Acorn Nursing Home

Acorn Nursing Home is a nursing home supporting up to 40 people over the age of 65 with varying physical and mental health needs. At the time of the inspection there were 35 people living in the home. The home is over three floors and there is both lift and stair access to each. There is a large kitchen and laundry on the ground floor. There is one large communal area on the ground floor and at the time of the inspection two further communal rooms were being redecorated for use by the people in the home.

People’s experience of using this service and what we found

We found some records and audits were not dated and there were some inconsistencies around the accuracy of records to support the implementation of the Mental Capacity Act. We have given two recommendations about these concerns. Where records had not been updated to reflect people’s current circumstance, we were assured this did not impact on the delivery of correct care as information on people’s needs were clearly and accurately recorded on handover records and in communication books. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service mostly supported this practice. Where we identified some incorrectly completed paperwork, we were told they would be immediately rectified. People told us they felt safe and were supported by well trained staff. Medicines were safely managed, and a medicines champion was in place to oversee this.

People told us they liked living at Acorn Nursing Home, we found positive staff relationships and meaningful activity taking place throughout the inspection. Staff treated people with dignity and respect and people were consistently given both choices and asked for their consent prior to any interaction.

The culture amongst the staff was positive with many staff describing their peers as “family”. The rota was mostly covered by permanent staff who had been in post many years. Audits were in place and were regularly completed on both management and care records.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 14 April 2022) and there were 3 breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 15, 16 February and 3 March 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the management of medicines, confidentiality and respect and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection

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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Acorn Nursing Home on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Acorn Nursing Home is a nursing home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. Single room accommodation is provided for people and there is a passenger lift for access to the upper floors. The service can support up to 40 people.

People’s experience of using this service and what we found

Some improvements had been made since the last inspection, however we found medicines were not always managed safely and care records did not consistently contain person centred and accurate information. People’s privacy and dignity was not always upheld. Audits and checks did not consistently drive improvement. Prior to the inspection concluding the registered manager took action to improve the service.

People told us they felt safe and they were supported by staff who helped them quickly if they needed this. Checks were completed to help ensure prospective staff were suitable to work with vulnerable people. Risk assessments were carried out to help minimise the risk of avoidable harm and staff knew the help and support people needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were cared for in a safe, clean and homely environment by staff who were caring, competent and knowledgeable about their needs. Staff told us training and supervision was arranged to ensure they had the skills to carry out their role.

People told us they were happy at the home and they felt cared for. They explained the food was good, enjoyable activities were arranged, and they were supported to access medical advice if they needed this.

Care was person centred, met people's needs and achieved good outcomes. People were cared for at the end of their life in line with their wishes.

Staff told us they felt supported by the registered manager and they were able to approach them if they needed support and guidance. People told us the registered manager was approachable and was part of the team.

People were consulted and asked their views on the service provided. People told us they were happy at the home and were confident any comments or complaints they made would be listened to.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 8 January 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

This service has been in Special Measures since 11 November 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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 COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

You can see what action we have asked the provider to take at the end of this full report.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to the safe management of medicines, record keeping, dignity and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service and what we found

People told us they felt safe, however the provider failed to demonstrate that risks were consistently monitored related to people’s health and welfare and in the maintenance of the building. People lived in a home that did not look visibly clean. There were not enough cleaning staff to keep the home clean. The provider failed to deploy enough staff while waiting to employ new housekeeping staff.

People’s dignity and privacy was not consistently upheld. Confidential information was accessible to people and visitors. Language used by staff and documentation did not promote people’s dignity and individuality.

Record keeping related to the administration of some medicines was not consistently completed. Best practice for the administration of medicines was not consistently followed. Audits failed to either identify concerns or drive improvement. Some documents in use had been reviewed as correct when they were not accurate. Systems were not always robust and operated effectively to ensure all regulatory requirements had been fulfilled.

The provider did not consistently follow robust recruitment procedures. We have made a recommendation about this. Some care plans did not include all the relevant information on people’s behaviours and health conditions. We have made a recommendation about this.

Observations showed people were happy and relaxed in the company of staff. Feedback on the registered manager was positive from people, visitors, staff and the local authority. One person told us, “I’m very happy with the home and the manager is definitely doing a good job.” The registered manager engaged with people, visitors and staff, through daily interactions and having an open-door policy. The management team had been working with a range of professionals following a COVID-19 outbreak in order to meet people's needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 11 September 2019).

Why we inspected

The inspection was prompted as part of CQC’s response to care homes with outbreaks of COVID-19, we are conducting reviews to ensure that the Infection Prevention and Control practice was safe, and the service was compliant with infection prevention and control [IPC] measures.

We had received concerns that IPC and environmental hygiene practices had deteriorated. A decision was made for us to inspect and examine those risks. We looked at IPC 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 COVID-19 and other infection outbreaks effectively.

We inspected and found there was a concern with IPC, cleanliness, risk management, and dignity and respect so we widened the scope of the inspection to include all five domains, safe, effective caring, responsive and well-led.

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 the management of risk, the cleanliness of the home, infection prevention practices, using language that promotes people’s dignity, the management of documentation and staffing levels at this inspection.

