CQC report explained · a nursing home
What the CQC found at Two Acres Care 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
- People were considered safe and risks were generally assessed and managed. However, checks on bedroom water temperatures and some fire safety areas were not carried out regularly and systematically.
- Effective?
- Good
- People received effective support with food, drink, healthcare and decision-making. Staff training and competency checks had improved.
- Caring?
- Good
- Inspectors observed kind and respectful care. People were involved in decisions, and staff supported dignity and independence.
- Responsive?
- Good
- Care plans had been rewritten and were more personal and regularly reviewed. People had activities, outings and support that reflected their preferences.
- Well-led?
- Requires improvement
- Management and staff morale had improved, but records and quality monitoring were not yet complete or consistent. Some audits did not cover all the areas inspectors expected.
What inspectors found, July 2019
Rated Requires Improvement and now out of special measures; inspectors found major progress, but safety checks and quality records still needed strengthening.
Inspectors visited on 16 and 17 April 2019. The inspection was unannounced on the first day. They spoke with people, relatives, staff and visiting professionals, observed care, and checked care, medicine, staff and management records.
The home had improved significantly since its previous Inadequate rating. Staffing had increased, agency use had fallen, medicines were better managed, care plans had improved, and people were treated with kindness and respect. Food, activities, consent and access to healthcare were also rated Good.
The home was still rated Requires Improvement overall because some health and safety checks were not systematic. Records and quality monitoring were also not fully reliable. The home had been in special measures, but inspectors found enough improvement for it to leave special measures.
Improved medicines management
People were receiving medicines on time. Records, audits and staff competency checks had improved.
“Improvements had been made in the recording of medicine administration.” from the report
Kind and respectful care
Inspectors saw positive interactions. People and relatives said staff were kind, patient and respectful.
“Throughout our inspection we observed kind, caring, and positive interactions.” from the report
Better staffing
Staffing levels had increased, agency use had reduced, and staff said they had more time with people.
“Staffing numbers had been increased on each shift and two supernumerary clinical leads appointed to work in the home full time.” from the report
Personalised support and activities
Care plans included people's preferences and communication needs. There were daily activities, outings and themed events.
“There were planned activities each day and staff supported people to be involved in these.” from the report
Improved involvement
People and relatives were more involved in care reviews and decisions about the home.
“People, relatives, and staff were positive about how the service engaged and involved them.” from the report
Incomplete safety checks
seriousBedroom water temperature checks were not systematic. Some fire safety checks were also not being done regularly.
“there was no system in place to ensure all bedrooms were checked on a regular and systematic basis and regular checks on some areas of fire safety were not being undertaken.” from the report
Quality records were not always robust
needs fixingSome care records and records of follow-up actions after incidents or concerns were incomplete. Inspectors also found gaps in the analysis of nutrition and some incidents.
“There were no clear records kept of job interviews and we did not always find robust recording of follow up actions in response to concerns or incidents in the home.” from the report
Some audits did not cover all areas
needs fixingThe home's monitoring systems had improved but did not yet identify every issue. Nutrition and challenging behaviour were not analysed as fully as falls.
“there were no audits and analysis of people's nutritional intake in the home.” from the report
Recruitment records
minorSuitability checks had been completed, but interviews with prospective staff were not written down. The manager said this would be addressed.
“however there was no written record of interviews with prospective staff.” from the report
- 01Have all bedroom water temperature checks and fire safety checks been put onto a regular, systematic schedule?
- 02How do you now check that care records and follow-up actions after incidents are complete?
- 03What audits are in place for people's nutrition and for incidents involving behaviour that others may find challenging?
- 04Has the manager's CQC registration been completed, and who is currently responsible for quality and safety?
- 05What evidence can you show that the improvements made since the previous Inadequate inspection have been maintained?
This was a planned inspection covering all five key questions, the premises and the care provided, with the previous Inadequate rating also reviewed. This explanation was written from the published report of 3 July 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.
