Acorn Lodge - Croydon 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 39 older people in one adapted building. At the time of our inspection 24 people were using the service, many of whom were living with dementia.At our previous inspection in April 2018 we found the provider was in breach of legal requirements relating to dignity and respect, need for consent, safe care and treatment, staffing and good governance. We rated the service 'requires improvement' overall and in each of the five key questions. Following the inspection, we asked the provider to complete an action plan to tell us what they would do to address the breaches of legal requirements we found.
At this inspection we found the provider had addressed the breaches of legal requirements relating to dignity and respect, need for consent, safe care and treatment and staffing. However, they had not taken sufficient action to address the breach of legal requirements relating to good governance. We also found an additional breach of legal requirements. The service remains rated 'requires improvement' overall and in each of the five key questions.
Appropriate recruitment checks were not made on staff to ensure they were suitable to support people. There were however enough staff to support people safely. Staff received relevant training to help them in their roles and they were encouraged to improve their working practices through supervision. But, there was no system in place to monitor that supervision took place at regular and appropriate intervals.
Some improvement had been made to the quality of information for staff on how people’s care needs should be met. However, the quality of information contained in people’s care records was inconsistent and variable by individual. Staff were still not maintaining accurate and complete daily records of the support provided to people.
Staff had access to improved information about how to manage risks to people’s safety. Staff understood the risks posed to people and how they should support them to stay safe. Staff were trained to identify abuse and understood when to report concerns to the appropriate person. However, they were not always consistent when recording and reporting accidents and incidents involving people.
Arrangements to support people with their health needs were not fully effective. However, staff liaised with visiting healthcare professionals and when people became unwell they sought appropriate support from them. People received their prescribed medicines as required. These were stored safely and securely. However, guidance for staff on when to administer ‘as required’ medicines was not easily available to staff. Recording forms with body maps were not used by staff when they applied topical creams or lotions.
People had more choice over daily decisions. Staff respected people’s privacy when supporting them with their personal care needs. But staff were sometimes not observant to people’s appearances to ensure this was appropriate. Communication between people and staff was still inconsistent.
People were supported to eat and drink enough to meet their needs. Menus had been revamped following consultation with people and their relatives to include more choice and options for meals that people preferred. But people did not always have a dignified dining experience.
Activities provision at the service had improved. However, some staff were still not providing the level of engagement and stimulation for people that was expected. Staff supported people with their social, cultural and religious needs and to be as independent as they could be. There were no restrictions placed on people’s friends and relatives about when they could visit the service.
The provider had acted to make the premises safer for people. There was regular maintenance and servicing of the premises and of equipment used in the home, to check these remained in good order and safe to use. The environment had been improved to make this more suitable for people living with dementia. There was better information for people around the environment. However, people’s bedrooms were sparsely furnished and lacked personalisation.
The environment were clean and hygienic. Staff followed good practice to ensure risks to people were minimised from poor hygiene and cleanliness when providing personal care and when preparing and serving food.
Staff were now aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and supported people in the least restrictive way possible. The policies and systems in the service supported this practice.
The provider continued to maintain arrangements to support people at the end of their lives. Relatives, where this was appropriate, had been included in discussions to ensure that end of life decisions were made with their involvement.
The provider maintained arrangements for dealing with people’s complaints. However, complaints were not responded to in writing, so people might not have been informed of their rights to take their complaint further.
The provider’s governance system was still not fully effective. No substantive management audits or checks of the service had been undertaken since September 2018 and the provider had not identified the issues we found during this inspection with the quality and safety of the service. The provider had not sufficiently monitored progress against their own action plan to address the breaches in legal requirements we found at the last inspection.
Relatives felt the provider had not always been open and transparent with them about management changes at the service. There was no registered manager in post. A new home manager had been appointed prior to our inspection who had had an immediate positive impact on people and relatives.
It was evident that the provider had made some improvements to the service since our last inspection. The provider had acted to capture the views of people and their relatives to identify how the service could be improved. The provider was continuing to invest in the service and planned to make further changes to improve standards and service quality.
At the time of this inspection the provider was continuing to meet regularly with the local authority as part of their ongoing contract quality monitoring arrangements. We noted that they responded to the local authority’s requests for information promptly and dealt with concerns in an appropriate way.
At this inspection we found the provider in breach of legal requirements with regard to fit and proper persons employed and good governance. We are taking enforcement action in relation to the breach of legal requirements with regard to good governance and we will report on this when our action is complete. You can see what action we told the provider to take with regard to the other breaches at the back of the full version of the report.