Archived: Five Acres Nursing Home

Following our previous comprehensive inspection, on 19-21 May 2015, we gave this location an overall rating of ‘inadequate’, and placed them into special measures. We found that there were no effective systems in place to manage and monitor the prevention and control of infection or ensure that the premises and equipment used was safe and cleaned to an appropriate standard. In addition, the registered person did not have effective systems in place to ensure there were sufficient quantities of medicines available which meant that medicines were not managed safely. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found that the registered person had not protected people against the risk of an unsafe and inadequately maintained environment. There was a lack of appropriate signage and decoration for the people living at the service. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person had failed to operate systems to ensure records were managed safely and effectively. Systems were not effective in terms of assessing, monitoring and improving the quality and safety of the services provided. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not treated with care, dignity and respect, which was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person had not taken steps to ensure that care and support was provided with the consent of the relevant person. Where consent could not be gained because people lacked capacity, the registered person had not acted in accordance with the Mental Capacity Act 2005. This was a breach of regulation 11of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person had not taken steps to meet people’s nutritional and hydration needs, which was a breach of regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that the registered person had not displayed ratings from the previous inspection of this service. This was a breach of regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person had not taken steps to notify the Care Quality Commission of requests made to supervisory bodies to deprive people of their liberty. This was a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (Part 4).

We also received some information of concern, which led to an additional focussed inspection on 02 July 2015. During that inspection we also found that the registered person had not sent statutory notifications to the Care Quality Commission. This was a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (Part 4).

The provider submitted an action plan to tell us how they would meet these regulations and the timescale they intended to have met them by. We carried out this inspection on 13 January 2016, to see if the provider had made the necessary improvements to meet these breaches of regulations, and to see whether or not they should remain in special measures. We found that the provider had implemented systems to meet these regulations and, as such, the service is no longer in special measures.

The service did not have a registered manager in post; however there was a manager who had been at the service for several months. They informed us that there were plans for them to change their role to become the clinical lead. We found that another manager had been recruited and were due to start a few weeks after our inspection. The current manager told us that the new manager would register with us as soon as possible after commencing 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.

During this inspection, we found that people felt safe at the service and were cared for by staff who were trained in safeguarding principles. Staff were knowledgeable about abuse and were prepared to raise any concerns they had. There were systems in place to assess and manage risks, and risk assessments were updated on a regular basis, to ensure they were accurate. Staffing levels had improved and the provider had carried out recruitment to improve continuity of care. Systems for the storage, administration of medication had been improved to ensure that this could be done safely and there had also been significant improvements to the infection control practices at the service.

Staff training had improved and we saw that staff members received regular training and refresher sessions, to ensure that their skills were up-to-date. Staff also received support from the manager, including supervision and appraisal meetings. People’s consent to their care was sought, and systems for the implementation of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards had been developed. People had access to sufficient food and drink and were supported to see healthcare professionals when necessary.

Staff treated people with kindness and compassion and promoted their privacy and dignity. They spent time engaging with people in conversation and exchanging jokes. People were provided with information about their care, and there were plans in place to improve the recording of people’s involvement in their care.

People’s care plans were reviewed regularly, to ensure they were an accurate reflection of people’s needs and wishes. The activities programme at the service had been improved and there were plans to extend this father in the future. Policies and procedures for feedback from people and their family members were in place, and the manager sought out people’s views to help develop the service provided.

There was clear leadership at the service. Staff and people were aware of who the manager was and were positive about the impact that they had at the service. The manager was aware of the requirement to send notification to the Care Quality Commission, and had done so where necessary. They had also implemented a number of checks and audits to ensure there were effective quality assurance systems at the service.

At the last comprehensive inspection this provider was placed into special measures by CQC. Although we identified a number of areas that still required improvement we were satisfied with the progress that had been made and determined that the provider was no longer in breach of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3). The overall rating for this service is ‘Requires Improvement’. This means that the service no longer requires to be in ‘Special measures’.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive to people's needs?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

All of the people we spoke with told us they felt safe living at Five Acres Nursing Home. One person said, 'I am being well looked after. I sit back and take it easy.' We observed that plans of care included risk assessments to promote people's safety such as assessments for malnutrition, the risk of falls and movement and handling. We also observed staff used safe movement and handling techniques.

Staff told us that they involved other health and social care professionals to support people with their needs. We saw evidence to confirm this in the care records, with evidence of engagement with mental health professionals and GPs. Where people displayed behaviour which may challenge others, the whole staff team were getting support and additional training from an external dementia champion from a local university.

