Acton Care Centre

Acton Care Centre is a care home with nursing for up to 125 people. There were 95 people living at the home at the time of our inspection. The majority of people were older adults. The home is divided into five units. Some units specialised in the care of people living with the experience of dementia, some were for people with complex health conditions and some were for people being cared for at the end of their lives.

The service is managed by Gold Care Homes Group, an organisation with 22 care homes within the UK.

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

People were well supported and cared for. People and their relatives felt safe and trusted the staff. Their care was personalised and met their individual needs and preferences. They had good relationships with the staff, who knew them well.

There were enough suitable staff, who were trained and supported. They had the information they needed to care for people safely and meet their needs. There were appropriate systems for recruiting staff.

People's care had been planned for. Plans included assessments of their individual needs and any risks they were exposed to. There was clear information to show the staff how to support people. The records of care showed these plans were followed. The staff worked closely with external professionals when providing care and support for people.

During the COVID-19 pandemic, visitors had been restricted and people's normal experience of care had been affected by temporary changes, which included spending more time in their bedrooms or individual units, rather than socialising with others. The staff had tried to compensate for this, by providing individual and small group social activities, and by supporting people to stay in touch with their loved ones.

The provider had effective systems to manage infection prevention and control. These had been updated and changed to reflect the risks associated with the COVID-19 pandemic. Staff had a good awareness about these and wore personal protective equipment (PPE) to help keep people safe. The provider had worked with the health care professionals to monitor how they were managing the home and also to start a programme of vaccinations to protect people living at the home and staff from COVID-19.

The provider's systems for dealing with complaints, incidents, accidents and safeguarding alerts were suitable. They carried out thorough investigations, worked with others to protect people and learnt from things that went wrong so improvements could be made to the service.

There was an experienced and committed management team, led by the registered manager. They worked alongside staff and knew the service well. Staff felt supported and respected the managers. There were effective systems for monitoring and improving quality at the service, which included a range of audits, regular communication with staff and asking people using the service and their representatives for feedback about their experiences.

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

Rating at last inspection

The rating for this service from the last inspection was good (Published 23 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding, infection prevention and control and how people's needs were being met. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed and remains good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Acton 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.

We inspected the service against two of the five questions we ask about services: 'is the service well led?' and 'is the service safe?' This is because the service was not meeting legal requirements in relation to safe care and treatment or good governance in June 2018.

No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity, so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

We found that improvements had been made and, following this inspection, we have rated the service good.

Acton Care Centre 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. Nursing care is provided at this care home. The service is registered to accommodate up to 125 older people and younger adults (people under 65 years old). At the time of our inspection 118 people were living at the service. The home is divided into five units. Two of the units, Donald Sword and Garden unit, were dedicated for people living with the experience of dementia. The other three units, Oak, Park and Westerly, provided care for people with complex healthcare needs, which included some people receiving care at the end of their lives. Westerly unit is for people with complex medical needs.

The service is managed by GCH (Acton) Limited, part of the Gold Care Homes Group, a privately-owned company running 21 care homes in and around London.

There was 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 and associated Regulations about how the service is run.

People living at the service told us they were happy there and well cared for. Most people told us there were enough staff and that they did not have to wait for care. They said that the staff were kind, caring and polite.

The staff told us that they felt well supported. They had the training and support they needed to care for people in a safe way. The provider's procedures for recruiting staff were designed to ensure that they were suitable. The staff received an induction to make sure they had the skills and knowledge needed to work at the service.

There were procedures designed to safeguard people from abuse and so the staff knew how to recognise and report abuse.

The environment was clean and appropriately maintained. The provider made sure equipment was safe to use and appropriately stored. There were procedures for managing the control and prevention of infection, and the staff followed these.

The risks to people's safety and wellbeing had been assessed and planned for. These assessments were regularly reviewed and updated, and we saw that staff followed guidance to help keep people safe.

Medicines were managed in a safe way. There had been improvements to the way in which these were managed and systems to ensure that any errors were dealt with appropriately.

People were able to raise concerns and felt that these were appropriately dealt with. There were effective procedures for investigating and responding to complaints, incidents and accidents. There were also thorough systems for monitoring and improving the quality of the service, which included effective communication between the staff and regular audits of different aspects of the service. People using the service, staff and visitors felt the registered manager was approachable and available when they needed them.

The last comprehensive inspection of the service took place on 9 December 2016. The service was rated requires improvement in all key questions and overall. We undertook a focussed inspection of the key question, 'Is the service safe?' on 1 July 2017. This key question and the overall rating remained requires improvement.

Following the last comprehensive inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all of the key questions to at least ‘good’.

At this inspection of 19 June 2018, we found that the service remains requires improvement. Whilst we found improvements had taken place in some areas, people remained at risk of unsafe care and treatment and the provider had not done enough to mitigate these risks. The rating of the key questions, 'Is the service safe?' and 'Is the service Well-led', as well as the overall rating for this service, remains requires improvement.

Acton Care Centre 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. Nursing care is provided at this care home. The service is registered to accommodate up to 125 older people and younger adults (people under 65 years old). At the time of our inspection 121 people were living there. The home is divided into five units. Two of the units, Donald Sword and Garden unit, were dedicated for people living with the experience of dementia. The other three units, Oak, Park and Westerly, provided care for people with complex healthcare needs, which included some people receiving care at the end of their lives.

The service is managed by GCH (Acton) Limited, part of the Gold Care Homes Group, a privately owned company running 21 care homes in and around London.

