The Acorns

The Acorns is a residential care home providing personal care to up to 5 people. The service also has a domiciliary care agency (DCA) and supported living registration. The service provides support to people with a learning disability. At the time of our inspection there were 4 people using the residential service and 1 person using the DCA.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Risks associated with people’s care were identified and actions were taken to minimise risk and keep people safe. Building and maintenance checks were carried at appropriately. We identified some concerns regarding infection control which were addressed by the registered manager.

People received their medicines as prescribed by staff who were trained and competent in the safe handling of medicines. We found some minor issues regarding medication record keeping.

Accidents and incidents were recorded and analysed to ensure risks were identified and mitigated and lessons were learnt.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People told us they enjoyed living at the home and felt staff were kind, caring and supported them well. Relatives were complimentary about the support and care their family member received.

Right Culture

Systems in place to monitor the service were not always effective and instrumental in identifying concerns and taking appropriate actions. We have made a recommendation that systems are embedded into practice.

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 (published 30 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe, caring and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Acorns on our website at www.cqc.org.uk

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Prominent and clear infection prevention control (IPC) signs reminded everyone at the point of entry and throughout the home about procedures for infection control.

The home was accessing regular testing, which had assisted them in identifying an outbreak of COVID-19.

Risks in relation to visitors had been assessed and action taken to minimise risks. Visitors were provided with PPE, asked to complete a health questionnaire and temperature check taken on arrival.

Staff were seen wearing PPE correctly and management carried out checks to ensure this was maintained.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People were supported to stay safe and understood safety measures in place, such as fire procedures. People were actively encouraged to manage their own risks and be independent in their care and support. Systems were clear for managing medicines in the home and staff supported people’s independence where they wished to manage their own medicines.

Staff had regular opportunities to update their skills and professional development. Staff demonstrated an understanding of the impact of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). People were 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.

There was a friendly, welcoming atmosphere and people experienced good quality interactions from kind and caring staff who knew each person well.Staff were highly motivated and worked well as a team, with effective support from managers in the organisation.

Care records contained clear information covering all aspects of people’s individualised care and support.People were enabled and empowered to be as independent as possible and they felt able to complain if they were unhappy about any aspect of their care.

There was a clearly defined management structure so that all staff knew their responsibilities. There was an open and transparent culture in which staff felt able to approach managers.

Further information is in the detailed findings below.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found -

Is the service safe?

At this inspection we followed up a compliance action which had been set in relation to appropriate checks not being undertaken prior to staff commencing work. We checked a staff file of the most recently recruited member of staff and this contained all the information required by the Health and Social Care Act. This demonstrated that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

We also followed up a compliance action in relation to records not being kept securely and not always being kept up to date. We found significant improvements had been made. Staff understood the importance of confidentiality and ensuring people’s records were kept securely.

Is the service effective?

People told us they were happy with the care provided and said staff understood their needs. It was clear from speaking with staff that they had a good understanding of people’s care and support needs and they knew them well. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People told us they had things to do. One person said they had cleaned their room and were supported to do their laundry. We saw this person had personalised their room which reflected their tastes and interests and helped to make their room more homely. Another person said: "Staff listen to me.”

Is the service responsive?

People told us they knew who to speak to if they had any concerns. We saw evidence to show people met with their key workers to discuss what was important to them. People had care plans and risk assessments in place which covered their needs. We saw people had access to health services when required. For example, there was evidence people had access to a doctor, an optician and dentist.

Is the service well-led?

We saw evidence the registered manager carried out regular audits on areas such as: care records, staff records, fridge temperature checks, fire tests and cleanliness. The registered manager recorded where action was needed, by whom and when. However, we found where action had been identified as being required, the information recorded within the audits was very limited. This meant it was difficult to establish what led the registered manager to believe action was required.

We looked at a sample of two care records and saw overall each person had a care plan and risk assessment which covered their needs. We found there was a good level of detail within the care plans which gave a clear picture of what people’s needs were and how they should be met. However, we did note where one person had a specific need there was not a care plan in place. We also found there were no specific care plans in relation to people’s personal goals. We therefore found people’s personal records were not always accurate and fit for purpose.

We looked at the menu planning which showed choices and variety were offered to people. Staff had received training in nutrition which helped to ensure people were offered a healthy balanced diet. All three people we spoke with were happy with the quality of food and told us they had a choice of food. One person commented; “It’s home cooking.” Another person told us; “I can choose what I want.”

We looked at three staff files and found effective recruitment and selection processes were not in place. We found references from one member of staff’s last known employer had not been obtained. Another member of staff had started work without a Disclosure and Barring Service check, although the person had been working with other staff members. The provider did not carry out appropriate checks before staff began work.

All three people we spoke with knew who to speak with if they were unhappy with staff or their care. People named three members of the management team they could raise any concerns with. One person told us about a complaint they had made a long time ago. They said they had been listened to and their complaint had been resolved.

People who used the service were given appropriate information and support regarding their care or treatment. One service user said, “I am in charge of my care and the staff here help me where I need support.”

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We were informed by all three service users they were involved in all the decisions about their care and had given staff permission to support them in the way they liked.

People who use the service were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements. Two people said they were supported by the staff and the house rules they had agreed to abide by helped them to be safe. One service user said, ”I always let the staff know what time I will be returning when I go out.”

The provider had an effective system to regularly assess and monitor the quality of service that people receive. Service users told us from time to time they attended meetings with staff and the manager at the house. They talked about what was good and anything they could change so that they were all able to continue enjoy living at The Acorns.