Archived: Acacia Care Centre

Acacia Care Centre is a care home providing personal and nursing care to 61 people at the time of the inspection. The service can support up to 62 people. Acacia Care Centre is a purpose-built care home arranged over four floors, each of which has separate adapted facilities. The home provides support to people with nursing needs including adults with complex health needs. One of the floors specialises in providing care to people living with dementia.

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

The home had safeguarding procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks had taken place before staff started work. Staff were deployed effectively to meet people’s needs. People’s medicines were managed safely. The provider had systems for monitoring, investigating and learning from incidents and accidents. The service had procedures in place to reduce the risk of infections.

People’s care and support needs were assessed when they moved into the home. Risks to people had been assessed to ensure their needs were safely met. Staff had the skills, knowledge and experience to support people appropriately. Staff were supported through induction, training and regular supervision.

People were supported to maintain a healthy balanced diet and they had access to health care professionals when they needed them. The design of the premises was meeting 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; the policies and systems in the service supported this practice.

People and their relatives had been consulted about their care and support needs. The home offered a range of facilities and activities to support people’s need for social interaction and stimulation. Staff understood the importance of working within the principles of the Equality Act and supported people in meeting their diverse needs. The home had a complaints procedure in place and people and their relatives said they were confident their complaints would be listened to and acted on. There were procedures in place to make sure people had access to end of life care and support when it was required.

The registered manager and staff worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people and their relatives views into account through surveys and residents and relative’s meetings.

There were systems in place to monitor the quality and safety of the service and any learning was identified and acted on. Staff enjoyed working at the home and said they received good support from the registered manager.

Rating at last inspection.

The last rating for this service was requires improvement (published 9 January 2021).

At that inspection we found improvements had been made and the provider was no longer in breach of regulations. At this inspection we found that the provider had embedded and consolidated the improvements made at the last inspection and the rating has improved to good.

Why we inspected.

This inspection was prompted by a review of the information we held about this service.

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.

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

Acacia Care Centre is a care home providing personal and nursing care to 35 people at the time of the inspection. The service can support up to 62 people. Acacia Care Centre is a purpose built care home arranged over four floors. The service provides support to people with nursing needs including adults with complex health needs, and people living with dementia.

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

Since our last inspection there had been a number of improvements made to ensure people remained safe. Risk assessments and risk management plans had been reviewed and updated. Care records contained information about the risks to people’s safety and how these were to be managed. Staff were able to tell us in detail the risks to people’s safety and how they were to be cared for. Medicines management arrangements had been reviewed and there was now a daily medicines audit to monitor improvements. There were sufficient staff to meet people’s needs and the staff worked well together. Safe recruitment practices were followed to ensure appropriate staff were employed. Incidents were regularly reviewed to ensure lessons were learned and practices improved to minimise the risk of recurrence.

People’s care assessments took account of best practice guidance and staff assessed people’s needs using recognised tools. Staff liaised with other healthcare professionals when required to ensure they had the specialist advice they required 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.

People and their relatives were involved in the care planning process and the development of their care plans. Care plans clearly identified people’s support needs and how they wished to be cared for. Staff knew the people they were supporting and were able to describe people’s support needs as well as provide information about the person, such as their family history, their likes and interests. Where appropriate, people had end of life care plans in place and relatives confirmed they were involved in discussions about people’s end of life needs to ensure people received a dignified death in line with their wishes.

Since our last inspection a new registered manager was in post. They had made a significant number of changes to the service to improve the quality of care provision, improve staff morale and team working. The registered manager had comprehensive processes in place to review the quality of service provision, including a range of audits. There was greater involvement and engagement with people and their relatives, through regular meetings and surveys. The registered manager was aware of their responsibilities including in relation to the submission of CQC statutory notifications about key events that occur and the duty of candour.

Despite the improvements made since our last inspection, it was too early to judge yet whether these could

be maintained and sustained. Some of the improvements relating to medicines management had not yet been fully embedded. This meant at the time of this inspection there was not yet enough evidence of consistent good practice over time.

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 requires improvement (published January 2020). The service remains rated requires improvement.

Why we inspected

We undertook this focused inspection of the key questions Safe and Well-led to check they had followed their action plan and to check whether the provider had met the requirements of the Warning Notices in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 issued at our previous inspection.

We also undertook a targeted inspection for the key questions Effective and Responsive to check whether the provider had addressed the breaches of Regulation 9 (Person-Centred Care) and Regulation 11 (Need for consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified at our previous inspection.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement.

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

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.

Acacia Care Centre is a purpose built care home arranged over four floors. The service provides support to people with nursing needs including adults with complex health needs, and people living with dementia. The upper floor specialised in supporting people with dementia nursing needs. People had their own bedrooms with en-suite and shared bathroom facilities available. There were shared living and dining spaces on each floor. There was a bar area that people and relatives could book for special events.

People’s experience of using this service

People did not always feel safe. Risks to people had not always been appropriately identified and measures in place to keep people safe were not always clear. The systems in place for the management of medicines did not ensure medicines were managed in a safe way.

People were not supported to have maximum choice and control of their lives and did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People and relatives were not consistently involved in planning and reviewing their care. Care plans lacked personalised details.

The governance arrangement had not identified or addressed issues with the quality and safety of the service.

Staff knew how to identify allegations of abuse, and knew what actions to take to ensure people were safe. The service cooperated with the local authority when allegations of abuse were made.

The provider had introduced a dependency assessment and staffing levels were based on people’s needs. People and their relatives told us they sometimes had to wait, or felt rushed by staff. People told us, and we saw, their independence was not always promoted.

Staff had been recruited in a way that ensured they were suitable. Staff received the training and support they needed to perform their roles.

People and relatives told us the food had improved significantly in recent times. People and relatives had been invited to tasting evenings to test new menus.

People gave us mixed feedback about the activities provision within the home. While some people felt there had been improvements and there was a good range of activities, other people told us they were not supported with activities.

Although staff told us they supported people to practice their faith, and faith representatives visited the home, people told us this was not their experience.

People and relatives knew how to make complaints. The provider responded to complaints in line with their policy.

The provider was working with various external organisations to develop their practice and contribute to research. Projects included developing Lesbian, Gay, Bisexual and Transgender champions within the home, supporting care staff to achieve nursing qualifications and working with a university research project about staff retention.

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 requires improvement (published December 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, good governance, person centred care and consent at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Acacia Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Acacia Care Centre provides nursing care. CQC regulates both the premises and the care provided and both were looked at during this inspection. The service provides care for up to 62 older people requiring residential or nursing care. There were 57 people using the service at the time of our inspection.

The home 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.

There were not always enough staff to care for people safely and in a compassionate and personal way. The provider lacked a robust system to assess the staffing needs of the service at the time of our inspection. Some people raised concerns about the length of time it could take staff to respond to call bells and the provider lacked a suitable system to monitor this.

We received mixed feedback about the meals and a person's dietary needs were not met well by the service. Staff sometimes rushed when supporting people to eat and mealtimes were not always used as an opportunity to encourage social interaction. People were not always supported to maintain their independence as far as possible. Although formal complaints were investigated and responded to appropriately, informally raised concerns were not always dealt with well.

The provider carried out recruitment checks on staff. The provider did not always store people's confidential records securely. Care plans were accurate and reliable for staff to following in caring for people.

Most people received their medicines safely although improvements were required to assess risks when a person self-administered their medicines and in relation to covert medicines for one person.

The provider responded appropriately to safeguarding allegations raised during our inspection. However, some staff were unaware of their responsibilities in relation to safeguarding.

Most parts of the home were clean although some areas required more attention. The provider monitored infection control practices in the home we identified an infection control risk which the provider had overlooked.

People's capacity to consent to their care was not always assessed in line with the Mental Capacity Act 2005. The provider did not always promptly identify when people coming to the service required legal authorisation to deprive them of their liberty. The provider had not notified CQC of the outcome of applications to deprive people of their liberty as required by law.

The provider used a number of audits and checks to assess whether the care provided was of good quality. Although these were comprehensive and detailed, they did not always identify shortfalls in quality and were not always effective at driving improvements within appropriate timescales.

People were supported in relation to their day to day health. The premises were well adapted to meet the needs of people with dementia. Staff received a programme of training and supervision to help them understand and meet people's needs. People were supported to plan how they would like to receive care at the end of their lives and the provider followed an accredited end of life care programme.

Most people were positive about the staff who supported them and staff knew people, although people fed back that managers were not very visible. Staff treated people with dignity and respect and people were given the privacy they required. People could take part in a wide range of activities based on their interests.

People, relatives and staff had opportunities to feed back about the service through meetings and surveys, although people were not always aware of these opportunities.

We found breaches relating to staffing, consent and statutory notifications. You can see the action we asked the provider to take at the back of the full-length version of our report.

Acacia Care Centre is a purpose built care home providing nursing care for up to 62 people who may have poor health, dementia, or other needs including mental health and learning disabilities. The service has a designated dementia unit. At the time of the inspection 59 people were using the service.

The service was last inspected in March 2015, it met all the regulations we inspected it against.

The service had a registered manager in post; they were available at the time of the inspection. ‘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.’

Policies and procedures including appropriate risk management processes were in place to make people were protected from the risk of harm. Staff were trained and understood safeguarding procedures. Appropriate robust recruitment checks were undertaken to make sure only suitable staff were employed.

Staffing levels were suitable with an appropriate skill mix deployed to meet the needs of people who used the service. Staff employed were appropriately supervised and supported, staff morale was good. There was an on-going training and development programme to enable staff continue with their professional development. It was acknowledged that additional training was needed in dementia care.

Acacia Care Centre was a well maintained premise, furnished, clean and hygienic, and provided a safe environment for people to live in and staff to work in.

Staff responded promptly to individuals seeking advice and consulting with relevant health professionals if there were any concerns. The number of general practitioners involved with people at the home has been reduced to five, this has helped people experience improved outcomes as they regularly consult with the same GP.

