This unannounced inspection took place on 9,10 & 14 December 2015.Acacia Court is a care home which provides personal care and accommodation for up to 27 people living with dementia. It comprises two large detached houses joined by an extension. The accommodation includes a large lounge, a spacious dining area and a large garden to the rear of the property. There is parking to the front of the building.
Twenty three people were living at the home at the time of the inspection.
A registered manager was in post and had been working at the home since 2010. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
We found the staffing levels were not sufficient to ensure people were being monitored at all times was. The staff duty rotas for October 2015 through to the first week in December 2015 showed a clear variation in staffing levels that did not reflect what staff said the staffing levels should be. Frequently the registered manager was working within the care staff numbers. You can see what action we told the provider (owner) to take at the back of the full version of this report.
People told us they felt safe in the way staff supported them. Staff we spoke with were clear about adult safeguarding. The majority of the staff team had not received training in adult safeguarding. We found five recorded incidents that should have been reported to the Local Authority as safeguarding concerns but had not. You can see what action we told the provider to take at the back of the full version of this report.
Medicines were not always managed in a safe way. We observed a topical medicine (cream) in a person’s bedroom was not stored securely. The medication reference book available for staff to use was out-of-date. The fridge temperatures were not always within the acceptable range. Medicines given by hiding them in a person’s drink or food was not done in line with the Mental Capacity Act 2005. The medication policy was not in accordance with good practice national guidance for managing medicines in care homes.
Recruitment practices were not robust. The home was short staffed so staff from the provider’s other homes locally were helping out. We were able to account for all of these staff except one person who had worked two shifts in October 2015. Therefore we were unable to confirm how the person had been recruited and whether they were suitable to work with vulnerable. You can see what action we told the provider to take at the back of the full version of this report.
A whistle blowing policy was in place and staff said they knew what whistle blowing was and would not hesitate to report any concerns.
Staff were receiving regular supervision and an annual appraisal. Training the provider required staff to complete was not up-to-date. For example, only 38% of staff had completed training in dementia care. Few staff had received food hygiene training. You can see what action we told the provider to take at the back of the full version of this report.
Arrangements to monitor the safety of the environment and equipment were not rigorous. For example, hoists and hoist slings were not being thoroughly examined in accordance with Lifting Operations and Lifting Equipment Regulations 1998 (LOLER). New window restrictors had been fitted following a serious incident but these were not in accordance with national guidance on window restrictors in care homes. The environment had not been designed, adapted or decorated to support the independence and orientation of people living with dementia. You can see what action we told the provider to take at the back of the full version of this report.
Appropriate referrals had been made to the Local Authority to deprive people of their liberty. Staff had received awareness training in relation to the Mental Capacity Act (2005). The way in which mental capacity assessments had been developed was not in keeping with the principles of the Mental Capacity Act (2005). The completed mental capacity assessments we looked at were generic in nature and did not identify the decision the person was being assessed as needing to make. You can see what action we told the provider to take at the back of the full version of this report.
People and families we spoke with were satisfied with meals. People said they had access to drinks and snacks throughout the day.
People had access to health care when they needed it, including their GP, dentist, optician and community mental health service. A visiting healthcare professional told us the registered manager and staff were approachable and responsive.
Risk assessments and care plans were not being revised as people’s needs changed. For example, a person had a care plan in place indicating they were at risk to falls even though the person was no longer mobile. You can see what action we told the provider to take at the back of the full version of this report.
People’s privacy was not always maintained. Some people liked to walk about and to go in and out of other people’s bedrooms. This was an on-going issue and we found a person asleep on another person’s bedroom during the inspection. You can see what action we told the provider to take at the back of the full version of this report.
Staff were caring and kind in the way they supported people. They treated people with compassion and respect. They understood people’s preferences and ensured people’s privacy when supporting them with personal care activities. People’s preferences and preferred routines were recorded and displayed in their bedrooms.
Recreational activities were externally facilitated for one hour four days per week. Very little recreational activity happened between these sessions. Occasional trips out were arranged and a trip to a pantomime was taking place on one of the days of the inspection.
A complaints procedure was in place and displayed in each person’s bedroom. People we spoke with and families were aware of how to raise concerns.
The approach to checking and auditing the service was not robust. Medication audits were established but they had not picked up on some of the issues we identified. Care record audits had not taken place for some time, which meant some of the concerns we identified with the care records had not been recognised by the registered manager. 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 location is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in Special Measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
You can see what action we told the provider to take at the back of the full version of this report.