We saw that the premises were well maintained with no risks to people's safety. We saw bedrooms were now fitted with appropriate safety equipment such as window restrictors and call bells. No slip or trip hazards were identified although some areas of the home had slight inclines and there were some small steps that had to be negotiated to access the outside. Despite this we saw a person manually propelling themselves in a wheelchair to all areas of the home and having easy access to the outside.

We found that there were enough staff on duty to support people's safely and to meet their needs appropriately.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DOLs). We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. Whilst no applications had been approved the service had considered, after prompting from the local authority, the impact the lift being out of action in the past, had on people's liberty. People's human rights were therefore properly recognised, respected and promoted.

Is the service effective?

We saw that people were involved in their care planning to the best of their abilities and that where appropriate relatives had been asked to contribute. It was clear that people had stated their preferences, particularly in relation to their food likes and dislikes, which were clearly recorded in the kitchen for the attention of the cook. This meant steps were taken to involve people in making decisions about their care and support. Staff we spoke with had a good understanding of people's needs and knew how they preferred to be supported. This meant people were supported appropriately in relation to their needs.The records we reviewed evidenced that the risks around people's nutrition and hydration were monitored and managed.

Since the last inspection the flooring in the communal areas had been replaced to eliminate the malodours that had been noted.

Is the service caring?

People told us that staff treated them well. We observed that staff had a good understanding and knowledge of people's needs and preferences and supported them appropriately. Staff were respectful and promoted the dignity of the people who used the service. For example at lunchtime people were supported unobtrusively. People were encouraged to use the toilet and taken to have soiled clothes changed in a dignified manner.

Staff spent time interacting with the people who used the service as they were going about their chores.

Is the service responsive?

Staffing levels were such that call bells were not left unanswered and people had their needs met in a timely fashion. The staff team underwent regular updates of their training to ensure they had the collective resources to meet people's needs. We saw that any staff that had not completed their training updates were not allowed to work shifts until they had done so. This ensured that people were cared for, at all times, by staff that had the appropriate training.

Activities were planned to help stimulate people although on the day of our inspection these were not taking place as the activity co-ordinator was not working in their role. We have asked the provider to consider how activities can take place in the absence of the activity co-ordinator, so that stimulation for the people using the service is on-going.

A variety of stakeholders had been requested to give their views on the care provided as part of satisfaction questionnaires. The manager confirmed these were to be evaluated and a report made to identify improvements that needed to be actioned.

Menus were well planned and ensured that people's nutritional needs were met whatever type of diet they required.

Is the service well- led?

At the time of our inspection the manager had not completed the process to register with the Care Quality Commission, however this had been started. Staff told us they felt able to speak with the manager and were confident the manager would address any issues they raised.

We were aware that earlier in the year some areas of non-compliance had not been identified by the manager prior to us identifying them. Currently there were effective procedures in place to monitor and improve the quality of the service provided and these needed to be sustained. The provider also needed to document how they assured themselves of the quality of the service provided to people.

Systems were in pace to ensure that staff had the right skills to care for people safely. Individual plans of care reflected people's health care needs and personal preferences. Risk assessments were in place to reduce and manage the impact of identified risk factors.

We found that there was sufficient numbers staff on duty to meet the needs of people who received care.

Some people who had dementia care needs were limited in their ability to recall or express their views. In these circumstances we spoke with two visitors, observed staff interact with people, met individually with staff, including the nurse-in-charge, manager, chef, and two support staff.

We saw that maintenance contracts were in place to ensure that all necessary equipment, such as the lift, hoists, and fire alarm systems were regularly serviced.

The two visitors we spoke with commented that although they were satisfied their relative received appropriate care they had sometimes found the home to be a 'bit smelly'. They did, however, describe the staff as 'friendly' and 'helpful'.

We saw that people were receiving the personal support and care they needed. We found, however, that the manager had not always ensured that the standard of cleanliness was consistently maintained throughout the home.

Some people who had dementia care needs were limited in their ability to recall or express their views. In these circumstances we used observation, for example, to inform our inspection. We also looked at four people's care records to see what support they needed and had received.

One visitor we spoke with said that their relative was 'well treated' and that the staff were 'good at their job and very kind'. They said they were always made welcome when they visited the home.

We found that there were sufficient numbers staff on duty to meet the needs of people who received care. We saw that people's privacy and dignity were respected and that people were enabled to participate in meaningful activities that suited them individually.

We saw the home was clean, appropriately maintained, and free from odour.