Background to this inspection
Updated
27 November 2020
The inspection
This was a targeted inspection to check on specific concerns we had around the management of medicines, risks and infection control.
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
This inspection was undertaken by two inspectors.
Service and service type
Acacia House 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 two managers in post both 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
We reviewed the information we had received about the service since the last inspection. We sought feedback from the local authority commissioning and safeguarding professionals. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
Due to concerns about COVID 19 infection we observed people from a distance and spoke with one person. We undertook a tour of the premises to check on infection control practice. We checked medicines management systems and viewed a range of records. This included three people’s care plans, multiple medical records and audits, and records relating to infection control policies, practice and audits within the service. We spoke with both registered managers, the operations manager, an administrator, two housekeeping staff, and two registered nurses.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data, and quality assurance records. We spoke with four relatives and one health professional who have regular contact with the service.
Updated
27 November 2020
This inspection took place on 1 and 2 August 2017 and was unannounced.
Acacia House provides accommodation for up to 47 people with nursing and personal care needs. There were 41 people living at the service at the time of our inspection, although one person was in hospital. Some people had complex needs and required continual nursing care and support, including end of life care. Others were living with dementia and because of physical frailty or medical conditions, needed assistance with person care and moving around the home safely.
The service is an old house with a new extension on the ground floor. There are 44 rooms of which three can accommodate two people. The lower floor provides a dining room and three lounges as well as level access to the secure and well maintained gardens. Access to the upper floor is by a passenger lift and two staircases. There is onsite parking available.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Acacia House was last inspected in May 2016 when the service was rated overall as ‘Requires Improvement.’ This was because people did not always receive their medicines in accordance with their prescriptions or medical guidance and some people’s wishes about their end of life care were not always recorded. People were not always involved in the decisions about their care and treatment and, if people or their representatives were involved in care decisions, the process was not always recorded. Quality monitoring was not always effective; shortfalls in people’s care and treatment had not been identified by the provider or senior managers and people and staff were not always consulted or involved in the running of the service. This inspection found improvement had been made.
Staff followed correct and appropriate procedures in the storage and dispensing of medicines. People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.
An adequate system to recruit new staff was in place and made sure staff employed to support people were fit and suitable to be working at the service. There were sufficient numbers of staff on duty to make sure people were safe and received the care and support that they needed.
Staff had completed induction training when they first started work at the service. Staff were supported during their induction, monitored and assessed to check that they had gained the right skills and knowledge to support people in a way that met their needs. Staff continued to receive training and support. There were staff meetings, staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and DoLS and the least restrictive measures were in place to keep people safe and ensure they were not deprived of their liberty unnecessarily. Staff continued to seek consent of people for their everyday care and support needs.
People were protected from the risk of abuse because staff had received safeguarding training and were aware of how to recognise and report safeguarding concerns. Staff knew about whistle blowing and were confident they could raise any concerns with the provider or outside agencies if needed.
The care and support needs of each person were different and their care plan was individual to them. Personalised care plans, risk assessments and guidance were in place to help staff to support people. People's legal rights were protected as staff provided care in line with the Mental Capacity Act (2005). Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve best outcomes for people.
Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff knew people and their support needs well, they treated people with kindness, compassion and respect. Staff took time to speak with the people they were supporting. People were offered a choice of nutritious meals, snacks and drinks were always available.
There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff. People's privacy and dignity was respected.
People and relatives said they knew how to complain if necessary and that the registered manager was approachable. There was a clear complaints process in place
Staff felt there was good communication and were clear about their roles. They felt well supported by the registered and deputy managers. Feedback was sought from people, relatives and professionals about how the service was run.
A number of audits and checks were carried out each month by the registered and deputy manager, which were effective in identifying and addressing concerns and driving forward improvements.
We have however identified a number of areas where improvement is required. You can see these in the full version of the report.