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Inspection carried out on 22 October 2019

During a routine inspection

Acorn Residential is registered to provide accommodation and personal care for up to eight people with a learning disability. This was the only home owned and managed by the provider who was a partnership, one was the registered manager, the other a senior care worker.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large domestic style property. At the time of our visit six people were living in the home. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Risks to people had been assessed and regularly reviewed. People were protected from avoidable harm, discrimination and abuse. Appropriate staff recruitment checks were made. Procedures were in place to reduce the risk of the spread of infection. Medicines were administered and stored safely.

Staff were suitably trained and supported. 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. People were supported to maintain a healthy balanced diet and to stay healthy, with access to health care services as and when required.

People received support from staff who were kind and compassionate. Staff treated people with dignity and respect and ensured people's privacy was always maintained. People were supported to do as much as they could and wanted to do for themselves to retain control and independence over their lives.

People’s communication needs were met. The provider had effective systems in place to deal with concerns and complaints and to assess and monitor the quality of the service people received.

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 5 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 28 March 2017

During a routine inspection

Acorn Residential Home is a care home that provides personal care and accommodation for up to eight adults. At the time of the inspection there were six people living at the home, all of whom had learning disabilities.

Acorn Residential Home is a family run home, the registered manager and deputy, are wife and husband respectively. Their son and daughter-in-law also work in the home. Other staff are employed to work during the night and at weekends.

At the last Care Quality Commission (CQC) comprehensive inspection in November 2014, we found some areas of concern and rated the service as ‘requires improvement’ in two questions we asked of providers, ‘Is the service safe?’ and ‘Is the service effective?’. Overall the service was also rated ‘Requires improvement’.

Staff had received training in line with their roles and responsibilities; however it was not regularly refreshed and some mandatory training such as medicines administration had not been refreshed for several years. Also the provider was not up to date with current guidelines and practices for safeguarding adults at risk. We asked the provider to write to us and let us know what action they would be taking to make improvements in the service.

In June 2015 we visited the service to make sure they had made the improvements we had asked them to. We saw evidence staff had refreshed their training. Additionally, measures had been taken to ensure the service was in line with current practice regarding safeguarding adults at risk. The service had re-written their policy and procedures for safeguarding adults at risk to make it clear what staff were required to do if they suspected anyone was at risk from harm; acquired the ‘London Multi-Agency Adult Safeguarding Policy and Procedures on safeguarding adults’ and the registered manager had refreshed their ‘safeguarding adults at risk’ training. As the service was meeting legal requirements and had made the necessary improvements, we changed their rating in the two key questions and overall from Requires Improvement to Good.

The service did have a registered manager 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 2008 and associated Regulations about how the service is run.

At our inspection in March 2017, we found people continued to be safe living at Acorn Residential Home. There were enough staff on duty and they had received sufficient training and support to meet people’s needs.

The provider had undertaken checks prior to the employment of staff to ensure as far as possible only suitable people were employed. Staff had received training to recognise the signs of possible abuse and knew what action they needed to take to keep people safe.

People were supported to maintain good health. They had access to healthcare professionals as and when they needed them. People received suitable nutrition and their medicines as prescribed to maintain their well-being.

Staff were kind and caring. They provided care in such a way to maintain people’s privacy and dignity. They were knowledgeable about people’s individual needs and how best to meet them. Staff were attuned to people’s communication and sought consent from people before providing care.

The provider put assessments in place so any risks associated with daily living could be identified and action taken to minimise them. In this way, they were promoting people’s independence where possible.

People were supported to be involved in a range of activities in line with their interests and preferences. This included volunteering and being involved in organisations representing people with learning disabilities.

The provider sought to gather stakeholders’ views about the service. People were encouraged to complete satisfaction surveys or

Inspection carried out on 17 June 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 3 November 2014 and breaches of legal requirements were found. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements. They said they would ensure the correct procedures were followed to safeguard adults at risk and to make sure all staff had received up to date training and which reflected best practice so they were fully equipped to care for the people who use the service.

