Acorn House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Outstanding.

This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.

This service scored 92 (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 always made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The management team took a co-production approach, to ensure they fully involved people and their relatives in care planning and reviews. Care plans were ‘strengths based’, which detailed what people could do, rather than a focus on any limitations they may have faced.

Prior to a move to the service, the management team completed a robust person-centred assessment for people. These assessments were developed into detailed care plans which provided clear guidance for staff on how to deliver safe and effective care. Risks associated with identified needs were assessed and managed appropriately, with clear strategies in place to minimise harm. These included risks associated with mobility, nutrition, skin integrity and emotional well-being. Reviews were undertaken regularly, or sooner if needs changed, which ensured the care provided remained effective and appropriate to people’s needs. Prompt referrals were made to other health and social care professionals when required. For example, speech and language therapists, the dementia outreach team and district nurses.

The majority of people and relatives we spoke with gave positive feedback regarding involving them as partners in their care. One person said, “They’ll ask me if I’m happy with my care. Whilst another person said, “I’m happy with my routine and the help I get.” A relative gave feedback, “We are always consulted about our family members needs.”

Records we reviewed showed people and their relatives had been involved in discussions around their care when any changes occurred. For example, one person had experienced a change in their mobility and a need for a specific piece of equipment had been identified by the service. We saw this had been discussed with the person, their relatives and an external health professional. The updated care plan had been developed with the persons’ involvement and agreement.

The provider always planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation. They worked to develop evidence-based good practice and standards.

People were supported to maintain a good nutritional and fluid intake, to support their health and wellbeing. Care plans and risk assessments in place for peoples identified health needs always followed best practice guidance. For example, the malnutrition, universal screening tool (MUST), used to identify unplanned weight loss or gain and The Waterlow Score, used for effective skin management. Staff we spoke with understood the importance of ensuring care delivery met these standards. Where people were monitored for their weight, we saw regular checks of this were recorded. If this weight fell out of range, prompt referrals to health teams were made.

We observed during our inspection that people weroffered regular drinks by staff, with this consistently recorded in their daily records. If daily records for people who were encouraged to increase their fluid intake showed this had not been achieved, there were flags in place on the electronic system to alert staff to this. Hydration stations were available in the communal areas. In bedrooms, people had a jug of water provided, others had a water bottle containing squash. People had their own supply of soft drinks if they wished. Hot drinks were offered frequently by staff, a kitchenette was available on each floor, so people and their visitors could access drinks at any time. The weather was exceptionally hot during our site visit, and we saw people being offered ice lollies and increased fluids. One person said, “They keep me topped up with drinks, especially while it’s hot.”

Where people lived with a risk of falls, we saw robust risk assessments were in place. These focussed on multi factorial risks, considering the impact of medicines, a person’s gait and balance, hydration levels and infection risks. Staff we spoke with understood the importance of encouraging people’s independence and mobility, whilst considering these risks. We saw the activity coordinator led a chair-based exercise class during our visit. The session was well received by people who took part, with much laughter and conversation amongst the group.

The provider always worked well across teams and services to support people. They shared thorough assessments of people’s needs when they moved between different services, so people only needed to tell their story once.

The service worked in effective partnership with external partners, to ensure people had a positive admission to their new home. If people required assessment from an external health or social care team, we saw the service had made prompt referrals and followed up on the prescribed actions.

Staff worked exceptionally well as a team and understood their responsibilities to work together to meet people’s assessed needs. Staff told us this strong team approach, training and effective communication enabled them to provide exceptional person-centred care for people. One staff member told us, “We are encouraged to reflect on what's gone well, what has been celebrated. This is not just a tick box exercise, which has made this more meaningful and has improved our approach to care.”

The service had excellent links with healthcare professionals which were effective in ensuring people received the care needed and often reduced the need for a hospital admission, because any deterioration was identified promptly. A local GP visited the home each week to carry out a ‘ward round’. This allowed the GP to become familiar with people, which reduced anxiety for people and allowed any changes in presentation to be picked up at the earliest opportunity. One person said, “The stoma nurse visits me every few months. The GP comes every Tuesday, and you can ask to see her if you need to. I’m also on the chiropody list.” A relative gave feedback, “Management are on it with contacting the GP, 111 and our family if needed.”