We have taken enforcement action. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 of 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.

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.

Acorn nursing home is situated in a residential area of Blackpool close to public transport. Single room accommodation is provided for people and there is a passenger lift for access to the upper floors. The service can support 40 people who require nursing care. At the time of our inspection there were 39 people who lived at the home.

People’s experience of using this service and what we found

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns. People told us they felt safe when supported by staff. Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. People were safely supported to receive their medicines as prescribed.

People's needs were assessed, and care and support had been planned proactively and in partnership with them. Staff had received regular training and supervision to support them to meet people's needs. People were provided with a nutritious and varied diet. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were positive about the service and said staff were kind and caring. People were treated with dignity and respect and their right to privacy was upheld. The service provided people with information about local advocacy services, to ensure they could access support to express their views if they needed to.

People received person-centred care which was responsive to their needs. People’s communication needs had been assessed and where support was required these had been met. The registered manager managed people’s concerns and complaints appropriately and people told us they felt listened to.

The service worked in partnership with a variety of agencies to ensure people received all the support they needed. People were happy with how the service was managed. Staff felt well supported by the registered manager. The registered manager and provider completed regular audits and checks, which ensured appropriate levels of quality and safety were maintained at the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 01 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Acorn provides nursing care and treatment of disease, disorder or injury. They support a maximum of 40 older people who may live with a physical disability. At the time of our inspection there were 40 people living at the home. Acorn is situated in a residential area of Blackpool close to public transport. Single room accommodation is provided for people and there is a passenger lift for access to the upper floors. There are ample toilet and bathing facilities and a variety of communal areas and gardens for people’s use.

A registered manager was in place. 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.

At the last inspection on 24 March 2015, the service was rated as good in all five key areas and overall. The service met the requirements of the regulations.

During this inspection, we found the provider had systems to manage accidents and incidents to reduce the potential risk to people’s safety. Care files contained risk assessments to guide staff to reduce the risks of harm or injury to people who lived at Acorn. Staff demonstrated a good understanding of how to protect people from potential abuse and had training to underpin this. Everyone we spoke with told us they felt safe living and working at the home.

People who lived at Acorn told us staffing levels were adequate to their needs. We saw evidence to confirm the management team checked staff backgrounds prior to their recruitment to ensure their suitability. Staff said they were effectively trained to undertake their duties and records we looked at confirmed a varied training programme was in place. One staff member said, “There’s lots of training. There is no issue with attending courses.”

The registered manager had systems to oversee the safe management of medication to protect people from potential harm. For example, staff had relevant training and all related processes were audited to monitor their effectiveness. Staff signed charts after the administration of medicines to confirm individuals had taken them.

Those who lived at the home said they had a choice of what to eat and where to have their meals. One person told us, “I like my meals in my room. The staff are very obliging with that.” We saw staff supported them to meet their nutritional needs with a respectful approach. The registered manager completed risk assessments to protect people from the risks of malnutrition.

Records we looked at held evidence to confirm people or their representatives had signed consent to care and treatment. We found those who lived at the home were not deprived of their liberty. Staff received training to underpin their knowledge of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards.

We observed staff were kind and engaged with people and their relatives in a meaningful way. Staff encouraged them to be fully involved in their care planning and we found this was personalised to their individual requirements. The main aim of agreed outcomes centred upon maintaining the person’s independence, whilst respecting their culture, diversity and human rights.

Staff, people and their relatives told us the home was well organised and had good leadership. The registered manager had suitable arrangements to check and monitor the home’s quality assurance. Satisfaction surveys were provided for staff, visitors and people who lived at the home. We saw action was taken when issues were identified to maintain everyone’s safety and welfare.

At our previous visit in October 2013 we found minor shortfalls in some areas of care the residents received. This was because there were times when there was no oversight of the residents in the lounge areas. We also observed that some moving and handling practices were unsafe. This meant that at times, the residents were at risk of not receiving appropriate support.

The manager had addressed the issues by introducing documentation to ensure 'end of shift welfare checks' had been completed. This was a checklist of duties for staff to complete daily. One staff member said, 'We now have a list that ensures all footplates on wheelchairs are checked daily. It works well.'

During our inspection we used a method called Short Observational Framework for Inspection (SOFI). This involved observing staff interactions with the people in their care. SOFI helps us assess and understand whether people who use services are receiving good quality care that meets their individual needs. We observed staff being responsive and attentive. This confirmed people who required support with their personal care were being treated with respect and dignity.

The manager told us the staff were now attending training courses in moving and handling. Staff we spoke with confirmed this.

We spoke with people who lived at the home. They told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs. One person said, 'The care is wonderful, the staff are superb and I am very happy here.'

We spent time in areas of the home, including the lounge and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff interactions with those in their care. In general we found that staff treated people with respect and provided support or attention when requested. However there were occasions when there was no oversight of the residents in the lounge areas. We also observed that some moving and handling practices were unsafe. This meant that at times, the residents were at risk of not receiving appropriate support.

There were a range of audits and systems in place to monitor the quality of service people received. Residents and relatives told us that they were well supported by the manager and staff team. A relative said, "You can always speak to the manager, her door is always open."