Acorn House

Acorn House is located in a residential area of Nottingham City and is registered to provide accommodation for up to 64 people who require personal care and support. At the time of inspection there were 52 people using the service.

We found the following examples of good practice.

People were supported by trained staff and in line with government COVID-19 guidance. Relatives and professionals visiting the home were required to complete COVID-19 testing.

Staff were trained in the use of Personal Protective Equipment (PPE). This was accessible throughout the home and staff were using this in accordance with Government guidance. The Quality and Compliance Manager had created a wipeable pocket guide for staff with all of the latest guidance and provider policies to ensure staff were kept up to date of any changes.

The service was cleaned to a high standard, with additional cleaning schedules having been put in place ensuring high touch surfaces were cleaned more regularly. The service was well laid out to support social distancing, with bright and spacious communal areas and large en-suite bedrooms.

The provider's infection control policy was up to date and regular audits were in place to monitor cleanliness, handwashing and PPE use. The service actively engaged with a programme of regular testing according to Government guidance. Essential visiting was supported appropriately, and palliative care requirements for people had been sensitively considered by the provider.

People’s mental health and wellbeing had been fully considered during the pandemic. The service had an Activity Manager who supported people in creative ways, including organising culturally appropriate events for people who had been unable to celebrate these with their relatives in the community. People were enabled by staff to keep in touch with those important to them in a variety of ways.

We found the following examples of good practice.

¿ The service had introduced enhanced cleaning with extra cleaning of frequent touch points.

¿ There was a manager on each shift to maintain standards and the management team performed daily walk rounds to check on staff wearing personal protective equipment (PPE).

¿ The service had a sheltered garden for people to see their relatives through windows and had adapted a spare room with direct access from outside to allow visits inside.

¿ When a person living at the home had a visitor, the service had used video calls to involve more family members on the call.

¿ All rooms were en suite which meant people could be isolated easily and safely.

¿ People isolated in their rooms had been supported by wellbeing staff on a one to one basis while group activities were not occurring.

¿ Staff entered the service at the side of the home after temperature checks at reception and were allocated to work in specific areas to reduce mixing. Lounges in each area had been adapted for staff to have socially distanced breaks, this meant that staff were not walking around the building.

¿ Staff were not using lifts, lifts were being used to transport meals trolleys up to each level from the kitchen and served by staff working in that area, so the movement of kitchen staff was limited.

¿ People’s wellbeing was being monitored and the management team had introduced wellbeing checks and risk assessment scores to identify people who may have a low mood.

¿ Staff were also completing questionnaires to check their wellbeing, support was offered for staff isolating and on return to work.

¿ One of the managers had temporarily moved into the home to provide extra support.

¿ The management team told us the staff had been excellent and had ensured extra shifts were covered to avoid using agency staff.

Further information is in the detailed findings below.

At our last inspection in October 2015, the service was rated 'Good' overall. At this inspection we found that the service remained 'Good’ overall and had improved to ‘Outstanding’ in Responsive.

The service had a registered manager in place at the time of our inspection. 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 were supported by staff who understood and acted appropriately in relation to their responsibility to keep people safe. Risks to people’s health and safety had been identified and mitigated to reduce the risk of harm as much as possible. People were supported by a sufficient amount of staff, received their medicines safely and lived in a clean and hygienic service.

People were supported by staff who had received appropriate training and support. People were supported to eat and drink enough and staff monitored and responded to changes in their health conditions. People lived in a building which had been specifically designed to meet their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with kindness and respect and we saw that staff took time to sit with people and let them know they mattered. The staff we spoke with were knowledgeable about the people they supported and ensured that people were involved in making decisions about their own care as much as possible. People could be assured that their privacy and dignity were respected by staff.

People received care which was focused on them as individuals and staff went the extra mile to enhance people’s lives. Efforts had been made to overcome any barriers people may face to achieving their aspirations, partake in activities and maintain or develop relationships. People were provided with opportunities to make a complaint about the service and these were responded to efficiently. People’s preferences as to how they wished to be cared for at the time of their death were recorded and followed and relatives were complimentary of how their loved one had been supported at the end of their life.

There was an open and transparent culture at the service and the management and staff team were committed to a shared philosophy to deliver excellent care. People’s views regarding their satisfaction with the service and any areas for improvement were regularly sought and acted upon. Robust systems were in place to monitor the quality of the service and the management continually sought to make improvements to the service people received.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We spoke with ten people who were using the service and asked if they felt safe living at the service. People told us that they did feel safe, one person said, 'Yes I do feel safe, I have a key to my room.' Another person said, 'Yes I have not had any problems. Staff check up on me to make sure I am alright.'

We saw that the provider had an appropriate policy in place in relation to the safeguarding of vulnerable adults. Staff were aware of this policy and of their responsibility to protect people from the risk of abuse. The contact details of the local safeguarding team were available for staff and people using the service.

We observed the staff who were responsible for administering medication on the day of our inspection. We saw that medication was administered appropriately and in a timely manner. However people were not protected against the risks associated with medication, because the records did not always reflect the medication that had been given. People had not always received their medication as prescribed.

There were enough staff available to meet people's needs on the day of our visit. The provider explained that the staffing levels were due to increase shortly after our visit. We looked at future rotas which confirmed this increase in staffing levels.

Is the service effective?

People's needs were not always properly assessed and care was not always planned and delivered in line with their individual care plan. We looked at the care plans of six people who were using the service. A care plan describes a person's needs and gives guidance to staff in how to meet those needs. We saw that the care plans were not always person-centred and did not always provide adequate guidance to staff.

Staff had received an appropriate induction and a comprehensive range of training. Whilst supervision processes had not been fully embedded, staff had received supervision and felt supported by the provider.

Is the service caring?

We asked people if they felt staff treated them with dignity and respect. One person said, ''The staff are very good. They are kind and can't do enough for us.'' Another person told us, 'Staff know us and have a laugh with us. They are very kind.'

Is the service responsive?

We observed the support that people received during our inspection. There was a continual staff presence in the communal areas of the home. When people made requests for support in the communal areas these were responded to in a timely manner. However there was sometimes a delay in response when people pressed the call bell in their bedroom.

Is the service well-led?

People using the service told us that they would speak to the provider or staff if they had any concerns. However the provider had not formally asked people for their feedback about the quality of the service being provided. The provider did not have an effective system in place to monitor the quality of the service.