Acorn House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Outstanding. At this assessment the rating has remained Outstanding.

This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 89 (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 was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

People were fully respected as individuals, with unique life stories and backgrounds. Care plans contained detailed, ‘all about me’ sections, which showed in depth conversations had taken place between people, their relatives and the staff team. Care plans were truly person centred and focussed on people’s clinical needs, communication requirements, wishes and aspirations. We saw these had been clearly communicated so a consistent approach was maintained between services.

We observed warm, caring interactions between people and staff during our visit. For example, one such interaction came from a person when a staff member arrived at work after their day off. The person said, “I have missed you”. The staff member greeted the person with a broad smile and explained they were working on a different floor today, but said the person was welcome to join them if they liked. Another person spoke of the warmth of the staff team, they said, “Staff are very kind to me, and my family when they visit.”

People had developed genuine friendships between each other, giving a real sense of community at the service. People expressed concern if another person was feeling unwell or had been out for a health appointment. For example, one person became unwell during the lunch service. We saw the staff team responded promptly, placing a modesty screen around the person. The staff serving meals gave reassurance to other people in the dining room who were worried about this person. When people had their hair or nails done, or had a new item of clothing, people noticed and gave compliments to each other. For example, one person returned from their appointment with the hairdresser, and another person said, “Oh I love your hair, that style really suits you.”

The service was an active participant in the local community and people had chosen to ‘pay back kindness’. We saw the activity coordinators had arranged a ‘toy drive’, which had collected donations at Christmas for the children's ward at the local hospital. The service had arranged for one person to have a special, candlelit meal with their husband, in a quiet space, to celebrate a recent wedding anniversary. All activities and events were celebrated as ‘good news stories’ and folders of these special times were on display in the foyer for all visitors to see.

The service had a ‘pub’ in one of the small communal lounges. The registered manager explained how this was used regularly for celebrations of birthdays and also for holding a celebration of people’s lives after a funeral. They explained how they still had visits and contact with relatives of people who had sadly passed away, and how important it was to retain those supportive relationships.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Care plans were person centred and focussed on people’s clinical needs, communication requirements, wishes and aspirations. We saw these had been clearly communicated so a consistent approach was maintained between services. People had oral care plans in place, which detailed their preferences, and any support needs. Daily records showed people were supported to maintain independence with cleaning their teeth or dentures. People had access to dental services, chiropody, opticians, their GP and a hairdresser. One person said, “I’ve had the optician make a visit for my new glasses. I get the chiropodist, which is most months.”

People had clear communication plans in place, that detailed any reasonable adjustments required. Guidance ensured staff understood the individual needs of each person. Changes in people’s presentation, emotional state or distress, which may indicate a deterioration in health or wellbeing was recognised. Where a person may struggle to express their pain levels, there were personalised pain scales in place, and gave staff guidance on how a person may present and signs to look for.

The provider always supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider recognised that all people had different communication strengths. They ensured staff understood the importance of allowing people to express their views, needs and preferences. The provider ensured that the staff team developed effective ways to communicate with people who may have difficulty verbalising their views or who may live with cognitive impairment. For example, one person had a highly detailed communication plan, which gave prompts for staff, explained particular facial expressions the person may make, detailed any words they may find triggering, and guided staff in how they should respond to the person.

The service had a digital display screen in the foyer, which gave a photograph of each staff member working that day, their role and which floor they were assigned to. This ensured people and their visitors could easily see a visual guide of who supported them each day. This display also included a pictorial and written guide of the menus for each day and an overview of the planned activities.

The service followed the five steps to meet the Accessible Information Standard, (AIS). The service ensured support plans and records captured ways that met people’s requirements for meaningful communication and decision-making. This enabled all people to be active participants in their care. Person centred care plans detailed people’s individual communication needs, such as language, aids such as glasses or hearing aids, and any additional resources such as writing aids, picture aids or technology required to assist them. The service produced literature for people in different font sizes, easy read documents or audio versions to assist in sharing information for people.

The provider was exceptional at enabling people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff always involved people in decisions about their care and told them what had changed as a result.

People and their relatives were able to provide feedback on their care, through regular care plan reviews, meetings and by speaking with the registered manager and the staff team informally. Documents were available in an accessible format for people who may find difficulty with reading information. People showed the inspection team their bedrooms. We saw people’s bedrooms had been personalised to their own tastes, with pictures, photographs and ornaments. Each bedroom included any equipment or adaptations to support each person’s needs, such as raised toilet seats, sensor mats and pressure cushions. Each bedroom door had an ‘I live here’ picture of the persons choice, and the room number.