We undertook this focused inspection on 17 June 2015 to check that the provider had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Acorn Residential Home on our website at www.cqc.org.uk

Acorn Residential Home is a care home that provides accommodation and personal care for up to eight people. The home provides care and support to people who have a learning disability, many of whom have lived together for a number of years. At the time of our visit, there were seven people living at Acorn Residential Home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 2008 and associated Regulations about how the service is run.

We saw there were up to date policies and procedures for safeguarding adults at risk. Staff were aware of these and the actions they needed to complete in order to escalate any future concerns they might have and to help ensure the safety of people.

We found people received enough training to help ensure people receive effective care which was based on best practice. Staff had the knowledge and skills they needed to carry out their roles and responsibilities.

Inspection carried out on 3 November 2014

During a routine inspection

This unannounced inspection took place on 3 November 2014. When we last visited the home on the 5 December 2013 we found the service was meeting the regulations we looked at.

Acorn Residential Home is a care home that provides accommodation and personal care for up to eight people who have a learning disability. At the time of our visit, there were seven people living at Acorn Residential Home.

The service has a registered manager 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 2008 and associated Regulations about how the service is run.

People using the service told us they felt safe and well cared for. The atmosphere was calm and, relaxed when we visited. We saw risks to people were identified and plans put in place to address these. Staff attended to people’s needs promptly and showed patience and care. Relatives we spoke with were also happy with the care provided. However, the home was not up to date with processes and procedures for safeguarding adults at risk of abuse, so people who used the service may be at risk if correct procedures were not followed.

People’s needs were assessed and plans put into place so their needs could be met. This included people’s health needs and making sure they stayed well. People had access to relevant health professionals when they needed them. People were involved in writing their own plans and reviewing them so they were getting the care they wanted and the information was always kept up to date. People were encouraged to be as independent as possible. There were a range of activities for people to participate in, if they wanted to.

There were gaps in staff training so there were risks people might not receive safe and appropriate care at all times. This was a breach of the relevant legal requirement and you can see what action we told the provider to take at the back of the full version of the report.

Relatives and outside professionals said the manager listened to their views and acted on them. People who used the service told us if they had a problem or issue they would talk to the manager or other staff who were often at the home and available to speak to.

Inspection carried out on 5 December 2013

During a routine inspection

We spoke to three people who used services, three relatives, the registered manager, two members of staff, a case manager from the local council and two workers at a Day Centre used by people who live in the home. People's care and treatment was delivered in a way that was intended to ensure their welfare and safety. People who used the service said 'I like it here' and 'I like the staff'. Relatives told us 'it's a very nice home' and 'they do everything possible to make people happy'. We found that people were able to express their views and were involved in making decisions about their care and treatment. People who used the service, their representatives and staff were asked for their views about care and treatment and we saw that they were acted on. There were enough skilled, qualified and experienced staff to meet people's needs. Medication was managed safely.

Inspection carried out on 31 January 2013

During a routine inspection

people who used the service told us that they were well supported and they talked about a wide range of activities they took part in. One was a committee member of a self advocacy organisation. Some people who used the service were enabled to go out unaccompanied and others with staff support. They all used local shops, pubs and community facilities. One person told us they liked it at the service and that they chose their own food. Another told us that they were "in charge" and that they did the housework. we were also told by one person that attended their own review meetings and also went to college.

We saw comprehensive policies and procedures as well as support plans, health action plans, risk assessments and person centred plans. People told us they would know what to do if they had a problem or thought they had been abused.

Staffing levels were appropriate to meet the needs of the people who used the service and all staff had to undertake Common Induction Standards and other mandatory training. They then went on to undertake qualifying training, for example NVQs. There were a number of systems in place for measuring and monitoring the quality of the service, including sending questionnaires to relatives, seeking the views of the people who use services and monitoring health and safety, incidents, accidents and medication errors. there was engagement with other agencies, including the Local Authority, health professionals and the day centre some people attended.