CQC report explained · a nursing home
What the CQC found at Acorn Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, September 2020
Rated Requires Improvement; inspectors found safe and caring support, but staffing, records and management needed to improve.
This was a focused inspection on 13 August 2020. Inspectors looked only at whether the home was safe and well-led. They spoke with people, relatives and staff, and checked care, medicines and management records.
People received support when they needed it, and relatives generally felt people were safe and treated well. The home was clean, infection control was good, medicines were managed safely and staff understood people's risks.
Inspectors found that activities were limited because staff were busy. Records were not always accurate or up to date, and accident and incident information was not analysed fully. The home did not have a registered manager, and the interim manager was also working as a nurse.
The overall rating remained Requires Improvement. The Safe and Well-led ratings were Requires Improvement. The other three areas were not inspected at this visit, so their previous ratings were used in the overall rating.
People felt safe
People and relatives said they felt safe. Staff knew how to report suspected abuse and safeguarding referrals were made when needed.
“People told us that they felt safe at the service.” from the report
Risk management
Risk assessments covered areas such as falls, choking, nutrition and skin care. Staff understood how to reduce risks, including keeping people hydrated.
“The risk assessments provided guidance to staff about the risk, action to take to minimise the risk and how to support people.” from the report
Medicines
Medicines records matched people's current treatment. Inspectors found that medicines were given when needed, including medicines used for pain.
“Medicines were managed in a safe way and relatives told us their loved ones received their medicines when needed.” from the report
Cleanliness and infection control
The home was clean and well maintained. Staff had infection control training, used protective equipment and carried out cleaning and hand hygiene checks.
“The service was clean and well maintained.” from the report
Communication with families
Relatives said staff kept them informed about changes and incidents. During COVID-19 restrictions, the home provided updates and arranged garden visits.
“The provider regularly updated the families on how their loved ones were being cared for and had implemented garden visits for them to see their relatives.” from the report
Limited activities
needs fixingThere were not enough staff available to provide activities consistently. Inspectors saw that activities were lacking when care staff were busy.
“However, on the day of the inspection activities were lacking as staff were busy providing support to people.” from the report
Staffing and management capacity
needs fixingThe interim manager was also rostered to work as a nurse. This affected the time available for management tasks, including record audits.
“The manager told us this had an impact on them not being able to complete audits of records appropriately.” from the report
Care records
needs fixingCare plans contained a lot of information, but it was not always clear which information was current and accurate. Inspectors recommended improving how records were maintained and reviewed.
“The care plans contained a large amount of information. It was not always easy for staff to navigate to the most up to date and accurate care plan.” from the report
Accident and incident analysis
needs fixingThe home responded to accidents and incidents, but did not record themes and trends well enough to show whether incidents could be prevented.
“Although there was some analysis of accidents and incidents, there was no record around themes and trends to determine whether accidents could be avoided.” from the report
No registered manager
needs fixingThe home was still trying to recruit a manager registered with the CQC. The interim manager was carrying out both management and nursing duties.
“At the time of the inspection the provider was still trying to recruit a registered manager.” from the report
- 01How many staff, including nurses, are planned for each shift, and how will activities be provided when care staff are busy?
- 02Has a registered manager now been appointed, and who is responsible for management when the interim manager is working as a nurse?
- 03How have care records been updated so staff can quickly find the current and accurate care plan?
- 04How are accidents and incidents now analysed for themes and trends, and what changes have resulted?
- 05What actions have been completed from the CQC action plan, and when will the next review take place?
This was a focused inspection of Safe and Well-led only; Effective, Caring and Responsive were not inspected and their previous ratings carried over into the overall rating. This explanation was written from the published report of 12 September 2020 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, October 2019
Acorn Lodge is rated Requires Improvement; inspectors found safe care but problems with dignity, personalised activities and management checks.
Inspectors made an unannounced visit on 13 August 2019. They spoke with people, relatives, staff and managers, observed care, and checked care, medicine, staffing and management records.
The home was rated Good for Safe and Effective. Risks were managed, staffing levels were sufficient, medicines were handled safely, staff were trained, and people had access to food and healthcare.
The ratings for Caring, Responsive and Well-led were Requires Improvement. Inspectors saw people not always treated with dignity, activities that did not reflect people's interests or dementia needs, confidential information on bedroom whiteboards, and checks that had missed problems. The overall rating fell from Good to Requires Improvement.
Risk management
Inspectors found that risks were identified, assessed and managed safely. Staff had guidance and followed it.
“People's risks were identified, assessed and managed safely.” from the report
Safe medicines
Medicines were administered by nurses whose competence had been checked. Records showed why as-required medicines were given and whether they worked.
“Medicines were managed safely and audits were effective.” from the report
Staff training
Staff completed training relevant to their roles and people's needs. They also had regular supervision.
“Staff completed a range of training relevant to their role and specific to people's needs.” from the report
Personalised care records
Care plans included people's life histories, likes, dislikes and preferences, giving staff detailed guidance.
“Care plans were written in a person-centred way and provided detailed information and guidance to staff.” from the report
Food and healthcare
People had menu choices, support with eating and drinking, special diets when needed, and access to healthcare professionals.
“People were supported to eat and drink enough to maintain a balanced diet.” from the report
Dignity during care
seriousInspectors saw care that was not always respectful. One person waited for toilet support without reassurance, and another person's wish to stop eating was ignored.
“People were not always treated with dignity and respect.” from the report
Personalised activities
needs fixingActivities did not consistently reflect people's interests or dementia needs. One person was offered colouring despite saying they did not enjoy it, and another activity created a safety risk.
“Activities were not designed in a way that took account of people's interests or, where relevant, their dementia.” from the report
Unpleasant odour
needs fixingA strong smell of urine remained in part of the home throughout the day. The manager later sent cleaning schedules and information about how this was being addressed.
“In one particular part of the home on the ground floor, there was a strong smell of urine which came from one person's room.” from the report
Confidential information
seriousWhiteboards in bedrooms displayed personal care information, including continence needs and resuscitation decisions. The manager said these were removed after the inspection.
“Personal information about people was not always kept confidentially or in a sensitive way.” from the report
Management checks
seriousAudits had not found several problems identified by inspectors. This included issues with consent records, activities, the odour and confidential information.
“Audits were not effective in identifying issues to drive improvement.” from the report
Legal authority records
needs fixingSome records about Lasting Powers of Attorney were inaccurate. Relatives or appointees had signed some consent forms without the correct authority for those decisions.
“Some records relating to Lasting Powers of Attorney (LPA) were not always accurate.” from the report
- 01What has changed to make sure people are treated with dignity when they need the toilet, personal care or help with eating?
- 02How are activities now matched to each person's interests, abilities and dementia needs?
- 03How do you check for and prevent unpleasant smells, particularly on the ground floor?
- 04What information is now displayed in bedrooms, and how do you keep personal information confidential?
- 05How do your audits now identify problems with consent records, care and activities?
This was an unannounced planned inspection covering all five CQC questions; the Safe and Effective ratings stayed Good, while Caring, Responsive and Well-led fell from Good to Requires Improvement. This explanation was written from the published report of 19 October 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Acorn Lodge
4 rated inspections over 5 years: the service has slipped, from Good to Requires improvement.
- September 2020Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- October 2019Requires improvementdown from GoodSafe: GoodWell-led: Requires improvement
- January 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- March 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 26 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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