Acre Care Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 did not always have a proactive and positive culture of safety. Staff did not always investigate safety events. Lessons were not always learnt to continually identify and embed good practice.

Incidents and accidents were recorded but there was an inconsistent approach to investigating and learning from incidents. Some incident reports included details of people having fallen and staff supporting them up from the floor. The registered manager had not completed an investigation of these incidents, and they were not able to confirm how staff had supported people. This meant the provider could not be assured staff had used appropriate manual handling techniques, in line with care plans and the provider’s policy, to support people safely.

The failure to fully investigate incidents meant lessons were not always learned and the provider could not be assured that good practice for supporting people who had fallen was embedded and sustained across the service. We identified this as an area of practice that needed to improve. Following this assessment the registered manager told us all incidents were now monitored and fully investigated.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People spoke positively of having regular care workers assigned to their visits. One person told us they considered this to be the best thing about the service, saying, “I think it’s the continuity, and the staff themselves, they are very, very caring.” Some people were receiving multiple visits, and they had a small team of regular care workers. A relative told us, “She knows all of them (staff), some have been doing it for four years or so, and new ones have been introduced, but she has regular ones.”

A staff member described how planned visits were allocated to staff who understood people’s needs. They told us, “I mostly go to the same people, it helps us to build a good relationship.”

The provider’s communication systems supported staff to know about changes in people’s needs or circumstances, and this supported good continuity of care. A staff member told us how they were informed of a change in one person’s needs. They said, “It means we know what to expect next time we visit.” Another staff member described how information from health care professionals was also communicated to staff to ensure good continuity of care. They gave an example saying, “There was a change to the person’s medication, this was highlighted so we would know what to look for at our next visit.”

People and their relatives told us staff worked effectively with health care partners. One person said, “They phoned the community team, and they came out to provide dressings.” Another person told us how staff monitored a sore on their leg. They told us, “They have a very good system. If there is something that emerges, if my leg has a sore spot, they photograph it, send it to [manager] and she sends it to the surgery. The district nurse will then follow up on that and it works quite well.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

People told us they felt safe because they had familiar staff visiting. One person said, “I am very happy with the people who visit me.” They described how staff understood their needs saying they were, “Well trained,” and “Very professional.” Another person said they had confidence in the staff and told us they felt safe because, “They(staff) take care of me.” A relative said, “They (staff) put my mind at rest, reassure me she is in safe hands.”

Staff had received training in safeguarding adults and children and demonstrated a clear understanding of their responsibilities to report any concerns. One staff member said, “I am confident I would recognise signs of abuse, and I would report anything straight away.”

Records showed staff had reported safeguarding concerns appropriately.

The provider worked well with people to understand and manage risks.

Risks to people’s health were identified and assessed and care plans provided information about how to support them to manage their conditions. For example, one person had diabetes. They had a detailed risk assessment and care plan identifying signs and symptoms that might indicate if their condition had deteriorated. Staff were knowledgeable about the people who they visited regularly and were confident they would notice changes that could indicate a deterioration in their condition.

Care plans provided detailed information for staff. For example, one person was assessed as being at high risk of falls due to a decline in their mobility. Their care plan included supporting the person to move with the use of stand aid equipment. This provided clear and detailed guidance for staff in how to support the person safely and in the way they preferred.

People and their relatives said they had been included in developing plans for managing risks and with reviews to update records. One person said there had been a recent review of their risk assessment and care plan. They told us, “Originally, we were involved (when the service started) and we have been able to revise it. It just works very well.” Another person said, “They come every three months to do a review and an update if anything has changed. I have a copy.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider’s systems included environmental risk assessments to ensure staff were able to provide safe and effective care to people in their own homes. Risks assessments were comprehensive and included internal and external areas of the property, equipment that was needed to provide safe care and use of technology where relevant. Potential hazards were identified, and measures were put in place to reduce risks where needed. For example, where electrical appliances were used staff checked the condition and that they were in good working order and safe to use.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People spoke highly of the staff and described them as being professional, well trained, kind and caring. One person said, “The care is excellent,” another said, “We have every confidence in them.” A relative told us, “They (staff) definitely know her needs, they are professionals.”

There were enough staff to cover all the visits. Staff told us they had adequate travel time scheduled between visits and could request more time if needed. People said the service was reliable and staff stayed for the planned duration of the visit. One person said, “I am never rushed.” Another person said, “They (staff) always stay the full time, or as long as they need to.”

Staff told us they received the training and support they needed. One staff member said, “It’s a mixture of face-to-face sessions and on-line training. We have to be signed off as competent for manual handling and giving medicines.”

Records showed the provider had safe systems in place for the recruitment of staff, including references and checks with Disclosure and Barring Service (DBS), to ensure staff were suitable to work with people. Staff described consistent inductions when they started working for the provider. This included shadowing experienced staff to introduce them to people they would be caring for. One staff member said, “I felt confident and prepared after my induction, and you can always ring the office staff for support if you need to.” People told us they were introduced to new staff members, one person said, “The new carer comes with somebody and observes the first time they come.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People and relatives said staff were careful to follow safe infection control practice when providing care, including wearing gloves when supporting people with personal care. Staff told us they had access to the personal protective equipment (PPE) they needed. Staff demonstrated a clear understanding of how to manage risks to prevent the spread of infection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Some people were prescribed PRN (as required) medicines. Protocols were not in place for these medicines and this was not in line with the provider’s medicine policy or good practice. This meant staff did not have all the guidance they needed about when to administer the medicines, what the maximum dose was and what the gap between doses should be. There was no record of how staff assessed the outcome from administering PRN medicines to ensure the medicine was effective. Following the assessment the registered manager confirmed that where PRN medicine was prescribed protocols were now in place.

People were supported to have their other prescribed medicines safely and in the way they preferred. Some people were able to manage all or some of their medicines. Others needed prompting or had their medicines administered. People and their relatives told us they received the support they needed with their medicines. One relative said they had, “No concerns, they do it well.” They described how their relation had been reluctant to accept support with taking tablets, but staff had approached her gently and with encouragement. They told us, “She didn’t used to like taking pills, but they seem to cope very well, and she now takes it willingly.”

Staff administered medicines at the time people expected and needed them, including for a person who required their medicine as a specific time to support their mobility. One person told us, “They are always on time with my meds.”

Only staff who were trained, and assessed as competent, could administer medicines to people. One staff member told us, “I had the training and then a senior staff member came out and checked that I knew how to do it properly.” Staff completed Medicine Administration Record (MAR) charts on the electronic care system. Senior staff monitored the MAR charts to ensure medicines were being administered as prescribed. One staff member said, “The seniors check our practice when they do spot checks to make sure we are doing things correctly.”