Archived: Acorns Care Centre

Updated 23 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place over two days on 08 and 10 October 2018. The first day was unannounced, which meant the service did not know in advance we were coming. The second day was by arrangement with the management.

On 08 October 2018, the inspection team consisted of two adult social care inspectors and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. On 10 October 2018, one adult social care inspector completed the inspection.

Prior to the inspection we reviewed information we held about the home. This included statutory notifications, safeguarding referrals, previous inspection reports, action plans and the service improvement plan which had been developed in conjunction with the quality performance team at Wigan Council following previous inspections.

We also liaised with external professionals including; the local authority, local commissioning, safeguarding teams, environmental health and infection control to support our planning for this inspection.

A Provider Information Return (PIR) was not requested to support us with our inspection planning. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with seven people who lived at Acorns Care Centre and three relatives/visitors. We spoke with the director, regional director and home manager from caresolve. We also spoke with a nurse, team leader, two seniors and three care staff.

We looked at documentation including six care files, which involved looking at people’s food and fluid records, pressure care and equipment. We looked at medicines, staff recruitment, supervision, induction and training, staff rotas and policies and procedures.

Updated 23 November 2018

We undertook an unannounced inspection at Acorns Care Centre on 08 October 2018 and returned for a second visit by prior arrangement with management on 10 October 2018.

Acorn's Care Centre is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home provides single occupancy bedrooms with en-suite facilities across three floors, and is serviced by one lift. There is a communal lounge on the middle and top floor and a large dining area on the ground floor. At the time of the inspection there were 32 people living at the home.

We completed an inspection in November 2017, when the home was rated as inadequate and we took enforcement action. In July 2018, the issues raised in November 2017 had been remedied but we identified further concerns which meant we were not confident to withdraw our enforcement action at that time. We made the decision to undertake a further unannounced inspection within three months of our July 2018 visit to determine the concerns had been addressed and the quality of care provided had continued to improve.

In July 2018, the home had been rated as ‘requires improvement’ overall and in the key questions, safe, effective, responsive and well-led. Caring was rated as ‘good’. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding; safe care and treatment, meeting people’s nutrition and hydration needs and good governance. We also made a recommendation regarding staffing.

Our re-visit in October 2018 was positive. At this inspection, we found the previous concerns raised in November 2017 and July 2018 had been addressed but identified new concerns regarding medicines. This meant there had been further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; safe care and treatment and good governance. The overall rating of Acorns Care Centre remains ‘requires improvement’ but effective and responsive have improved to good following this inspection.

Because of the significant improvements identified, we have withdrawn the enforcement action taken regarding the home following our November 2017 inspection when the home was rated inadequate. We have completed our enforcement action taken against the registered manager and cancelled their registration with CQC. The home continues to be supported by the local authority through a service improvement plan (SIP) and we attend meetings bi-monthly to monitor the homes progress.

At the time of our inspection, there was no 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 2008 and associated Regulations about how the service is run. A home manager from the consultancy firm (caresolve) brought in by the provider to support the home to make progress commenced in post in July 2018. The home manager attended the home four days a week. Recruitment for a permanent nurse manager who would register with CQC was ongoing at the time of inspection.

We found past failures to assess risks relating to bed rails and airflow mattresses had been addressed. Since our last inspection, divan beds had been replaced by profiling beds with built in bedrails. Airflow mattresses were checked to ensure they remained on the correct setting for the person’s weight to reduce the risk of the person developing pressure areas.

At this inspection, we found medicines were not managed safely. There was medication administration charts (MAR) without photographs, missed signatures and medicines that could not be determined as being given. Cream records didn’t demonstrate creams were being applied as prescribed.

The system implemented to investigate and respond to accidents and incidents remained effective. This continued to be disseminated to staff to promote learning.

Recruitment was effective and appropriate checks completed before new staff commenced working at the home. Recruitment was ongoing for nurses and care staff and we observed interviews being completed whilst undertaking the inspection.

Staffing was determined using a system based on people’s needs but we previously made a recommendation about this as the calculation didn’t take in to account the logistics of the building. Prior to us undertaking the inspection, the staffing numbers had been increased and we will continue to monitor this through the SIP meetings.

People’s hydration needs were being met. Documentation had improved since the last inspection in July 2018 and there was no longer gaps on the records for the time of day drinks were being offered. People’s recommended daily fluid intake was being achieved.

Staff received an induction and appropriate training and supervision to support them to fulfil the requirements of the role. People told us staff knew what they were doing and met their individual needs and wishes.

People living at the home and their relatives were complimentary about the care provided. Staff and people spoke with fondness about each other and people’s preference and choices were upheld by staff that knew people’s likes and dislikes. People were treated with kindness and respect. Staff promoted people’s independence and ensured their dignity was maintained.

People had been involved in their initial assessment and development of their care plans. However, the nursing staff remained responsible for completing all the care plans and daily notes which meant some details were missed. Senior care staff had been appointed and they were receiving training to undertake some of these duties.

Feedback had been sought from people, relatives and staff. Resident and staff meetings were held on a regular basis which provided a forum for people to raise concerns and discuss ideas.

The home has improved and there were clear plans and identified timeframes to continue that trajectory of improvement. The home will continue to be monitored through the SIP which is in place to support the management to address the outstanding requirements.