Staff engaged with a range of other professionals which included community nurses, therapists, and social care teams, to support people’s health and wellbeing. Referrals were made in a timely manner where required, and professional advice was followed, to ensure care remained effective and responsive. For example, we saw staff discussed the recommendations of the community nurse for a person who lived with insulin managed diabetes. These were promptly added to the persons diabetes care plan, to ensure this guidance was followed. Staff chaperoned people to appointments where required, to ensure information about them was shared effectively, if they were unable to. This meant people only had to tell their story once. This joined-up approach supported positive outcomes for people. One person said, “When I’ve got a hospital appointment, they send you in a hospital car and a carer goes with me.”

The provider always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff were proactive in supporting people to live healthier lives, and placed a strong emphasis on independence, risk reduction and well-being. People were consistently encouraged to be involved in decisions about their health and supported to have ownership of their clinical conditions, where they were able to. For example, a person was encouraged by staff to monitor their blood sugar levels via a device worn on their arm. We saw the person discuss their reading with staff, and the staff member showed they understood the reading given was within the persons’ usual range. The interaction was calm, unhurried and gave the person the lead in managing their own health.

Staff supported people to access external health appointments as well as being available when home visits took place. For example, where an assessment had been requested from occupational therapists and physiotherapists to assess for equipment to reduce falls risks or to improve mobility. This approach to people’s mobility contributed to them retaining as much independence as possible. For example, we saw people were encouraged to take positive but considered risks, to maintain their mobility. One person said, “I cannot fault the staff, they encourage me all the time.”

Mealtimes were an important part of people’s daily lives, not just to meet nutritional needs but to promote friendship, social interaction, and well-being. This reflected and embraced the person-centred culture at Acorn House. People were very positive about the meals and choices provided. One person said, “The food is delicious and they do me special sugar-free meals. Like they’ll do me a nice salad for tea instead of sandwiches. I have special cutlery which makes eating easier for me.” Another person said, “It’s as good as you can expect. They ask us in advance what we’d like and offer some options instead, like a cheese plate or jacket potato. I know they’d make me a sandwich if I was hungry, but I’ve got my own box of snacks from family, so I don’t go without.” We saw the experienced kitchen team had a great rapport with people and asked each person individually what they would like for their meals each day. Pictorial guides were used where people may have difficulty reading menus. A member of the kitchen team told us, “I enjoy getting to go around and see people, I take the biscuits and the drinks and serve up meals. The residents are funny. They call me the biscuit lady because I take the biscuits out to them."

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Regular care plan reviews enabled the management team to have full oversight of the health and social care needs of all people. The nominated individual completed regular audits of all planned care, to enable any updates or changes to be made promptly. People and their relatives were involved as partners in their care and supported to maintain their independence around decision making. One person said, “I know mine is due to be updated so I’ll see it again shortly.”

The service regularly and proactively sought the opinions of people and their relatives. This was carried out with a regular meeting on each floor of the service to gain feedback from people and their relatives. The service had a ‘residents committee’, which met monthly to discuss any changes or suggestions. We saw the outcomes of these meetings were developed into a ‘you said; we did’ poster, which was on display in the foyer and throughout the service.

The management team also used questionnaires to reach relatives and people who may not be able to participate in planned meetings. Records showed the management team had listened to the feedback from these and used this to look at what was working well, and where changes needed to be made.

The provider always carefully explained to people what their rights around consent were, made sure they fully understood them and always fully respected these when delivering person-centred care and treatment.

The service championed informed consent and the least restrictive approach to care provision for people. People told us that staff always asked for consent before carrying out any personal care or moving them with the use of equipment. People told us staff addressed them by their preferred names and pronouns and spoke with them respectfully. One person said, “They will ask me if I’m ready, then get on with whatever I need doing.” Another person said, “I find them good at checking with me first and they are all very polite.” People’s privacy was fully respected. We saw staff knocking on bedroom doors or bathroom doors and waiting for the person to respond before entering.

Where people had no relatives involved in their care and had been unable to discuss their care provision, we saw the service had arranged an independent advocate to support them with decision making.

The management team had ensured they were working within the principles of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.

We checked whether the service worked within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were e met. We found the service worked within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.