Acorn Residential Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff were supported to deliver consistently safe, person-centred, and inclusive care and to support people in line with the provider’s vision and values for the service. Systems and processes had been designed in line with this vision and focused on people and meeting their individual needs. The registered manager told us, “We are a small family run care home and we treat everyone who loves and works here as part of our family.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The service continued to be run by the registered manager and same small group of staff who had all been in post for many years. They understood the context in which the service delivered care and support and embodied the family run culture and values of their workforce and the provider. They undertook continuous learning and development to maintain their skills and knowledge. An external care professional told us, “The management at Acorn residential home are accessible and approachable. They are doing a good job of running the care home.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

People living in the care home and their relatives were comfortable raising any concerns they might have with the registered managers and other staff and felt their views were taken seriously and acted upon. Staff were encouraged and supported to speak up if they had any concerns. They were supported to have their say and make suggestions for improvements through regular day-to-day contact and supervision meetings with the registered manager.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The registered manager understood the importance of having a fair and inclusive workplace environment for staff to work in. For example, they respected the diverse cultural and religious needs of her staff team.

The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did act on the best information about risk, performance and outcomes, or shared this securely with others when appropriate.

The registered manager did not always understand their responsibilities in relation to their regulatory requirements around notifiable incidents. Our records indicated notifications were not always made to the Care Quality Commission [CQC] in a timely manner. This included a failure to formally notify us about the deteriorating health care of a service user which resulted in their admission to hospital for treatment, an allegation of abuse made in relation to a service user, and application made to a court in relation to depriving a service user of their liberty.

We discussed these notification issues with the registered manager at the time of our assessment who agreed they needed to be more transparent with the CQC. They responded immediately during and after our assessment by retrospectively notifying us about all the aforementioned occurrences. The CQC must be notified about such occurrences in a timely manner, so where needed, we can take appropriate follow-up action.

The provider continually recorded and reviewed data and were able to identify any themes and trends developing. The registered manager routinely conducted checks and audits at the care home.

We saw the service's previous CQC inspection report was displayed in the care home and easy to access on the provider's website. The display of the ratings is a legal requirement, to inform people, those seeking information about the service and visitors of our judgments.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Managers and staff worked closely with relevant external health and social care professionals and bodies and regularly shared information and learning with these partners. They followed guidance and recommendations they received from these professionals to support staff learning and improve the safety and quality of the service they provided. An external care professional told us, “The service always works collaboratively with us to support the individual wellbeing of our clients and is good at sharing information about any changes in their needs.”

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The service had a proactive culture of continuous learning and improvement. Audits and checks the provider conducted were routinely analysed to identify performance shortfalls and learn lessons.