About the service: Acorn Lodge is a care home, providing personal care and accommodation for up to 60 people. It provides care to older people, some of whom are living with dementia. Care is provided over two floors. Each floor has communal lounges, dining areas and a kitchenette. The home has secure gardens that people can access. At the time of our inspection visit 54 people lived at the home.
What life is like for people using this service:
Risks were not consistently well managed. Medicines were not always stored safely, which posed risks of harm to people. Where people had identified risks of harm, or posed potential risks to others, risk management plans were not always in place to guide staff on actions to take to mitigate those risks. Staff did not always know how to protect people from identified risks of harm. For example, when dietary guidance had been given and was not followed by staff.
Overall, there were sufficient staff on shift. However, at times staff deployment meant people’s needs were not always met, such as during mealtimes on the first floor. Night staff felt there were sufficient staff on shift. Staff received an induction, training and support from within the staff team, the provider’s trainer and managers. Staff were trained in how to protect people from the risks of abuse. Further training was planned for staff where the registered manager had identified knowledge needed to be refreshed, this included skin care.
Overall, people had their prescribed medicines available to them and were supported with these by trained staff. The home was clean and tidy, and staff understood how to prevent risks of cross infection.
People had their needs assessed before they moved into the home. Whilst people had plans of care relevant to most of their needs, staff could often not find information. People’s care notes and care plans were not well organised, and some contained conflicting information. The registered manager and regional manager told us about their plans to improve care records and review people’s care plans before the end of July 2019.
Overall, people had opportunities to engage in group activities, however, there was limited opportunity on the day of our inspection visit because the activities staff member had taken four people out, which left limited opportunities for people at the home.
People had access to healthcare when required. On the day of our inspection we saw people were offered enough food and drink to meet their dietary requirements. However, important records related to people’s fluid intake reflected their needs were not always met.
Overall, positive caring interactions took place between people and staff, and people felt well cared for.
Overall, staff followed the provider’s policies, however, a few staff did not. One staff member told us they knew the dress code policy but had not followed it, another staff member told us they had forgotten to lock a door to secure medicines.
People made day to day decisions about their care and were supported by staff who worked within the principles of the Mental Capacity Act 2005. Mental capacity assessments had not always been completed for people.
Systems were in place for people to give their feedback on the service. Overall, people and relatives were happy with the services. A few people shared some concerns they had, such as about the quality of the food.
The provider had recognised they had gone through a period of instability when the previous manager had left. A new manager, who had registered with us, had started during January 2019 and was making improvements to the services provided. These needed to be embedded and sustained and some further improvements were required.
The provider had identified improvements were required to people's care records. However, they had not taken timely action to implement those to ensure staff had the information they needed so people received a safe service.
Overall, the provider’s quality assurance system identified where improvements were needed, and a service improvement plan was shared with us detailing the provider’s timescale for implementing the improvements.
We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
These were:
Regulation 12 Regulated Activities Regulations 2014 – Safe care and treatment
Regulation 17 Good governance
Rating at last inspection: The service was rated Good. (The last report was published on 26 January 2017).
Why we inspected: This was a planned inspection based on the rating of the last inspection. The service is now rated as ‘Requires Improvement’ overall.
Enforcement: Action provider needs to take (refer to end of report).
Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk