Archived: Acacia Lodge - London

At the inspection in March 2016 we judged that the provider had made improvements and had met the requirements of this enforcement notice. Whilst improvements had been made we were unable to change the rating for safe.

.Acacia Lodge is a privately run residential home for up to 32 older people, some of whom are living with dementia. The home also provides a respite service. There were 23 people living at the home at the time of our inspection.

There is a registered manager at the service. 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 this inspection we found that significant improvements had been made to risk assessments overall. There was still one risk assessment missing as it did not address a risk situation identified in the care plan, and one risk assessment without guidance for staff to mitigate the risk. These have since been completed by the service. The registered managed had developed quality assurance systems. We saw these were in place and were broad ranging and audits were carried out on a regular basis. However, they had not picked up the missing risk assessment.

We have made a recommendation that the service reviews its auditing procedure to ensure it is fully effective.

Staff had been carefully recruited and there were enough staff to meet people's needs. Staff felt supported and there was evidence of supervision taking place across the last 12 months. Training had taken place in relevant areas so staff had the skills and knowledge to offer a good service.

Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm. Staff and people using the service told us they felt confident any incidents or allegations would be fully investigated, and this was confirmed by relatives.

People were supported to have a healthy diet and spoke highly of the food provided by the service. The service had recently been awarded five stars (highest rating) for food hygiene. The service’s premises were clean and we could see there were systems in place to maintain good infection control.

There was a record of essential services such as gas and electricity and being checked, and equipment safely maintained. There was also clear documentation relating to complaints and incidents.

Acacia Lodge is a privately run residential home for up to 25 older people, some of whom are living with dementia. The home also provides a respite service. There were 18 people living at the home at the time of our inspection.

The home manager appointed in October 2015 and is currently going through the registration process to become registered manager. 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.

We undertook an unannounced focused inspection on 17 March 2016 to check that the service was now meeting legal requirements in relation to the enforcement notice served in December 2015. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Acacia Lodge on our website at www.cqc.org.uk

We did not inspect the other breach of regulation at this inspection and will do so when we return to carry out our next comprehensive inspection.

At our inspection in November 2015 we found inconsistencies to the way risk to individuals were managed. At our inspection in March 2016 we found that the provider had made a number of improvements. Staff had received training in fire safety procedures and the provider had made a number of improvements to the environment, this included the installation of new fire equipment and a fire alarm panel. Staff reported that there had been huge improvements and felt the newly introduced procedures helped them to effective carry out their role in the event of a fire. A recent visit from the London Fire Brigade Authority showed that they compliant with fire safety procedures. Risk assessments were in place and there had been some improvements to the way risks were managed.

People had their individual risks were assessed and reviewed. However, further improvements were required to ensure that all risks were clearly documented. Although in the main staff knew what to do to manage areas of risk, such as people with pressure sores or people at risk of falls, staff knowledge of risk management was limited. Staff told us they felt they would benefit from further training to understand risk management and more involvement in the risk assessment process.

We judged that the provider had made improvements and in the main had met the requirements of this enforcement notice. Whilst improvements had been made we are unable to change the rating for safe. We will review the ratings for the service at our next comprehensive inspection.

As part of this inspection we spoke with four people who use the service, two relatives, the registered manager, the administrator, three care staff and healthcare professionals. We also reviewed records relating to the management of the home which included, seven care plans and daily care records.

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

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

Is the service safe?

People were put at risk of being affected with a healthcare associated infection because the provider did not have systems in place to monitor infection control practices. Although staff knew how to deliver care, records relating to people using the service were not always accurate or up to date, therefore not fit for purpose.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. Staff we spoke with understood people’s needs. A relative told us when their relative arrived at the home they couldn’t walk and now is able to. They said of the care, “excellent, they (staff) paid full attention to dad’s needs.”

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People and relatives told us that they were happy with the way staff cared for them. One person said, “they look after us very nicely here.”

Is the service responsive?

We saw evidence of referrals to healthcare professionals, such as the dietician and podiatry. This helped facilitate communication between different professionals involved in the people’s care and to ensure continuity of care. However, healthcare professionals told us that referrals were not always completed in a timely manner.

Is the service well-led?

Staff we spoke with showed that they understood the needs of individual people they cared for. People were cared for by staff who understood their needs.

Although there were systems in place for monitoring the quality of the service, the lack of audits in areas of infection control and records meant that the provider could not be sure that people were protected from the risk of unsafe or inappropriate care.

We looked at five care plans; four of which had person centred risk assessments covering falls, manual handling and pressure sores. Although all five care plans had recently been reviewed there was no evidence that the reviews had involved the person receiving care or their relatives.

We saw that care was delivered in safe accessible surroundings that promoted people's wellbeing. The home's communal areas and people's bedrooms were clean, warm and well maintained.

We looked at provider staff training records. We saw that the manager was holding regular supervision meetings with staff. We also saw that staff had recently undergone training. Care staff told us that the new manager was supportive, helpful and approachable.

We noted that people appeared comfortable and well cared for. Staff were supervising and assisting people. Comprehensive assessments had been carried out and care plans had been prepared for people. Care provided had been carefully monitored. The healthcare needs of people had been attended to. The arrangements for the administration of medication was satisfactory and the medication administration charts had been regularly checked by the manager.

People indicated that staff were capable and able to care effectively for them. We saw that staff worked well as a team and were busy assisting people who use the service. There were arrangements to ensure that staff received supervision and support from the manager. There were no records available to indicate that the manager had received any formal supervision. This meant that the manager was unsupported and this could lead to inconsistent care practice.

Some maintenance issues were noted in the kitchen. However, the provider took prompt action to rectify them.