Acacia Lodge

Acacia Lodge is a residential care home providing accommodation and personal care to 18 people at the time of the inspection. The service can support up to 32 people. The home also provides a respite service. The service supports a range of people, some of whom have dementia or mental health needs as well as physical health needs.

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

People and their relatives told us staff were kind to them and they felt safe.

Since the last inspection we found some improvements had been made to the quality of the care people received. However, we still found concerns with some aspects of record keeping for people at risk of dehydration or malnutrition. We also found the electronic care planning system was not up to date for all of the people using the service, and some risks still lacked guidance for staff.

Some people still did not have an up to date mental capacity assessment in place. The service could not evidence people were always supported to have maximum choice and control of their lives. Although staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Since the last inspection a new manager had been appointed but they have not applied yet to be the registered manager. The manager is working with the provider to establish more effective systems but there remains some areas that still require improvement.

Improvements had been made to the audits carried out by the management team. We saw medicines audits, infection control audits and building maintenance checks were being carried out.

Since the last inspection new care staff had settled into their roles and we were told recruitment was underway for additional management team members and administrative staff. Lack of key personnel had hampered progress against the action plan set out following the last inspection.

Recruitment was safe and there were enough care staff to support people.

People told us they enjoyed the food, and menu options had improved. This improved the overall dining experience.

We saw accidents and incidents were recorded more effectively and the provider representatives were reviewing trends in these to help staff understand patterns of behaviours, and minimise reoccurrence of incidents.

We saw evidence that appropriate medical personnel were contacted when issues of concern were raised, and we saw use of PPE had improved.

The ordering and storing of medicines was safe. We saw improvements to ‘as needed’ PRN protocols had taken place following the first day of the inspection.

Staff received the required training and support to carry out their role effectively through a mixture of online and face to face training. New care staff told us that they felt that the management team was supportive.

Rating at last inspection

At the last inspection we rated this service Requires Improvement. The report was published on 13 January 2022.

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

Breaches of legal requirements were found, and a Warning Notice was issued. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, the effectiveness of the service and the governance of the service.

Why we inspected

We carried out a comprehensive inspection of this service on 20 April and 10 May 2022.

This inspection was carried out to follow up on action we told the provider to take at the last inspection. This report covers all five domains.

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.

Enforcement and recommendations

We have identified a repeat breach in relation to nutrition and hydration. Whilst there were improvements in the management of the service, not all issues raised in the Warning Notice have been addressed. Therefore, we have identified a breach related to the governance of the service.

We have made a new recommendation in relation to the use of suitable recording for people with mental health needs.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Acacia Lodge is a residential care home providing accommodation and personal care to 22 people, two of whom were in hospital at the time of the inspection. The service can support up to 32 people. The home also provides a respite service. The service supports a range of people, some of whom have dementia or mental health needs as well as physical health needs.

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

People and their relatives told us that people were safe and staff were kind to them.

At the time of the inspection, the service was undergoing significant changes as the registered manager had left at the end of August 2021, and a new interim manager was in place. There was also a turnover of care staff.

We were concerned at the lack of consistent leadership of the service and the lack of effective scrutiny by the provider to ensure the quality of care was good. Whilst people were quite happy living at the service, we found significant concerns in relation to care planning, oversight of accidents and incidents, and safeguarding of people. We were also concerned that people were not always referred to health professionals appropriately.

Lack of consistent leadership meant that oversight of systems was not effective. For example, key audits had not always taken place, and documentation required to ensure the safe administration of medicines by staff was not in place. All systems to ensure safe evacuation of people in the event of a fire or other incident were not in place.

The management team were not always aware of their regulatory responsibilities associated with their role.

The home was mostly clean. Most staff wore PPE appropriately, but we have made a recommendation in relation to infection control.

Recruitment processes and procedures were safe. Essential checks on staff had taken place before they started working for the service.

The ordering and storing of medicines was safe.

The service had significant change of staff, and so whilst there were usually enough staff on the rota to provide care, staff were extremely busy as they lacked familiarity with some people. Agency staff were also used to supplement permanent staff.

Staff received the required training and support to carry out their role effectively through a mixture of online and face to face training. New care staff told us that they felt that the management team was supportive.

Rating at last inspection

At the last inspection we rated this service Good. The report was published on 18 January 2021.

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

Why we inspected

We carried out a comprehensive inspection of this service on 14 and 18 October 2021. The inspection was prompted in part due to concerns received about safeguarding incidents and staffing levels. A decision was made for us to inspect and examine those risks.

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.

We have identified breaches in relation to safeguarding, safe care and treatment, meeting nutritional and hydration needs and governance of the service.

We have made recommendations in relation to infection control and end of life care.

Please see the action we have told the provider to take at the end of this report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of 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 continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner.

