Acorn Manor is a residential care home providing accommodation and personal care to 29 people aged 65 and over at the time of the inspection. The service can support up to 30 people in one adapted building.People’s experience of using this service and what we found
People did not receive safe care. The registered manager had not developed a way of checking the safety and quality of care provided and as a result many aspects of poor care had not been identified.
Arrangements to protect people during the COVID-19 pandemic were insufficient with no evidence that the registered provider had sought to keep in touch with updates and requirements needed to keep people safe. The premises were not always hygienic or well maintained.
People were not always safeguarded from abuse. The registered manager did not demonstrate an understanding of what constituted abuse or how to report it effectively. People were at risk of serious injury through a number of unwitnessed falls that were not analysed effectively and or referred to other agencies that could assist to minimise such occurrences. There was no reflective learning after incidents had occurred and the risk of re-occurrence was very likely.
Staffing levels were maintained although dependency tools used were unclear as to how numbers of staff on duty were matched to people’s needs. Medication management was safe.
The service was not always effective. Assessment information for people who came to live at Acorn Manor Residential Home was incomplete, lacking in detail and did not demonstrate a person-centred basis for care practice. One person us “I have been independent in the past, but no-one has looked at what I can do for myself”. Staff training had been completed but was not effective. Staff did not follow the principles of the Mental Capacity Act and had basic understanding of the needs of those who lived with dementia.
We have made a recommendation about the best practice and following guidance related to the mental capacity act.
The design of the building did not fully reflect good practice to cater for the needs of people living with dementia. Liaison with other professionals was incomplete, for example, there was limited evidence of follow up with falls teams to gain support for people who were at risk of regularly falling and becoming injured. People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
The service was not always caring. The independence of people was not always taken into account and sensitive information was not always kept secure. People were not provided with the contact details of other agencies that could support them, for example, advocacy services.
The service was not always responsive. People were not provided with effective formats of information reflecting their communication needs. People told us that they did not feel involved in decision-making and had not seen their care plans. Care was not person-centred as generalisations were made about people who were living with dementia and/or other health conditions. The complaints procedure was not transparent to people. Activities were not always in line with peoples assessed social interests.
Staff interactions with people were caring and positive. People’s comments included. “It is not what I expected. The home is not the problem; it is just a new way of living” and “Staff are kind and they are always around if I need them”.
Relatives we spoke with had had limited opportunity to visit their loved ones during the pandemic and therefore their views were based on information that they had received from the registered manager and staff in terms of their loved one’s experiences within the home. They told us that “I have been assured that [name] has settled in", "The manager and staff have been really helpful when[name] went to live there” and “Yes I am more than happy with the care”
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 17/07/2020 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns about infection control, the management of accidents and incidents, and the governance of the service. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see all sections of this full report.
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 assurance that the service can respond to coronavirus and other infection outbreaks effectively.
You can see what action we have asked the provider to take at the end of this full report.
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 person-centred care, safe care and treatment and governance at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.