There was 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 and associated Regulations about how the service is run.

The risks to people's safety and wellbeing had not always been assessed, monitored or mitigated. In particular, cleaning products had not been safely stored, good infection control practices were not always followed and medicines were not always managed safely.

The provider had systems for monitoring the quality of the service. However, these were not always effective at identifying risks to the health and wellbeing of service users.

We found two breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance.

We are taking action against the provider for failing to meet Regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People using the service were happy with the care and support they received. They had been involved with planning their care and felt they were given choices. People liked the staff who supported them and said that they were kind, caring and compassionate. People's needs had been assessed and recorded in care plans. These were regularly reviewed and updated in partnership with the person, their representatives and other relevant professionals.

The staff were happy working at the service. They felt well supported and had the training they needed to understand and carry out their roles. There were systems for the staff to communicate with each other and work together to provide effective care.

There were procedures for safeguarding people from abuse and the provider worked with other organisations to investigate and respond to allegations of abuse. People were able to make complaints and felt that these were listened to and acted upon. The provider had systems for learning from mistakes and responded appropriately to incidents and accidents.

There were a range of social and leisure activities offered to people. These reflected people's interests, religion and culture.

The environment and equipment were generally clean and appropriately maintained. The provider had plans to improve the design of the environment to replace damaged and worn furnishings and to reflect best practice guidance for dementia friendly environments.

The registered manager was supported by a team of senior staff and the provider's representatives. Together they undertook regular audits and consulted with people using the service and other stakeholders to ask for their views on the service. The provider responded effectively when other agencies, such as the fire brigade, clinical commissioning groups and Healthwatch identified areas for improvement. Following our inspection visit, the regional director contacted us to explain the action they had taken to make changes in the areas we had identified as requiring improvements.

This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Acton Care Centre on our website at www.cqc.org.uk. At the last inspection the service was rated ‘Requires Improvement’ in all key questions and overall. We have not amended the ratings of any key questions at this inspection.

Acton Care Centre is a purpose built home that can accommodate up to 125 people. There are two units for people living with dementia and three units for people with nursing care needs. The home can provide high dependency care for people with complex nursing needs.

The home is situated within a residential area of the London Borough of Ealing. At the time of our visit there were 26 people receiving support in the Garden Unit.

At the time of the inspection there was a registered manager in place. 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.

The service was last inspected in January 2017 and was rated Requires Improvement with breaches in relation to infection control and complying with the Mental Capacity Act 2005. The overall rating for the service has not changed following this focused inspection.

One of the concerns raised was about staffing levels on the unit. We found that overall there was adequate numbers of staff on the unit. Whilst care workers were not always available during the morning at busy times to be with people in the lounge, people using the service did not experience extended waiting times for support from care workers. The registered manager agreed to review how staff were deployed on the unit.

In regards to the recording of incidents and accidents, we noted that appropriate records were completed when these occurred with detailed information and any actions taken by staff to manage these. We also found that whilst risk assessments and care plans were reviewed monthly, these were not updated immediately after an incident or accident had occurred so where necessary appropriate actions were taken to prevent reoccurrence. We discussed this with the registered manager who agreed to review this shortfall.

Acton Care Centre is a purpose built home that can accommodate 125 people. There are two units for people living with the experience of dementia and three units for people with nursing care needs. The home can provide high dependency care for people with complex nursing needs.

The home is situated within a residential area of the London Borough of Ealing. At the time of our visit there were 105 people using the service.

At the time of the inspection there was a registered manager in place. 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.

The provider was registered with the Care Quality Commission for this location on 17 October 2017. This is the first rating inspection since the change in provider.

Chemicals used for cleaning were not stored securely and there was a risk of cross contamination as equipment and continence supplies were stored in people’s bathrooms.

Risk assessments did not provide up to date information in relation to individual risks when receiving care. An action plan had been developed to identify how these issues would be resolved.

The provider had appropriate processes and training in place for the safe administration of medicines.

The provider had a policy in relation to the Mental Capacity Act 2005 but was not always working within the principles of the Act.

Activities were organised at the home but some of these were not always meaningful for people and when the activities coordinator was busy there were limited activities organised by other staff. The provider had identified staff across the service required training in providing appropriate activities and this was being planned. We have made a recommendation in relation to providing activities.

Records relating to care and people using the service were not completed accurately to provide a current picture of the person’s needs and support provided. The provider had developed an action plan identifying issues arising from the transition from the previous provider’s systems to those of the new provider. A copy of the action plan was provided during the inspection.

The provider had a range of audits in place but some of these had not provided appropriate levels of information to identify aspects of the service requiring improvement and action had not always been taken to address issues. These issues had been identified by the provider and included in the action plan they had developed. A copy of the action plan was provided during the inspection.

The provider had processes in place for the recording and investigation of incidents and accidents.

Staff had not completed all the training identified as mandatory by the new provider. A training programme was in place to meet identified training needs.

There was a good working relationship with healthcare professionals who provided support for people using the service.

The care plans and records of daily care were task focused. The provider planned to implement a new care plan template which was more focused on people’s preferences on how their care was provided.

The care plans identified the cultural and religious needs of people using the service. The provider had a complaints process in place and people knew what to do if they wished to raise any concerns.

The provider had processes in place for the recording and investigation of incidents and accidents. Each person using the service had an evacuation plan in place in case of an emergency.

The provider had an effective recruitment process in place. There was a policy and procedure in place for the administration of medicines and these were administered in a safe way.

We found two 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.