Archived: Acorn Park Lodge

Acorn Park Lodge is a ‘care home’ that provides care for a maximum of nine adults with learning and/or physical disabilities. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The culture of Acorn Park Lodge was exceptionally inclusive. Every aspect of the running of the service was done in collaboration with the people who lived there and where appropriate, their families. Each person's unique personality and needs were understood and captured into a personalised 'This Is Me' document that clearly brought to life people's personalities, needs, aspirations and goals. The registered manager told us, "Our approach is to support resident's goals and aspirations as they develop and experience greater opportunities to grow and develop." The service was proactive in ensuring equality and diversity standards were integral to people's care plans. People were encouraged to fulfil their goals and aspirations to the full and we saw multiple examples, outlined in this report, of how they did this.

The care service was established five years ago and was designed to provide group living for people with learning disabilities and physical disabilities. Work had been done, and was continuing, to develop the service in line with the values that underpin the CQC ‘Registering the Right Support’, and other current best practice, guidance. This guidance includes the promotion of the values of; choice, independence and inclusion. The service was working with people with learning disabilities and autism that used the service, to support them to live as ordinary a life as any citizen.

At the time of the inspection there were nine people living at the service; seven of whom lived in the main house and two people had their own separate accommodation made up of a separate flat, and an annexe flat attached to the main building. Though the service is technically a little large to be compliant with the maximum number of people (six) stated in the Registering the Right Support Guidance, this is offset by the structure of the service and the individualisation of the support provided for each person. The service was spread out over three floors with access to the upper floors via stairs or by using a shaft lift. The design, layout and decoration of the building met people's individual needs. Corridors and doors were wide enough to allow for wheelchair access. Seven rooms had en-suite facilities and there was one shared bathroom with shower facilities. Shared living areas included two lounges, a dining room/ kitchen, a separate kitchenette, a conservatory lounge, a garden with decking area and also a patio seating area.

Each person who lived at Acorn Park Lodge received highly individualised support. The registered manager told us, “Each resident has their own support team who understands that the resident’s safety is our paramount concern”. On the day of the inspection there were eight support staff plus a senior manager who led the shift and provided additional support when required. Seven people had one to one individual support and two people shared staff support. However, if people wanted to go out individually the deputy manager, or additional staff would be booked to work, to enable each person to have individual one-to-one support. The service was central in the town of Redruth which meant that people were able and did take an active role in their local community.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

The atmosphere at Acorn Park Lodge was vibrant and happy. During the inspection there was a birthday party for one person and a baby shower to celebrate the forthcoming arrival of a staff member’s new baby. Everyone was involved in the various celebrations. There was lots of singing on a karaoke machine, people making cakes, and lots of visitors.

Most people living in the service had limited verbal communication and were not able to tell us their views about the care and support they received. However, we observed people were relaxed and comfortable with staff, and they received care and support in a way that kept them safe. People had an excellent relationship with staff and were happy with the staff that supported them. People's behaviour and body language showed that they felt really cared for and that they mattered. Some people were able to tell us their views and said they felt safe and happy living at Acorn Park Lodge.

Relatives were very positive in their feedback about the service. We were told people were welcome to visit and the service was ‘a home from home’. We heard repeatedly about the ‘family atmosphere’ and we saw and felt this. Comments from relatives included, “It is such a special place, is all I can say. We followed the [previous registered manager] from her last place. Since [current registered manager’s name] has taken over it has continued to go from strength to strength. We are very lucky this service is here. It has given my [relative] such a full and happy life”; “Absolutely excellent is all I can say. There isn’t a single wrong thing I could tell you” and “The best thing about Acorn Park Lodge is the staff attitude; they are so kind but also really encouraging of people to do what they want to do. They have a real ‘life is for living’ attitude!”

Staff were passionate about the people they supported and actively advocated on behalf of people to ensure they lived the fullest life they could. Staff displayed empathy and helped people overcome fears and challenges. This had resulted in positive and measurable changes for the individuals who lived at the service. For example, relatives told us how much people had ‘blossomed’ since moving to Acorn Park Lodge. One person told us with great pride about their continuing work as an ambassador for iCare. This is an organisation active across England which helps promote quality care within the Adult Care sector. We saw examples of a range of activities the person had taken part in as part of their role. This included taking part in training videos for people wishing to make a career in Adult Social Care.

The culture at the service was exceptionally inclusive. The staff, family members and external professionals worked alongside people to support them. This meant that people’s best interests were always being discussed and planned for. The provider was willing to adapt and change approaches based on information from the staff, families or others. They constantly reviewed people’s care and staff reflected on their own practice. This meant staff anticipated and responded to changes in people’s needs and took action to provide the support they needed. This was driven with great drive and pride by the registered manager. On the first day of inspection we saw how touched the registered manager was on receiving a bouquet of flowers from a relative of a person who lived at the service. The relative told us that in her many years of advocating for and supporting her relative she had never experienced such an inclusive and supportive team; “It’s how care should be. My [relative] has a great life here. He has had some ongoing health issues recently and [registered manager] has worked with me, and it has been a battle at times, to get in place quite a complex plan of care to sort this out. It takes a lot for me to value and really trust people looking after [relative] but [registered manager] really deserves it. She has been absolutely fantastic.”