People were able to raise concerns or complain and then be listened to. For people who could not verbally communicate or understand written documents, we found there were appropriate advocates involved in people’s lives. A staff member spoke of the importance of involving people in discussions, they said, “We listen and respond quickly to the needs of all the residents in our care.”

Residents’ meetings were held regularly to support people to be actively involved in shaping the service. The residents committee were involved in decision making, and from this, we saw a ‘corner shop’ had been set up. The registered manager explained how this was available weekly, or as required, and sold confectionary, toiletries and snacks for people who may be unable to access the community.

The provider ensured people could access the care, support and treatment they needed when they needed it.

Human rights principles were echoed throughout people’s individual care plans. The staff team showed how they put these into their practice, through a variety of ways. For example, staff ensured people and their relatives had the opportunity to visit the service for themselves prior to admission and be a part of the decision-making process.

People were supported to use alternative forms of communication to enable them to keep in touch with their relatives and friends. Staff supported video calling to ensure all people had equal opportunities to maintain relationships. One person was seen chatting with staff about a planned call with their relative the following day.

The service provided information for people in different formats. For example, resident surveys had both large print as a standard but also used pictures to elicit more accurate feedback. There was access to easy read documents, such as how to raise a complaint or explaining how to place a vote as well as consent forms.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

People’s care, treatment and support promoted equality and protected their rights. People were empowered by the management and staff team to give their views and understand their rights, including their rights to equality and their human rights. The management team actively listened to any experiences of discrimination and inequality; these were acted upon to improve care outcomes for people.

People were supported to have access to the community and places which held meaning for them. A wide variety of activities were planned to support people and encourage them to remain active in their community. Alongside this, the activity coordinators supported ‘spontaneous’ activities, which were chosen by people. For example, dominoes, bingo or pampering sessions.

One of the activity coordinators spoke of their absolute passion for ensuring people had the, ‘best day, every day’. They used their skills to create innovative and interesting activities, which were tailored to the suggestions made by people. A relative gave positive feedback about activity provision, they told us, “There’s lots going on but my family member has to be persuaded. The activity person is really good at getting them all to join in.”

The Saturday after our visit, a Summer Fair had been planned. The activity coordinators had been busy preparing for this. People had painted pictures, made keyrings and had collected items to sell, all to raise funds for the resident activity fund. On day 1 of our visit, people enjoyed a ‘summer holiday reminiscence’ outside in the garden. The garden was set up with a drinks trolley, paddling pool, sand, and parasols, for people to enjoy time outside and talk about their holiday memories. On day 2 of our visit, the activity coordinators took some people out into the local community to hand out sweets for ‘national give something away day’. We saw the happiness this brought to people, and one person chose to give out sweets to the inspection team upon their return.

Each floor had a framed picture display, which had been created by people placing their fingerprints into paint. We saw these had been put together to form a tree and a heart. The note next to these pictures explained how this was a way that ensured every person had a lasting imprint and impact on the service. The note said, ‘Each one special to us all, so we made them into art, to hang on the wall’.

People were encouraged to follow their faith, and the service held a regular monthly church service and supported people to visit relevant places of worship. We saw the service asked for feedback from people afterwards, to gain their views, and ask what other activities they may enjoy in future.

People were given support to plan for important life changes, so they could make informed decisions about their future, including at the end of their life.

The service supported people at the end of their lives. The management team explained how they could ensure people received high quality clinical care, due to their positive relationships with community nursing teams.

We found people’s advanced decisions and what mattered to them was clearly recorded in their plans of care. One person said, “The doctor came one day with the question and after our discussion, I said it didn’t want to be resuscitated if it came to it.”

Staff supported people and their relatives to create detailed care plans. People had the opportunity to express their wishes around advanced care. We saw people had highly personalised and detailed funeral plans where they had chosen to discuss this.

The management team and staff we spoke with showed empathy and understanding of caring for people at the end of their lives. The service worked well with external health and social care teams to ensure people’s wishes and feelings about their palliative care needs were implemented and fully respected. All of the staff team had received training in dying and bereavement and understood the importance of people’s needs and wishes being met.