Archived: Acacia Nursing Home

Updated 10 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was carried out by two adult social care inspectors for every day of the inspection, a medicine inspector for one day and a nurse specialist adviser for one day. This inspection was undertaken in response to concerns we had received from relatives and external healthcare professionals who visited the service. The concerns primarily related to people receiving safe care and treatment, staffing and leadership and governance.

When Acacia Nursing Home was last inspected in February 2018, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

As this inspection was brought forward following concerns received the provider had not completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Before the inspection we reviewed the information that we had about the service including the information of concern we had received that triggered the inspection, the provider’s action plan, safeguarding records, complaints, and statutory notifications. Notifications are information about specific important events the service is legally required to send to us.

Some people in the service were living with dementia and were not able to tell us about their experiences. We used a number of different methods such as undertaking observations to help us understand people’s experiences. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with eight people who used the service and five people’s relatives or visitors. We also spoke with 15 members of staff. This included two directors, the deputy manager, nursing staff, care staff and ancillary staff.

During the inspection, we looked at 12 people’s care and support records. We also reviewed records associated with people’s care provision such as medicine records and daily care records relating to food and fluid consumption. We reviewed records relating to the management of the service such as the staffing rotas, policies, incident and accident records, recruitment and training records, meeting minutes and audit reports.

During the inspection we asked for 14 documents and explanations to be sent to us which we were unable to find at the home. Eight of these were not sent within the deadline. Most were discussed prior to the inspection closing with the management. They sent further information to us following the inspection.

Updated 10 January 2019

We undertook an unannounced focused inspection of Acacia Nursing Home on 23 and 24 October 2018. This inspection was undertaken in response to multiple, significant concerns we had received about the service from a variety of sources. The concerns primarily related to people receiving safe care and treatment, staffing levels and leadership and governance.

The inspection team inspected the service against two of the five questions we ask about services: is the service well led and safe. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At the last inspection in August 2018, the service was rated inadequate. We had found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. These were all repeated from the February 2018 inspection. We identified significant concerns with the safe care and support of people including ongoing medicine management and pressure care issues. Staffing levels and training were not adequate to keep people safe. There was a lack of governance by the management to monitor the quality of care people were receiving. Legal notifications had not been received by the Care Quality Commission as required.

Following the inspection in February 2018, we imposed some conditions on the provider’s registration to drive improvement in the home. After the August 2018 inspection, we continued to restrict admissions to the service because there had been little improvement. The provider was still required to send us a monthly report of how they were improving those concerns we had found. There had been a delay in us receiving the latest report and this was provided during the inspection. The service remained in special measures due to a lack of improvement between February 2018 to August 2018.

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.

At this inspection, there had been small improvements with the provider notifying us of significant events and with medicine management. However, substantial concerns were still found which placed people at significant risk of harm or actual harm. Most staff, including senior staff, told us they felt people were not safe at the home. Staffing levels were potentially dangerous at times including a high use of agency staff and there were periods of time people were not supported to keep them safe. People with specific health conditions were not having their needs met including pressure care and those at risk of seizures. The management continued to fail to identify and improve the service people received. Some concerns which had been resolved between February 2018 and August 2018 had returned. Staff were no longer being recruited safely. People who were at risk of choking were not always being supported safely.

Acacia Nursing Home 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 can accommodate up to 39 people. There were 26 people living at the home during this inspection. The building is purpose built and has a courtyard garden in the middle. There are three floors with communal spaces such as lounges and dining rooms on each floor. At this inspection everyone had their own individual bedroom.

There was now a registered manager at the home. 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 had recently returned to work after a period of being absent. This meant there was a period between the August 2018 inspection and this inspection where one of the directors, who was a nurse, was acting as the manager.

The service was not well led. There was a lack of communication between management. People, relatives and staff did not always feel listened to. Shortfalls identified during this inspection had not been identified by the quality assurance processes. Documents which should be readily available during the inspection were not always. There was still disorganisation by the management and systems in place to audit the service people were receiving were not always acted upon. The provider failed to have a monthly audit ready until the second day of inspection.

People were at significant risk of harm because they did not receive care and treatment in line with their health needs. Risks were found for people in relation to pressure area care and some people had suffered harm since the last inspection. Some people were placed at potential risk of choking and aspiration. Although small improvements had occurred with the storage of medicines we found medicines were not always managed safely.

Staff had not received training to have the skills and knowledge required to effectively support people. New staff did not have adequate training to keep people safe if they had not previously worked in care before and come with experience. Although thickening agents were now being stored securely, some people who required special diets and drinks did not have their needs met. At times, people were placed at risk of choking and aspiration.

There were not enough staff to meet people’s needs and keep them safe. Most permanent staff told us they were planning to leave or had a leaving date. There was a high use of agency staff. People were not always protected from potential abuse because systems had not ensured measures were put in place when allegations had been made. Staff understood how to recognise signs of abuse and knew who to report it to. The recruitment procedures were not ensuring people were protected from unsuitable staff supporting them.

People’s care plans had some improvements to make them personal. However, they still contained inconsistencies and there was sometimes a lack of specific information to guide staff to people’s needs and wishes. Guidance which was in place was not always known about by staff or followed.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some of these breaches were repeated from the previous inspections in February 2018 and August 2018.

Following this inspection, we identified significant risks to people’s safety and welfare. The local authority and other agencies took action to keep people safe and support people to move to other care homes. The provider decided they would close the home. The home is now closed.

You can see the actions we took at the end of this report.