Acacia Lodge is a residential care home providing accommodation and personal care to 17 people at the time of the inspection. The service can support up to 32 people. The home also provides a respite service. The service supports a range of people, some of whom have dementia or mental health needs as well as physical health needs.

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

People and their relatives told us that people were safe, staff were kind and that their relatives received good care and support. Health and social care professionals spoke highly of the new registered manager and the work of the staff and management team.

Recruitment processes and procedures were safe. Essential checks on staff had taken place on staff before they started working for the service

People received their medicines safely and as prescribed.

Systems and processes were in place to keep people safe and risks associated with people's care needs had been assessed and documented. Staff had clear guidance on how to minimise the identified risk to keep people safe.

There were enough staff to meet people's needs.

The home was clean and odour free. There were increased infection control measures, including daily audits, in response to the coronavirus outbreak.

Staff received the training and support to carry out their role effectively through a mixture of online and face to face training. Care staff told us that they felt that the management team was very supportive, and in particular, praised the new registered manager for their support and guidance.

Relatives confirmed that they received regular updates and feedback about their family members.

We found significant improvements at the service since our last inspection. There was a positive culture that focused on providing care that was personalised, and systems were established which supported good care. A new electronic care management system enabled both care and management tasks to be effectively carried out.

The management team were aware of their regulatory responsibilities associated with their role.

Rating at last inspection

At the last inspection we rated this service Requires Improvement. The report was published on 6 September 2019.

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

Why we inspected

We carried out a focused inspection of this service on 9 December 2020. This report only covers our findings in relation to the Key Questions safe, effective, and well led as we were mindful of the impact and added pressures of Covid-19 pandemic on the service.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services

Follow up

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

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

We found the service did not always provide person-centred care. Activities took place at the service but documentation for people was not always personalised. There was limited information on care records on how to communicate with people who had memory issues or sensory impairments.

Care records were in place and were up to date but some needed additional information to provide guidance to staff in caring for people.

Whilst there were some aspects of the service that were well-led we found other areas in which further improvements were required. This included paperwork related to medicines management and learning from accidents and incidents.

People and their relatives told us staff were kind and we saw caring interactions between people and staff.

The majority of people told us they liked the food and we saw that a range of options were available for people to choose.

The service was clean, there was no smells and infection control procedures were in place to minimise the spread of infection.

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.

We have made a recommendation in relation to activities documentation and end of life care. We found a breach of regulation in relation to governance of the service.

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 26 November 2018). At our last inspection the provider had failed to robustly assess the risks relating to the health safety and welfare of people. This was a breach of regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 12.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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.

Why we inspected

This was a planned inspection based on the previous rating.

Acacia Lodge is registered to provide accommodation for up to 32 people who require personal care. The home also provides a respite service. The service supports older people, many of whom have dementia. There were 28 people living at the home at the time of our inspection.

We last inspected this service on 11 July 2016 and the service was rated good. Since the last inspection there has been a change in the provider’s company name. This means the home has been registered as a new service but there is a clear link between the old location and provider and the one currently registered.

There was a registered manager at the service, who was on leave at the time of the inspection. The service manager was providing day to day management of the home. 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.

People told us they felt safe and enjoyed living at the service and we saw staff were kind and caring.

We found a number of issues with fire safety including one fire exit door which had the key pad code changed but not all staff knew the new code to enable a quick exit. This issue was resolved subsequent to the inspection.

We found there were comprehensive care plans and risk assessments in place for people living at the service. People received good quality care.

The service was clean throughout, and staff used effective controls to minimise the spread of infection.

We could see quality audits took place on a regular basis. However, we found the service did not always ensure all building related matters were safely managed. We also found the service had recently moved people to different rooms without the necessary consultation and impact assessments taking place.

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. The service was not always recording accidents and incidents thoroughly. The service have updated their processes subsequent to the inspection.

Whilst the majority of safety checks had taken place related to the building and facilities, for example, fire safety equipment and hoists. We found the gas cooker had not been serviced annually to ensure it was functioning safely since installation in 2016. Subsequent to the inspection this has now taken place.

All necessary checks took place prior to staff starting work; so staff were considered safe to work with vulnerable adults. We found staff were not rushed when providing care, but we have asked for staffing levels to be reviewed to accommodate all safety concerns around people who have behaviours that challenge, and the risk they pose to other people.

Medicines were safely stored and administered, and people told us they received medicines on time.

Staff undertook training in key areas and supervision and appraisal took place regularly. Staff told us they felt supported and enjoyed working as part of the team.

The service had been awarded five stars for food hygiene, and people told us they enjoyed the food.

We found a breach of the regulations related to safe care and treatment of people due to poor fire safety at the premises. We have made a recommendation in relation to staffing levels.