The management team demonstrated an open, transparent and reflective leadership style. They provided visible direction and a person centred approach to their staff teams. They exhibited a passion for providing a high quality service, which continually developed in order to meet people's needs in a holistic manner. Staff comments about working for the service included, "[Registered manager’s name] is absolutely fantastic. She doesn’t take any nonsense and she reminds us regularly that we’re here for the people who live here. There is a great team spirit here which I think you can see”; “The manager and deputy are always available. There are no stupid questions here, I can go to see any of the managers here at any time and I feel that what I have to say is valued” and “It is a really lovely place to work. Everyone here is like one big family."

An external healthcare professional who spent time at the service was extremely positive in their feedback commenting, “Overall I would honestly say that if one of my own family members needed this sort of care that I would happily place them into Acorn Park Lodge without hesitation.”

People felt safe living at the service. The staff had a proactive approach to supporting people. There was clear information about situations and environments which might trigger people’s anxiety or agitation. The staff were aware of these and responded to triggers by supporting people to feel calm, removing the trigger and diverting people’s attention. Families of people who lived at the service told us they were confident their relatives were safe. One relative told us, "We are happy that this is a very safe environment for our [relative] to be living in, more importantly he loves living there.”

People received their medicines safely. There were sufficient numbers of suitably qualified staff

Acorn Park Lodge is a small care home that can accommodate up to nine people with learning and/or physical disabilities. At the time of our inspection there were nine people living in the service.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

The atmosphere at Acorn Park Lodge was relaxed and welcoming. Relatives told us there was a good ambience in the service whenever they visited. One relative said, “There is always a relaxed family atmosphere”. Throughout the day we met with people as they moved around the premises between going out and completing daily chores.

Most people living in the service had limited verbal communication and were not able to tell us their views about the care and support they received. However, we observed people were relaxed and comfortable with staff, and they received care and support in a way that kept them safe. People had an excellent relationship with staff and were comfortable with the staff that supported them. People’s behaviour and body language showed that they felt really cared for and that they mattered. Some people were able to indicate to us that they felt safe in the service by showing us their rooms and areas of the home they liked to spend time in.

Relatives told us they were happy with the care and support their family member received and believed it was a safe environment. One relative said, “We can breathe a sigh of relief knowing [persons’ name] is safe and well looked after.”

People were encouraged and felt confident to make decisions about their daily living. Staff enabled people to be as independent as possible, and it was clear that because of this encouragement, people were open to new challenges and personal development. One relative said, “Living at Acorn Park has turned [person’s name] life around. He has grown up and is now so much more independent.”

Staff supported people to access the local community and take part in a range of activities of their choice. Multiple vehicles were available for staff to use and people were able to go out either individually, or in groups, as and when they chose to.

Support was provided by a consistent staff team who knew people well and understood their needs. Staff were matched to work with particular individuals, both for their skills and how their personalities fitted together. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.

People had access to an annual health screening to maintain their health. Specialist services such as occupational therapists, epilepsy nurses and dieticians were used when required. Relatives told us they were confident that the service could meet people’s health needs. People were supported to eat and drink enough and maintain a balanced diet. Menu planning was done in a way which combined healthy eating with the choices people made about their food. The kitchen had been designed with some lower work surfaces so people with wheelchairs could help with meal preparation and cooking.

Care records were up to date, had been regularly reviewed, and accurately reflected people’s care and support needs. Details of how people wished to be supported were personalised to the individual and provided clear information to enable staff to provide appropriate and effective support. Any risks in relation to people’s care and support were identified and appropriately managed.

People were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate. Staff demonstrated a good understanding of the main principles of the Mental Capacity Act (MCA).

People and their families were given information about how to complain. People had a specially adapted version of the complaints form, which had been designed by people living in the service, and covered areas they felt they might want to raise a concern about. Roles and responsibilities of staff were well-defined and understood by the staff team. There was a positive culture in the service, the management team provided strong leadership and led by example. Staff said about working for the service, “The manager and deputy are always around in the service. I can walk up to them at any time and ask anything. Nothing is too much trouble”, “This is a really lovely place to work” and “The staff and the residents are all like one big family.”

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. Senior management were visible in the service and regularly visited to check if people were happy and safe living at Acorn Park Lodge.

We saw the home was comfortable and clean. We observed each person had individualised their own room to suit their personal taste. Relatives we spoke with told us their family members were encouraged to choose how they spent their time and had free choice about areas of their life such as when they went to bed and what choice of meals they had. We saw people coming and going from various activities during the day. People were happy to spend time socialising together, talking with staff and visitors to the home or spending time in their own rooms. We saw people moved around the home with no restrictions.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We saw there was a choice of suitable and nutritious food and drinks, in sufficient quantities to meet people's needs.

The provider was operating an effective recruitment procedure, to ensure people who lived at the home were safe and their health and welfare needs were met by staff that were appropriately qualified, skilled, experienced and of good character.

The provider had developed a policy and procedure which assessed and monitored the quality of the service provided by the home to ensure people received safe and appropriate care and treatment.