Archived: Acorn Hill Nursing Home

At our last inspection of Acorn Hill (report published on 16 November 2018) we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service as Requires Improvement. At this inspection we found the breaches were met but further improvements were needed to ensure people received safe, effective care that met their needs.

About the service

Acorn Hill Nursing Home is registered to provide accommodation, nursing and personal care to up to 59 people, some of whom are living with dementia and/or have complex physical and mental health needs. At the time of our inspection there were 29 people using the service.

People’s experience of using this service

Since our last inspection the registered manager, provider and staff have made many improvements to the home. People, relatives and staff were positive about the home and told us about some of the improvements they had seen.

However further improvements were needed in the following areas: infection control; care records; staff following care plans and risk assessments; people and relatives’ involvement in care reviews; and the home’s audit system. The registered manager, provider and staff were working to address these issues.

People and relatives said the home was safe. A relative said, “[Person] is definitely safe. I can see how the staff look after [person] and I’ve seen them ensuring the safety of other residents here.” Staff were trained in safeguarding and knew how to protect people from abuse and harm and who to report any concerns to.

Staff were kind and caring when supporting people and offered them choices. People told us staff encouraged them to express their views and make decisions about their care and support. Care plans focused on people’s abilities and what they could do for themselves.

Staffing levels had improved. A relative said, “There is more staff than there used to be. I’m happy with it now and I have no complaints about the staff.” During our inspection visit there were enough staff on duty to meet people’s needs and spend quality time with people, assisting them with activities and socialising.

Staff were knowledgeable and experienced. A relative said, “I’m happy with staff skills. [Person] has as good a quality of life as they could get.” Improvements had been made to the storage, management and administration of medicines. People had the medicines they needed at the right time.

People and relatives said they liked the food served. A person said, “The food is good and we always have lots of drinks.” A relative told us, “[Person] loves the food. I’ve eaten it and it’s very nice. Very good portions, seconds offered.” Staff monitored people’s nutrition and hydration tools and ensured they had enough to eat and drink.

Staff ensured people’s healthcare needs were met. People saw GP’s and other healthcare professionals when they needed to. Staff monitored people’s well-being and took action if they were unwell. The home was working within the principles of the Mental Capacity Act 2005 and staff knew how to support people in making decisions and choices.

Improvements had been made to the premises to ensure they were fit for purpose. Better signage was in place to help people find their way around and staff had made the environment more stimulating using tactile objects, pictures, and murals.

People and relatives said they thought the home was well-led and the managers and staff kind and approachable. A relative said, “I chose this home because I like the lay out, the food, and the friendliness.” People, relatives and staff were invited to share their views about the home at meetings, through surveys, and on a one-to-one basis. They were listened to and changes and improvements made because of their input.

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

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Acorn Hill Nursing Home 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 59 older people in one adapted building. Some of the people using the service had complex physical and mental health needs and many people were living with dementia. At the time of our inspection there were 40 people using the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

People were not always protected from the risk of infection. Procedures and systems were not effective in preventing the risk of infection.

The premises were not consistently well maintained or assessed to prevent potential risk of harm for people.

Risks to people were not always assessed in a timely manner. Records lacked clarity in providing guidance for staff on the measures they needed to take to keep people safe.

The management and monitoring of people's wounds was not safe or effective in protecting people from the risk of infection or prevent further deterioration of wounds as far as possible.

Improvements were needed to ensure people's medicines were stored and administered as prescribed.

The registered manager undertook a range of audits and checks to monitor the quality of the service; producing action plans to identify and address where improvements were required. We found these had not been effective in identifying the areas of concerns we found.

There were insufficient arrangements in place to ensure sufficient numbers of staff were always deployed in response to unplanned staff absence, although sufficient numbers of staff were available on most occasions.

Staff told us they had completed a range of training to give them the skills and knowledge to provide effective care and this was evaluated during regular supervision. Training records were not fully completed or kept up to date to support the effective monitoring of staff training.

People's care and support needs were not always effectively monitored and reviewed to ensure care was provided in the way they needed. People were supported to eat and drink. However records did not reflect people were always protected from the risk of poor nutrition.

The premises did not fully support people to engage with their environment or support them to orientate around the building. Improvements were needed to ensure people were provided with meaningful activities that engaged and stimulated them and provided them with a sense of purpose.

Care plans were personalised and supported staff to provide personalised care. There were limited opportunities for people and their relatives to be involved in their care planning or to share their views about the service.

The provider had systems to manage any complaints they received. Although people and relatives knew how to raise concerns, they were not confident that improvements would be made or sustained as a result.

People felt safe when they were receiving care from staff. Staff understood their roles and responsibilities to safeguard people from the risk of harm.

Staff were appropriately recruited. Checks to ensure they were suitable to work with people had been completed before they started work.

People were supported to make decisions and choices about their care. Staff understood the principles of the Mental Capacity Act 2005 and sought consent before providing care and support.