What inspectors found, November 2018
Rated Inadequate and placed in special measures; inspectors found serious safety, staffing, care and management failings.
This was an unannounced, comprehensive inspection over 15, 16 and 21 August 2018. Inspectors spoke with people, relatives and staff, observed care, and reviewed care records, medicines, staffing and training.
The home was rated Inadequate overall. Safe and well-led were Inadequate. Effective, caring and responsive were rated Requires Improvement. Inspectors found missed or late medicines, poorly managed risks, insufficient staffing, safeguarding concerns and weak oversight.
Inspectors also found people did not always receive kind, dignified or personalised care. There were problems with food choices, drinks, activities, care planning and consent. The home was placed in special measures, meaning CQC expected significant improvement and planned to keep the service under close review.
Clean environment
The home was visibly clean and staff had access to protective equipment for personal care.
“Two Acres Care Home was visibly clean throughout, with no unpleasant smells or odours identified.” from the report
Emergency planning
Each person had an emergency evacuation plan which included relevant risks, including risks linked to dementia.
“Each person had a personal emergency evacuation plan in place for use in the event of an incident such as a fire.” from the report
Safer recruitment checks
The recruitment files reviewed included references, identity checks and DBS checks before staff started work.
“Employment records examined contained references, copies of proof of identity documents and Disclosure and Barring Service (DBS) checks” from the report
Access to health professionals
Records showed people received support from doctors and other professionals, including dieticians, speech and language therapists and chiropodists.
“We found that there was information showing people received support from their doctor, dietician, speech and language therapy and chiropody services.” from the report
Medicines were not safely managed
seriousSome medicines were late or unavailable. Records had gaps, and medicines were sometimes stored incorrectly or given during distracted medicine rounds.
“Some medicines had recently not been given to people because they had not been available and obtained in time to ensure their treatments were continuous.” from the report
Risks were not controlled
seriousRisk assessments and care plans did not consistently give staff the information needed to prevent harm. Inspectors found problems with repositioning, falls, pressure care, equipment and unsecured hazardous items.
“There were significant shortfalls in the assessment and mitigation of risks to people using the service.” from the report
Not enough staff
seriousStaffing levels did not consistently match people's needs. People sometimes waited a long time for help with going to bed, using the toilet, eating or getting up.
“We observed people asking to go to bed repeatedly, or asking to go to the toilet, with staff telling them they could not assist as there were insufficient staff in the lounge.” from the report
Safeguarding failures
seriousThe report describes unexplained injuries and a serious skin ulcer that had not been properly investigated or reported. Staff did not consistently follow safeguarding procedures.
“We were unable to source assurances that staff and the management team were routinely following safeguarding policies and procedures to ensure people living at the service were being kept safe.” from the report
Weak care planning and activities
needs fixingCare plans lacked important personal information and did not always reflect changing risks. People had limited access to meaningful activities and trips into the community.
“People did not have access to meaningful activities in groups or on a one-to-one basis, and there were no regular, planned trips out or integration with the local the community.” from the report
- 01What has changed to ensure medicines are available, given on time and recorded correctly?
- 02How do you now match staffing levels to people's dependency and prevent long waits for toilet care, meals and getting up?
- 03How are pressure ulcers, falls, moving and handling risks and other care risks assessed, recorded and checked?
- 04How do you ensure safeguarding concerns, unexplained injuries and serious skin problems are investigated and reported promptly?
- 05What meaningful activities and personal choices are now available, and how are people's preferences recorded in their care plans?
This was an unannounced comprehensive inspection covering all five key questions, the premises and the care provided. This explanation was written from the published report of 22 November 2018 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. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of Two Acres Care Home
5 rated inspections over 4 years: the service has held its Requires improvement rating throughout.
- July 2019Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2018Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- March 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- October 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- May 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- June 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 30 December 2010.
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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13 live-in carers within about an hour of Norfolk
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.