We carried out a review of the data available to us about Acomb Court on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Acomb Court, you can give feedback on this service.
Acomb Court is a Residential nursing home providing personal and nursing care for up to 76 older people, some of whom are living with a cognitive impairment. At the time of the inspection there were 49 people living at the home.
Acomb Court is a purpose-built nursing home providing accommodation over three floors. The Grace unit is specially adapted to support people living with a cognitive impairment. All rooms have en-suite facilities and there are a number of communal dining areas, lounge facilities and other amenities.
People’s experience of using this service and what we found
People told us there were enough staff to support them with their needs and staff responded to their requests in a timely manner. The provider had in place an appropriate recruitment system to ensure suitably experienced staff were employed at the home. The home was clean and tidy, and staff were following national guidance on infection control and the use of personal protective equipment (PPE). Medicines were managed safely and effectively, and people told us they received their medicines on time.
People told us staff were pleasant and supportive to them. They told us staff treated them with respect. We observed staff to support people in a manner that maintained their dignity.
The provider had in place systems to monitor the quality and safety of the service and ensure staff followed policies and guidelines. Where any short falls were identified then action had been taken to address them.
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 Good (7 February 2018)
Why we inspected
As part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure that the Infection Prevention and Control practice was safe and the service was compliant with IPC measures. This was a targeted inspection looking at the IPC practices the provider had in place and considering potential risks around staffing, medicines, dignity and respect and quality management, we had identified as part of CQC intelligence gathering.
This inspection took place on 7 December 2020 and was announced on the morning of the visit to the home.
We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe, Caring 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 Acomb Court 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.
This inspection took place on 26 and 28 July 2017 and was unannounced. The last inspection we carried out at this service was in November 2015 when we found the provider was meeting all of the regulations that we inspected and we rated the service as good.
A new registered manager was in post and the service had been taken over by a new care provider. We were told that communication about the transition to the new provider had been good. Our records showed the new manager had been formally registered with the Care Quality Commission (CQC) since June 2017. A registered manager is a person who has registered with the 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 checked the management of medicines and found safe procedures were in place for the ordering, receipt, storage and administration of medicines. Staff received regular training and competency checks to administer medicines.
The premises were clean and well maintained. Procedures to prevent the spread of infection were followed and a number of checks to the safety of the premises and equipment were carried out. Individual risks to people were assessed and plans were in place to mitigate these. Accidents and incidents were monitored by the registered manager to check for patterns or trends.
There were suitable numbers of staff on duty during the inspection and staff records we checked found recruitment processes helped to protect people from abuse as appropriate checks on applicants were carried out. Staff had received training in the safeguarding of vulnerable adults and knew how to report concerns of a safeguarding nature.
People were generally 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. We found one example of where people’s rights and choices had not been supported due to the understanding of staff and training was provided to address this issue. We made a recommendation that the registered manager monitors practice in this area to ensure training is embedded in practice.
Staff received regular training, supervision and appraisals, and new staff completed an induction into the service.
The nutritional needs of people were supported. Assessments were carried out and action taken in the event of people at risk of malnutrition. People had access to a range of health professionals including GP, dietitian, and other healthcare professionals as required.
Staff were polite and caring towards people. We received positive feedback about the manner of staff from people, relatives and visiting professionals.
Care plans were in the process of being transferred to the standard documentation of the new provider. We found some care plans lacked detail and these were mainly the older style records. The registered manager had recognised this issue and had developed a plan to ensure all care plans were reviewed and updated while being transferred to new documentation. The newer style plans we read contained satisfactory information.
There were mixed views about the availability and suitability of activities. Some people told us they were happy with the activities available while others felt they had reduced. The activities coordinator was absent at the time of the inspection and we received confirmation that activities staff were back on duty following our inspection. We have made a recommendation that the provider monitors satisfaction with activities in light of the mixed feedback we received.
The registered manager carried out a range of meetings, audits and checks to monitor the quality and safety of the service. Staff were recognised for 'going above and beyond' and some had received 'Kindness Awards' from the company in recognition of their efforts.
Acomb Court provides residential and nursing care for up to 76 older persons, some of whom are living with dementia. At the time of our inspection there were 63 people in receipt of care from the service.
This inspection took place on 10 and 11 June 2015 and was unannounced.
The last inspection we carried out at this service was in November 2014 when we found the provider was not meeting all of the regulations that we inspected. These included; care and welfare of people who used the service; assessing and monitoring the quality of service provision; safeguarding people from abuse and improper treatment; dignity and respect; safe care and treatment (in respect of medicines management) and good governance (in respect of records). The provider was issued with two warning notices and they submitted action plans linked to the remaining four breaches of regulations, stating how and by when they would meet the requirements of the law. Overall we had rated the service as inadequate and the provider’s request to review that rating is on-going.
At this inspection we found improvements had been made in all of the regulations that had previously been breached.
A registered manager is required under this service’s registration with the Care Quality Commission (CQC). There was a new registered manager in post at the time of this inspection who had been registered with the Commission since May 2015. 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.
People told us they felt safe and comfortable living at Acomb Court. Staff were aware of the provider’s safeguarding policies and procedures and said they would not hesitate to raise matters of a safeguarding nature with the registered manager. Records showed that the registered manager had referred incidents to the safeguarding team within the local authority for investigation in line with her responsibilities.
Risks that people were exposed to in their daily lives had been assessed and these were reviewed regularly. Where amendments were needed to risk assessments or care plans, these had been actioned. Environmental risks within the home had been assessed and measures put in place to protect the health and wellbeing of people, staff and visitors. Health and safety checks such as those related to the servicing of equipment were carried out regularly.
The management of medicines was safe and medication audits were effective. Where minor issues with medicines had been identified these were rectified promptly. Staffing levels were sufficient to meet people’s needs and staff had been vetted through the provider’s recruitment procedures to ensure they were both of suitable character, and mentally and physically fit, to work with vulnerable adults. Staff were trained in key areas such as infection control and safeguarding. In addition, staff had received training in areas specific to the needs of the people they supported, such as training in challenging behaviour and falls prevention. Staff told us they felt supported by the newly appointed registered manager and they received regular supervision and appraisal which demonstrated this.
The Mental Capacity Act 2005 (MCA) and the principles of the best interests decision making process were appropriately applied. Where people’s families held a lasting power of attorney related to health and welfare decisions, copies of the documentation issued to prove this, had been obtained by the provider. Deprivation of Liberty Safeguards (DoLS) had been considered and applications submitted to the local authority safeguarding team for consideration.
People’s general healthcare needs were met and where there were concerns about people’s health and welfare, healthcare professionals such as psychiatrists were contacted for input into people’s care. The food available within the service was healthy and wholesome. People told us they enjoyed the food that they received. Their nutritional needs were met and they were assisted to maintain their food and fluid intake if necessary.
Our observations confirmed people experienced care, treatment and support that protected and promoted their privacy and dignity. Staff engaged with people in a kind, caring and compassionate manner and people told us they enjoyed a positive relationship with staff. We saw improvements to the effectiveness with which staff delivered care particularly to those people living with some form of dementia or cognitive impairment. People’s relatives and external healthcare professionals linked to the service gave us feedback which supported this.
Staff were aware of people’s individual needs. People told us that they were supported to engage in activities within the home if they wished to but it was their choice. Choice was promoted and we heard staff asking people throughout our visit what their wishes were. People were encouraged to be as independent as possible, although staff were available for support at the same time.
Care records overall were well maintained. A small number of daily notes had not been fully updated and we received assurances from the registered manager that this would be addressed with staff.
The home had undergone an extensive refurbishment since our last visit and the environment of the upper floor had been redecorated and accessorised with the needs of people living with dementia or some form of cognitive impairment in mind. For example, there were tactile objects for people to engage with and signage to aid orientation.
The provider gathered feedback about the service from people, their relatives and staff via meetings and surveys. There was a complaints policy and procedure in place and records showed that complaints were handled appropriately and documentation retained.
Quality assurance systems were in place and these were used to monitor care delivery and the overall operation of the service. For example, audits related to medicines management and health and safety within the building were carried out regularly. Checks on the building and equipment used in care delivery were undertaken within the recommended time frames.
The provider had a staff reward scheme in place where staff could enjoy discounts with large organisations and a bi-annual recognition awards ceremony was held, where staff could be nominated by colleagues, people and visitors for their attitude and good practice.
We noted many positive changes within the service since our last inspection. People, relatives, staff and healthcare professionals linked with the service all said that they welcomed these changes.
This inspection was unannounced and took place on the 11, 12 and 17 November 2014.
Acomb Court is registered to provide accommodation to up to 76 people with either residential, nursing or dementia care needs. Accommodation is split over three floors and at the time of our inspection there were 68 people living at the home.
The home had a registered manager who had been registered with the Care Quality Commission to manage the service since April 2011. 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.
People told us they felt safe living at Acomb Court but some said that staff did not always treat or speak to them appropriately. There were systems in place to protect people from abuse and channels through which staff could raise concerns. However, we received information which we subsequently passed on to the local authority safeguarding team for investigation.
