values that underpin the Registering the right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was in place. 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 also the provider.

At our last inspection, there was a failure to ensure service users were protected from the risks associated with improper operation of the premises including inadequate fire safety systems and processes. A visit was made by the fire service and the fire safety systems were now adequate.

Since our last inspection, the registered manager and deputy manager had made many improvements.

The registered manager had reviewed and updated risk assessments and care plans to ensure staff were aware of how to support people to remain safe and to be as independent as possible. Staff had received training in safeguarding and they told us they were encouraged to report any concerns about the safety or the quality of the service people received. There was now enough staff to keep people safe. Staff were visible throughout the day and they responded to people’s needs in a timely way. Improvements had been made to the checks carried out on new staff to ensure recruitment was robust and safe. People were given support to take their medicines as prescribed. Audits were carried out by senior staff to ensure medicines were managed safely. Staff were observed following good infection control practices to help reduce the spread of infection.

Staff had access to relevant training and regular supervision to equip them with the knowledge and skills to care and support people effectively. Nutritional needs were met and people were supported to access healthcare services if they needed them. People's health needs were closely monitored and any changes to their needs were immediately reflected in their care plans and the care that they received. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff were kind and caring and treated people with dignity and respect. People were relaxed and comfortable in the company of staff. Staff knew people well including their preferred method of communication.

Staff supported people to follow their own hobbies, activities and interests. Care plans were detailed and staff regularly reviewed them with the person and family members. Staff worked with and took advice from health care professionals. There were systems in place to support people if they wished to complain or raise concerns about the service.

The registered manager had received support and advice from the local authority and external consultants to review all areas of service provision. This meant effective management systems were now in place from lessons learnt.

This inspection took place on the 20 & 26 June 2017 and was unannounced.

Acorn Lodge is a residential care providing care and support for up to 15 adults who have a learning disability and support for people living with dementia. At the time of our inspection there were 11 people using the service.

The service has a registered manager who is also the provider. 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.

This inspection was prompted in part following information of concern received from the local authority and their safeguarding team telling us people were at risk of not having their needs responded to in a safe and effective way. At this inspection we identified a number of serious concerns.

We returned to the service to complete the inspection on 26 June 2017 and found that many of the urgent concerns identified on 20 June remained and we continued to identify concerns which escalated the risk to people using your service. Urgent action was required to make improvements as we found major concerns in relation to the lack of competent, skilled and knowledge staff available to provide safe care and treatment to people at all times of the day and night. There was a failure to ensure that service users were protected from the risks associated with improper operation of the premises including inadequate fire safety systems and processes. This meant that the safety and welfare of people using the service was at risk and the provider was failing to provide a safe service. In response to our findings we asked the provider to inform us immediately of the urgent actions they would take with immediate effect to protect people and raise standards.

Immediately following our inspection we notified relevant stakeholders such as the local safeguarding authority and Essex Fire service of our findings.

People did not receive safe and responsive care. People were not protected from being cared for by unsuitable staff because robust recruitment procedures were not in place and operated effectively. We found there was inadequate numbers of skilled and knowledgeable staff employed with a command of English which would enable them to understand and respond to people’s health, welfare and safety needs. These staff were sometimes left in charge at night and we were not assured that they could respond to emergency situations and communicate effectively with people to enable them to understand, be understood and be able to respond to appropriately to people’s care and treatment needs.

People were not always supported by staff that had the necessary skills and knowledge to meet their needs. Staff did not always receive appropriate and effective training and supervision support which meant staff had not received adequate training to deliver effective care. Not all staff were familiar with safeguarding procedures and had not received adequate training on recognising and responding to acts of abuse and keeping people safe.

There were systems in place to manage people’s medicines in a safe way. However, we recommend that the provider reviews its procedures in relation to the safe storage of medicines to ensure people’s medicines are stored at a safe temperature and ensure that they are compliant with best-practice guidance for storage of medicines in care homes.

Staff had limited resources such as adequate staffing to enable them to fully enhance people’s quality of life. Whilst staff were kind and caring in their approach they were often task focused. People did not always have the communication tools they needed to make themselves understood.

The provider did not promote a culture that encouraged openness, transparency and honesty at all levels. There was also a failure of the provider to notify CQC of incidents being investigated by the police as they are required by law to do so.

The provider had a limited governance system in place to monitor the quality and safety of the service. This was inadequate as it did not identify the shortfalls we found and identify the risks to people’s safety and welfare. For example, in relation to fire safety, the safe moving and handling of people and the insufficient numbers of skilled and knowledgably staff, available to meet people’s needs at all times.

Care and support plans were cumbersome, repetitive with lots of information which was difficult to navigate. Not all care plans were personalised with some records containing generic information which had been copied and pasted which resulted in people being referred to by the wrong name and incorrect gender.

People were not always supported to take part in meaningful activities. Staff did not have up to date, skills and knowledge as to current good practice in meeting the needs of people with a cognitive disability including those living with dementia and those with a learning disability.

People had access to healthcare services but access was not always provided in a timely way which meant people were put at risk of delayed access to treatment. People were weighed monthly and weights recorded. However, it was not always clear what action had been taken to support people who had been identified as losing weight.

We were not assured that the registered manager and staff had up to date, skills and knowledge as to current good practice in meeting the needs of people with a cognitive disability including those living with dementia and those with a learning disability.

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Acorn Lodge Care Home provides care and support for up to 15 people with a learning and physical disability. There were 15 people living at the service when we visited.

The service has 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 had been trained to recognise signs of potential abuse and how to report them. People felt safe living at the service. There were processes in place to manage identifiable risks. People had risk assessments in place to enable them to maintain their independence and to minimise any unnecessarily restrictions on their liberty.

The provider carried out recruitment checks on new staff to make sure they were fit to work at the service. There were suitable and sufficient staff employed with the appropriate skills mix to support people with their needs. Systems were in place to ensure people were supported to take their medicines safely and at the appropriate times.

Staff had been provided with induction and on-going essential training to keep their skills up to date. They were supported with regular supervision from the registered manager.

Staff ensured that people’s consent was gained before providing them with support. People were supported to make decisions about their care and support needs; and this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of the guidance and followed the correct processes to protect people.

People were supported to maintain a balanced diet and were able to make choices on what they wished to eat and drink. If required, people were supported by staff to access other healthcare facilities and were registered with a GP.

Positive and caring relationships had been developed between people and staff. There were processes in place to ensure that people’s views were acted on. Staff provided care and support to people in a meaningful way. Where possible people were encouraged to maintain their independence and staff ensured their privacy and dignity was promoted.

Pre-admission assessments were undertaken before people came to live at the service. This was to ensure people’s identified needs would be adequately met. A complaints procedure had been developed in an appropriate format to enable people to raise concerns if they needed to.

There was a positive, open and inclusive culture at the service. The registered manager was transparent and visible. This inspired staff to provide a quality service. Effective quality assurance systems were in place to monitor the quality of the service provided and to drive continuous improvements.

Staff listened to people and treated them with respect. It was evident that staff knew people well and understood their individual needs. People received care and support that was person-centred and caring.

There were suitable arrangements in place to ensure people's medication was managed safely.

Staff received support and training to make sure they had the skills and knowledge to care for people safely.

We found that the provider had systems in place to monitor and respond to any complaints received by the home. There were adequate systems in place to ensure records were accurate and maintained.