People consented to the care and support they received. Staff supported people in line with the principles of the Mental Capacity Act (MCA) 2005, holding best interest meetings when required.

People’s preferences and choices were known and respected; they received care and support as planned. Staff knew the people they cared for well and could respond to their individual care needs and preferences. Staff were kind and patient, they were mindful to take into account people’s privacy and dignity and consider their individuality.

The registered manager and staff were clear about their roles and responsibilities; staff were motivated and worked well as a team. They were committed to providing a good standard of care and support to people who lived at the home. The home had a complaints system which addressed any complaints within the agreed timescale. The service had developed a quality assurance system; driven by the views of people, and combined with quality audits to make improvements.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, looking at records and speaking with people using the service, their relatives, and members of staff.

Please read the full report for evidence that supports our summary.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. One person told us, 'It's a lovely clean place. They keep it nice and clean.'

We found that staff were supported with regular training and supervision to provide safe and appropriate care. One person told us, 'The staff are very special, they are very caring.' A visitor commented, 'No qualms about this pace at all. I would have my mother stay here.' We saw people were treated with dignity and respect by members of staff.

We looked at a random selection of care plans for people using the service. We found that they were person centred and reflected the individual needs of each person. We saw that they covered a comprehensive range of care and healthcare needs including individual risk assessments. We found that care plans had been audited, regularly reviewed and were up to date which supported staff to deliver safe and appropriate care.

We found that appropriate checks were undertaken before staff began work at the home and there were enough qualified, skilled and experienced staff to meet people's needs.

We found that there were procedures in place to deal with foreseeable emergencies. For example, people had a personal emergency evacuation plan. In addition to the trained nurses that were on duty each shift members of staff were first aid trained. All staff had fire safety training once a year.

We found that there were appropriate measures in place in relation to the security of the service. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

There was evidence from the records we examined and our conversations with staff that learning from incidents / investigations took place and appropriate changes were implemented.

The Care Quality Commission monitors operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We identified that recent changes resulting from the Supreme Court in March 2014 could apply to some people using the service. The manager informed us that they were about to review whether people required DoLS applications to comply with the recent changes.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We were told that an assessment of people's needs was carried out before people came to the service.

We found that there were two activities' coordinators for the service six days a week. We saw a number of activities taking place in communal areas. A hairdresser visited twice a week. Most of the people we spoke with commented favourably about activities in the home. One person told us, 'There seems to be enough to do to suit most people.'

Staff received appropriate professional development. We were provided with information and records to show that staff received regular training. Staff were able, from time to time, to obtain further relevant qualifications

Is the service caring?

We saw that there were regular interactions between staff and people using the service that were positive and friendly. People and staff referred to each other on first name terms. Care was delivered in a kind and caring manner. One person told us, 'The care has been fine.' Another said, 'The staff are always very kind.' One person commented, 'Most of the staff are very nice.' One person told us, 'I am very positive about the care delivered here.'

Is the service responsive?

People expressed their views and were involved in making decisions about their care and treatment. We saw that care plans were person centred and recorded how people preferred their care and treatment to be delivered. People's care and treatment reflected relevant research and guidance. For example, the service was an accredited member of the Gold Standard Framework for end of life care and worked closely with St Christiopher's Hospice.

Is the service well led?

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

We spoke with people using the service, visitors and members of staff who told us that the manager had an 'open door' policy and was approachable. The provider had systems in place to assess and monitor service provision.

We were able to speak with people who used the service and also to three relatives who were visiting. All of them were very happy with the care and support they received. Comments from people included 'I like it very much here', 'my care needs are dealt with' and 'the staff treat me with dignity'. People told us they were able to choose how they spent their days and that activities were arranged for them. Their care plans showed that their healthcare needs were identified and reviewed regularly so that any changes were addressed.

People enjoyed their meals at Acacia Care Centre. They told us that they always had a choice and said 'the quality of food here is very good', and 'I always get enough to eat, portions are good, sometimes too much'.

We saw that medication was kept safely and administered and disposed of appropriately.

We saw that there were sufficient staff on duty to meet people's needs. An on-going training programme made sure that staff had the skills they needed to support people. People confirmed that staff were very kind and respectful towards them.

At the time of our inspection there were 31 people living on the top two floors. The second floor was occupied by people who had cognitive impairment or dementia. People we spoke with told us “it’s very nice here”, “the staff are very nice” and “they are very good to me”. People all had their own rooms with en-suite facilities, including a shower. They told us that they had been able to bring possessions from home in with them such as photographs and ornaments to make them more personal. There were also assisted baths on each floor. The home had a library, a bar and two hairdressing salons.

People said that they enjoyed the meals at Acacia Care Centre. They told us that they were always offered a choice and there were drinks and snacks available as well. When we visited, we saw that the home was very clean and tidy and free from unpleasant odours.

On the day of the inspection there were some activities arranged for those people who wanted to join in. There was a fulltime activities person and care staff told us that they help provide activities as well.