Acorn Hove

About the service

Acorn Hove is a residential care home which provides accommodation and personal care to 8 people at the time of the inspection. The service can support up to 12 people.

People’s experience of using this service and what we found

Right Support: People had their own individualised care plans in place, but they had not been reviewed for several months. Staff knew people well, but their needs were not always reviewed or updated regularly. Accident and incidents were not routinely monitored, which meant there were missed opportunities for learning. Robust recruitment checks were not being completed.

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 Culture: The governance and quality assurance systems at the service were not robust. There were audits and action plans in place to improve the quality of care. However, these were not consistently completed and, in some cases, actions were not followed up or documented. This meant that improvements were not always implemented, the provider's governance systems were not always followed and issues around the quality of care and safety of the environment at the service were not always addressed. There was a positive culture at the service and both staff and people spoke of how approachable the interim manager was when raising concerns.

Right Care: There were sufficient staff to ensure people’s safety. People were supported in the way they wished and received care tailored to them to enhance and enrich their lives. Staff had a good understanding of people's needs and people were comfortable and happy in staff's presence. People were happy with the care provided and enjoyed living at the service. People were complementary about the staff team and the changes that had happened since our last inspection. One person commented, "[Staff] are all great. I can tell them anything. We’re like a family.”

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 14 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service and in part due to concern we had regarding the governance at the service. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to safe recruitment of staff and the quality and assurance systems in place at this inspection. We have made a recommendation about the management of some medicines.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection on 17 & 18 June 2015, we rated the service as good, However, we identified some concerns in relation to the way medicines were managed. We asked the provider to take action to make improvements and this action has been completed. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

A registered manager was in post. 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.

We have made a recommendation about systems being implemented to comply with the Accessible Information Standards (AIS).

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including managing behaviour that may challenge others and awareness of autism. Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People’s end of life care was discussed and planned and their wishes had been respected.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people could give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People were encouraged to express their views and they said they felt listened to and any concerns or issues they raised were addressed. People's individual needs were met by the adaptation of the premises.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included one to one time scheduled for people in their rooms, visits from external entertainers and watching films. People were also supported by staff to attend day centres. People were encouraged to stay in touch with their families and receive visitors.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

The provider subsequently submitted an action plan detailing how the shortfalls would be addressed. This follow up inspection was carried out to monitor any changes and improvements made.

The manager told us that, in accordance with their action plan following the previous inspection report, regular formal staff supervisions had been resumed and staff meetings had been reinstated. This was also confirmed by care workers we spoke with and through supervision records and minutes of recent staff meetings that we were shown. One care worker told us 'Things have improved and people feel more involved now. We do use the computer now for recording residents' notes and we've all had supervision and at least one meeting since you were here last time'.

As part of the inspection process we spoke with three care workers and the manager. We looked at documentation including staff training records, supervision forms and minutes of recent staff meetings. We were given assurances by the manager that these improvements will be sustained and regular staff meetings and formal supervision will be on-going.

As part of the inspection process we spoke with three people who used the service, four care workers and the provider who was also the registered manager.

Positive comments received from people using the service indicated satisfaction with the home and the services provided:

'I'm happy living here. It's comfortable, the food's good and the staff are very kind and caring'.

'I like it here and wouldn't want to be anywhere else. I can go out when I want, which is important to me and there's always someone around if I need anything'.

In accordance with their individual care plans, people were supported to make choices about their daily lives. We found that care workers had developed a sound understanding of each individual's care and support needs. This was evident from direct observation of individuals being supported in a professional, sensitive and respectful manner.

Shortfalls were identified in the level of training and support staff received, including inconsistency in the provision of formal supervision. We also found that staff meetings were not taking place, which further affected communication within the home.

Appropriate arrangements were in place in relation to storing, administering handling and recording medicines.

The provider had satisfactory systems were in place to deal with comments and complaints.

We made observations throughout the visit and saw people being offered choices as to what they wanted to eat or what activities they wanted to take part in during the day. We saw people being addressed in a respectful manner. We looked at peoples individual care plans and saw that the information recorded enabled staff to plan and deliver the required level of care and support on an individual basis.

We saw that regular audits of the service were completed by the provider ensuring that people who used the service benefit from a service that monitors the quality of care that people received.

Staff told us that they had received regular training and that they felt that they were supported to carry out their roles and meet the needs of people who used the service.

People said that they had no complaints about the service and that if they did they would speak to the staff or the manager