A process was in place to assess people’s needs and risks they were exposed to. In addition, care records were regularly reviewed but we found that in practice care delivery did not always reflect instructions in care plans. For example, some people at risk of pressure ulcers were not repositioned as they should have been to prevent skin breakdown or promote healing of existing wounds. Medicines were not always administered in a timely manner and systems were not always in place to identify where medicines had expired and should no longer be used. Regular health and safety checks were carried out on the premises and equipment used within the home, but all of the documentation related to these was not available to demonstrate that the premises were suitably maintained. Recruitment processes were thorough and included checks to ensure that staff employed by the home, were of good character. Staffing levels appeared to be sufficient, but in practice the supervision of staff whilst working led to shortfalls in care delivery that need to be addressed.
Staff records showed that staff received regular training that was up to date. However, dementia awareness training was not effective in meeting the needs of people living with dementia. Staff received regular formal supervision and appraisal. The environment did not reflect best practice guidance in relation to attaining the best possible health and quality of life outcomes for people living with dementia. For instance there was no change in the colour of the walls to orient people and a lack of objects to occupy their attention.
CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act (2005). These safeguards exist to make sure people are looked after in a way that does not inappropriately restrict their freedom. We saw the registered manager had applied for DoLS for a number of people living in the home and that people’s ability to make their own informed decisions had been assessed at times, but this was not always fully documented.
People told us and records confirmed that their general healthcare needs were met. We saw that people’s general practitioners were called where there were concerns about their welfare and other healthcare professionals such as dentists and chiropodists as and when required. People gave us mixed feedback about the food they were served, some saying it was not nice and others that it was fine. We saw that people’s nutritional needs were considered and dieticians and speech and language therapists were involved in people’s care.
Some people told us that they were treated with dignity and respect by staff and others told us that they were not. Our observations confirmed that people experienced care and treatment that did not protect and promote their privacy and dignity and we saw several staff did not treat people with respect. The staff team spoke about people amongst themselves when people were present. We saw people were left sitting in an undignified manner at times. Staff did not always display caring and compassionate attitudes towards people.
People had individualised care plans and risk assessments that were regularly reviewed although these reviews did not identify shortfalls in care records or care delivery. Some people received care that was personalised and others did not. For example, one person at risk of social isolation was observed to have very little interaction with staff during the three days of our inspection. People told us and our own observations confirmed that there was little stimulation for people in the home. Some people commented that they were bored and it was a “glum environment”.
Some systems were in place to monitor the service provided and care delivered, but we found that these were not always effective and in certain areas, care delivery was not monitored when it should have been. We received mixed feedback from staff, people, their relatives and external healthcare professionals about the leadership and management of the home. Records were not always complete and at times people’s care records were difficult to follow.
The registered manager had not notified the Care Quality Commission of two safeguarding issues within the last twelve months that they should have. This was a breach of the Care Quality Commission (Registration) Regulations 2009.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and their corresponding regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were; Regulation 11 Safeguarding service users from abuse, which corresponds to Regulation 13, Safeguarding service users from abuse and improper treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 13, Management of medicines, which corresponds to Regulation 12 (f) & (g), Safe care and treatment, of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; Regulation 17, Respecting and involving people who use services, which corresponds to Regulation 10, Dignity and respect, of the Health and Social Care Act 2008 (Regulated Activities) 2014; and Regulation 20, Records, which corresponds to Regulation 17(2)(d), Good governance, 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 this report.
We found a further two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 where we have taken enforcement action against the provider. These were in respect of Regulation 9, Care and welfare of people who use services, and Regulation 10, Assessing and monitoring the quality of service provision. Information about the enforcement action we have taken is detailed at the back of the full version of this report.
We found people's care and support needs were appropriately assessed and their care was planned. They received care safely and to an appropriate standard. One person told us, "I get the help I need." Care plans were regularly updated and contained clear information about individuals' care. People or their relatives had been involved.
People were cared for in a clean and hygienic environment and we found the service had appropriate measures in place to monitor and manage infection control.
We found people were cared for by staff who were trained and supported to deliver care and treatment safely and to an appropriate standard.
People's personal records were accurate, fit for purpose and held securely. Staff records were kept in an appropriate form.
We saw how people were treated by staff and their involvement in making choices about their care and support. We saw staff provided care and support which respected people's dignity and privacy. We saw people could receive medical and specialist attention if they needed it and were helped to fulfil their social needs within the service and community.
treated by staff and their involvement in making choices about their care. They
also told us about the quality and choice of food and drink available. This was
because this inspection was part of a themed inspection programme to assess
whether older people living in care homes are treated with dignity and respect
and whether their nutritional needs are met.
The inspection team was led by a CQC inspector joined by a practising professional.
People said they received enough to eat and drink and relatives said they were happy that people who needed assistance to eat received it. People confirmed that they could receive medical and specialist attention when they needed it and were helped to fulfil their social needs within the home and community.
People told us that their home was clean, comfortable and warm. They said staff were kind and caring and seemed to be well trained. People confirmed that they were given the opportunity to comment on the service, change routine or raise complaints.