People described staff as being kind and caring. Staff had developed positive relationships with people through effective communication. Staff addressed people with respect and protected people's right to be treated with dignity and have their privacy protected.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 22 June 2017. After that inspection we received concerns in relation to people’s safety and the responsiveness of the care and support provided. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

Acorn Hill Nursing Home provides nursing and personal care for up to 49 people. A number of people accommodated at the service have complex physical and mental health needs. Some people are living with dementia and others are receiving end of life care. The service is located in Leicester and accommodation is provided over three floors with a lift for access. At the time of our inspection there were 33 people using the service.

The service has a registered manager. This is a person who has registered with the Care Quality Commission 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.

People told us they felt safe using the service and staff knew what to do if they had any concerns about their well-being. There were enough staff on duty to meet people’s needs. Staff were quick to respond if people needed support and answered call bells promptly. Staff were knowledgeable about how to provide safe and responsive care to people.

Staff took action to reduce risks to people and keep them safe. They ensured people were assisted to move around the premises safely and supported them with their meals. Improvements were needed to some people’s risk assessments to ensure they were accurate, up to date, and had the information in them that staff needed to maintain people’s safety.

People told us they liked and trusted the staff. The service employed both care staff and qualified nurses so people’s care and nursing needs could both be met on site. Staff were safety recruited and their competency checked to ensure they were suitable to work at the service.

People told us they received their medicines when they needed them. Medicines were mostly managed safely and administered by skilled, trained and qualified nursing staff. Improvements were needed to some medicines records.

People told us they were satisfied with the care the staff provided. There had been improvements to some care records making them more personalised. People and relatives had the opportunity to take part in care planning and reviews and have in say in how their care was provided.

Group and one-to-one activities were provided at the service and people said they enjoyed these. During our inspection people took part in a fruit tasting session, went for walks with staff, and took part in a religious service. People being nursed in bed had hand massages and a discussion about the day’s news.

People told us they if they weren’t happy with any aspect of the service they would tell staff. Records showed that when complaints were received the registered manager dealt with them in an open and positive way.

Acorn Hill Nursing Home provides nursing and personal care for up to 49 people. A number of people accommodated at the service had complex physical and mental health needs. Some people were living with dementia and others were receiving end of life care. The service is located in Leicester and accommodation is provided over three floors with a lift for access. At the time of our inspection there were 32 people using the service.

When we inspected the service did not have a registered manager. This is a person who has registered with the Care Quality Commission 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. The previous manager de-registered in January 2016. A manager was in post and was in the process of applying to the Care Quality Commission for registration.

The service was last inspected on 30 July 2015 when the provider was found to be meeting their requirements.

The service had a welcoming atmosphere and improvements to the environment meant that the premises were homely and inviting. A new manager was in post and people said she was friendly and approachable. Staff were available at the times people needed them and greeted people with a smile and an offer of assistance. During our inspection we saw that people had opportunities to purse their hobbies and interests. This included both group and individual activities. These activities gave people something to focus on and provided them with stimulation.

People using the service were safe and staff had a good understanding of how to manage risks associated with people’s care. Staff also knew how to support people if they became anxious, with a positive effect.

People received their medicines safely and at the required times. Medicines were kept securely and administered by trained staff. A few improvements were needed to medicines records to ensure they were complete and properly audited with issues addressed promptly where necessary.

Staff had undertaken most training the provider considered essential to meet people’s care and support needs. We observed staff put their training into practice to support people in a professional and caring way. There were enough staff on duty to keep people safe and meet their needs. Training in crisis intervention had recently been introduced to the service to ensure staff could effectively meet the needs of people who may become agitated. If people needed restrictions on their lifestyles these were applied lawfully.

People’s nutrition and hydration needs were mostly met and people had a choice of meals and drinks. If people needed assistance with their meals staff provided this. Improvements were needed to the way one person’s nutritional needs were monitored. People’s health care needs were identified and met by staff at the service or local healthcare professionals.

People made many positive comments about the staff and were at ease with them. Staff communicated with people in a warm and friendly manner. People were offered choice about all aspects of their lives and we saw this in practice, for example during lunchtime and when people were offered personal support. Visitors were welcome at the service at any time.

Staff had a good understanding of people’s social and healthcare needs and knew about people’s lives, for example their past occupations, family circumstances, and likes and dislikes. People’s preferences, for example getting up and going to bed times and personal care choices were included. Some care records were in need of improvement and the manager said she was in the process of reviewing and updating these.

People told us the manager was friendly and approachable. They said they would tell her if they had any concerns or complaints about the service. Staff said the manager always listened if they needed to talk with her and they had the opportunity in supervision sessions and staff meetings to raise any issues they might have.

The manager told us the service was subject to a programme of ongoing improvement. She said the views of the people using the service were central to this process and their opinions sought at every stage. Since we last inspected the service, on 30 July 2015, it had become more personalised and there was evidence that the people using it were more involved in how it was run.

The provider had a system in place to assess, monitor and improve the quality and safety of the service. Records showed the provider had worked to a series of action plans to make improvements to the service.

