CQC report explained · a nursing home
What the CQC found at Acorn Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found risks were not always properly assessed or monitored. Medicines were not managed safely, although staffing, recruitment, safeguarding and infection control were generally satisfactory.
- Effective?
- Good
- This question was not inspected during this focused inspection. Its previous rating was used in the overall rating.
- Caring?
- Good
- This question was not inspected during this focused inspection. Its previous rating was used in the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused inspection. Its previous rating was used in the overall rating.
- Well-led?
- Requires improvement
- Management checks did not identify important problems found by inspectors. Care records were not always up to date or person-centred, and known urgent actions had not been completed promptly.
What inspectors found, August 2023
Rated Requires Improvement; inspectors found risks and medicines were not always managed safely, and quality checks missed problems.
This was an unannounced focused inspection on 20 June 2023, followed by an announced visit on 27 June 2023. Inspectors looked only at Safe and Well-led. They spoke with people, relatives, staff and a visiting professional, and checked care records, staff files, medicines, the building and management records.
The home was rated Requires Improvement for Safe and Well-led. Inspectors found gaps in risk assessments and monitoring, unsafe medicines systems, incomplete care records and environmental safety checks that had not led to action. The lifts had also been unavailable since the end of May, limiting some people's access to communal areas and outdoors.
There were also positive findings. People and relatives said they felt safe and that staff were caring. Staffing, recruitment, training, infection control and safeguarding systems were generally satisfactory. However, the home remained in breach of regulations about safe care and treatment and good governance, as it had at the previous inspection.
People felt safe
People and relatives told inspectors they felt safe and trusted the staff. Most people and relatives also said staff responded promptly when needed.
“People and relatives said they felt safe and trusted staff.” from the report
Staff preparation
Recruitment checks were completed before staff started work. Staff had induction, training and supervision to support them in their roles.
“Staff had induction, training, and supervision to be able to carry out their role safely.” from the report
Infection control
Inspectors were assured that the home had suitable measures for preventing and managing infections, including safe use of protective equipment.
“We were assured that the provider was using PPE effectively and safely.” from the report
Working with professionals
The home worked with health and social care professionals and had regular involvement from the local GP.
“The provider worked very closely with the local GP who routinely visited people living at the service weekly.” from the report
Risk assessments and monitoring
seriousSome risks were not properly assessed or monitored. Records did not always show that people were repositioned as planned, and some people had no risk assessment for issues such as bed rails or complex behaviours.
“People were at risk of harm because risks had not been adequately assessed and monitored.” from the report
Medicines safety
seriousChecks on controlled drugs and medicine storage temperatures were not reliable. Records about fluid thickener were incomplete or contradictory, increasing the risk of choking or aspiration.
“Systems were not in place to ensure the proper and safe use of medicines. This placed people at risk of harm.” from the report
Management checks
seriousThe home's audits did not identify several problems found by inspectors. Some urgent care-record actions identified before the inspection had not been dealt with promptly.
“Shortfalls found at this inspection had not been identified by the provider's governance processes.” from the report
Access and water temperatures
seriousTwo lifts had been unavailable since the end of May, limiting some people's access to shared areas and outdoors. Water temperature checks found some baths and wash basins above the recommended safe temperature, without evidence of action.
“This exposed people to the risk of harm by scalding.” from the report
Recording people's involvement
needs fixingBest-interest records did not always clearly show who had been involved in decisions or how less restrictive options had been considered.
“They did not always clearly evidence how other professionals and people's representatives had been involved in the decision.” from the report
- 01How are you now checking controlled drugs, medicine storage temperatures and records for fluid thickener?
- 02How will you make sure every person's risks, including repositioning, bed rails and complex behaviours, have a current assessment and monitoring plan?
- 03What has been done about the two lifts being unavailable, and how are affected people accessing communal areas and outdoors?
- 04How are you checking water temperatures and recording the action taken when they are too high?
- 05What extra nursing cover, deputy management support and care-record checks have been put in place since the inspection?
This was a focused inspection of Safe and Well-led only; the other three question ratings carried over from the previous inspection. This explanation was written from the published report of 2 August 2023 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, June 2021
Acorn Nursing Home is rated Requires Improvement; inspectors found kind, consistent care but gaps in risk records, infection control and oversight.
This was an unannounced inspection in May 2021. Inspectors observed care, spoke with people, relatives, staff and a social care professional, and checked care, medicines, recruitment and management records.
The home was not always safe. Some care records did not reflect people's changing needs, including mobility, weight loss and fluid intake. Staff did not always use COVID-19 protective equipment correctly. The provider took immediate action to reduce these risks.
There were positive findings too. People and relatives generally spoke well of the care. Staff were described as kind, experienced and consistent. Medicines were managed safely, and people had access to health professionals.
The overall rating changed from Good at the previous inspection, published in December 2018, to Requires Improvement. Only Safe and Well-led were inspected at this visit. The other ratings were carried forward from the previous comprehensive inspection.
Kind and consistent staff
People and relatives gave generally positive feedback. Staff were described as caring, kind, experienced and consistent.
“People were supported by a consistent and experienced staff team.” from the report
Medicines managed safely
People received their medicines when they should. Staff were trained and their competence was checked.
“Medicines systems were organised, and people were receiving their medicines when they should.” from the report
Enough staff
People and relatives said there were enough staff to provide safe support. Staff turnover was low.
“People told us there were enough staff on duty to keep them safe.” from the report
Positive atmosphere
Inspectors found a welcoming atmosphere. People said they felt safe and staff were approachable.
“There was a warm and welcoming atmosphere throughout the home.” from the report
Links with professionals
The home worked with health and social care professionals to respond to people's needs.
“One social care professional described a "good working relationship" with the home” from the report
Out-of-date risk records
seriousCare plans and risk assessments did not always match people's current needs. This included mobility, weight loss and fluid intake, and could put people at risk of harm.
“Care records did not always explain how to keep people safe.” from the report
Infection control practice
seriousSome staff wore fabric masks or did not wear fluid-resistant masks correctly. Inspectors said this created a risk of infection being transferred.
“Staff did not always follow the provider's COVID-19 policy or infection prevention and control guidelines.” from the report
Weak management checks
seriousAudits had not identified the problems found during inspection. Care records were reviewed annually, which was not enough to ensure they stayed accurate.
“Quality monitoring systems were in place, but they were not always effective.” from the report
As-needed medicine instructions
needs fixingInstructions for some medicines used when needed did not contain enough personalised detail. The manager said this would be addressed.
“However, they would benefit from more person-centred detail to ensure medicines were administered consistently.” from the report
Communication
minorMost feedback was positive, but some relatives said communication could be better.
“Some relatives said communication could be improved but most people praised the registered manager.” from the report
- 01How are you making sure each person's risk assessment and care plan reflects their current mobility, weight and fluid needs?
- 02What checks now confirm that staff wear the correct COVID-19 protective equipment properly?
- 03How often are care plans and risk assessments reviewed now, and who checks that the reviews are effective?
- 04What changes have been made to instructions for medicines given when needed?
- 05What action has been taken in response to the Regulation 17 breach, and what evidence can you show that the problems have been fixed?
This was a focused inspection of Safe and Well-led, including infection prevention and control; the other ratings were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 24 June 2021 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 Nursing Home
6 rated inspections over 7 years: the service has improved, from Inadequate to Requires improvement.
- August 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2021Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- December 2018Goodup from Requires improvementSafe: GoodWell-led: Good
- October 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2017Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- April 2016InadequateSafe: InadequateEffective: Requires improvementCaring: InadequateResponsive: Requires improvementWell-led: Inadequate
- June 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 19 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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