We spoke with four of the people living in the home, six visiting relatives and three staff. Some of the people we saw in the home had memory problems or difficulty with communicating their needs.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At our inspection of 30 December 2013 we found that some people using the service were not stimulated by a staff group that largely reacted to contain situations rather than proactively engaged with people.

At this inspection we found the staff were more pro-active. That meant that when a challenging situation arose, with a person that lived in the home the member of staff dealt appropriately with the situation and helped the person regain their composure. Care plans were written in an individual way that ensured people received personalised care and support. There were arrangements in place to deal with foreseeable emergencies such as individual evacuation plans in case of a serious event such as a fire.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no recent applications had needed to be submitted. Relevant staff were aware when an application should be submitted.

Medicines were stored and administered securely. However we saw that the storage of care plans and other confidential materiel could be made secure and so increase confidentiality.

Staff told us they were provided with personal protective equipment (PPE). We also saw plentiful supplies of PPE placed around the home. We also noted that the cleaning schedules did not cover all the areas we would expect in the home, and a number of bins waste bins did not have disposable liners, which would have reduced the occurrence of cross contamination and cross infection in the home.

Is the service effective?

People's health and care needs were assessed, and they and their representatives were involved in the agreement of their plans of care. One visiting relative said, 'My sister had a form to complete about things that are important to our mother.' We later confirmed that care plans reflected that individual person's details. That meant care plans reflected people's individual preferences.

Is the service caring?

The service worked well with other agencies and services to make sure people received care appropriate to their needs. We saw where people were supported by visiting doctors, specialists and district nurses on a regular basis.

Is the service responsive?

The staff took action to ensure a wall light was moved after we highlighted the issue during our visit. A visiting relative stated, 'Although we've not had a problem, I wouldn't hesitate to go to the manager if there was a problem. I'm quite confident that they would do something about it.'

Is the service well-led?

Quality assurance systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. A visiting relative said, 'We appreciated that the manager was open about the problems and the plans to put things right.'

We were once again accompanied by an expert by experience who also observed and spoke with people using the service and their visiting families. People who spoke with the expert by experience said, 'I think it's improved a bit and changed with different staff.' A visiting family member said, 'For us, the staff have always been caring and my Dad feels safe, therefore both he and us are happy that he's in here.'

We noted that the acting manager had undertaken a number of quality assurance exercises that had resulted in improvements and changes to the care and support people received, and staffing numbers and deployment.

There had also been improvements to the furniture in the home, with a programme of redecoration planned to commence in January 2014.

Our inspection of 29 August 2013 found that we found continuing poor practice with the arrangements to supply medicines safely to people which might have resulted in people's needs not being fully met.

The provider wrote to us and told us that they would be compliant and have the issues resolved by 25 September 2013. When we visited we saw that medicines administration for people had improved in some areas. However we saw where a person had not received their full cours of treatment and another person their medicine on the correct day. This could have had an effect on their health and wellbeing.

We also saw at that visit, that the monitoring of staff and quality assurance systems were poorly organised, another area which is still apparent.

We observed staff administering medication which they did efficiently and accurately. People were spoken with in an appropriate way and we checked to see they were offered the correct medicines. We checked other parts of the medication system and noted improvements in the appropriate temperature of the room where medication is stored and daily nursing audits.

However we also noted that there are still some improvements required to the medication policy and procedure, temperature monitoring of refrigerated products, PRN or as required medicines and disposal of medicines that are no longer required.

We also looked at the changes to peoples care records and how they were completed by staff. We noted that all these documents had been gathered into two main files. This allowed staff to ensure the daily recording was in one file, which has led to a greater degree of accuracy of detail.

We also looked at how the Manager quality assured the medication processes that had been altered. We found there were areas where quality audits had been undertaken but had not resulted in a thorough check of the system. These checks were not well thought through or undertaken efficiently to reveal discrepancies that we found on our visit.

We observed staff talking with people this was done with their privacy and dignity in mind and showed the staffs' awareness of peoples individual support needs. We also observed how people are assisted to eat their meals; again this was done with the person's dignity in mind. We looked at how care and support plans are compiled and reviewed and how, when necessary receive additional dietary input. We also looked at how the staff were supported with training, and individual and group meetings.

We looked at medication and recognised not all the people in the home were assured of being given all their medication all the time. We also looked at how staff completed care and other supporting records and documents. These were not completed in a consistent way which left staff without clear direction and instruction.

We spoke with a number of people living in the service and a number of visiting relatives. One of the relatives of a person using the service stated 'the staff are kind and friendly' and 'the food looks lovely'. Another added 'we went through the care plan, we can see it anytime'.

On our tour around the home we noted a number of sitting and dining rooms. There has been a number of floor coverings replaced and some areas decorated recently. There is regular maintenance of the equipment in the home where a number of external contractors are used to ensure this is safe for use by the staff. Toilets and bathrooms have privacy locks in place, bedrooms have yet to be brought up to individual peoples needs.

The recruitment process has recently been updated and should now ensure people are safe. Staff receive regular training to ensure people are cared for safely.

We spoke with staff and they were able to tell us how people living in the home should be safeguarded and were aware how to follow this up with outside agencies were this necessary.