Acorn House

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 78 (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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

The registered manager fully understood and followed their duty of candour. We saw records showing correspondence and records of meetings, held with people and their relatives, when incidents had occurred.

Audits completed by the management team following incidents, showed a robust exploration of themes and trends, with detailed actions the service would take to reduce the potential risk for people. These audits in turn, informed the providers overall service improvement plans. These audits and plans were linked to the requirements under the CQC regulatory framework.

We found robust analysis of incidents had led to service improvement measures following any adverse event. Detailed investigations completed by the registered manager were shared with all staff, to ensure any learning was embedded. The service held a brief daily meeting with the heads of all floors and departments, to ensure lessons learned were shared promptly, which allowed improvements to be made.

The registered manager and the nominated individual were receptive and open to constructive criticism. The registered manager routinely shared a partner feedback form, to allow visiting professionals to share their views, and identify any learning points for the service. The management team used this feedback from external partners, to continuously review and improve care quality at Acorn House.

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.

We found the service worked collaboratively with external partners to ensure people had a safe admission to the service or when people experienced a hospital admission.

People had personalised admission care plans in place, which detailed their clinical needs, medicines, allergies, contact details for people important to them and their communication needs. These documents had been regularly reviewed and updated when a person’s needs had changed. We saw people had always been involved in regular care plan feedback. This gave them the opportunity to ensure they received care and support tailored to their needs. One person said, “It’s much nicer here than my last care home. It’s safe as you know someone is here all the time.”

Staff we spoke with showed an understanding of these documents, and where to access these in the event of an emergency.

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. The provider shared concerns quickly and appropriately.

Staff ensured people were safe and free from the risk of abuse or harm. This was a priority at Acorn House. People we spoke with told us they felt safe and well supported by staff. One person said, “I can’t think of anywhere safer. I’m treated very well and the staff are like friends.”

Staff we spoke with understood the importance of putting the provider policies and processes into practice, to ensure people were protected from the risk of harm or abuse. We observed staff who listened and responded to people who expressed anxiety or distress and then recorded this information in daily records. The registered manager routinely reviewed people’s records, to ensure appropriate referrals were made to external teams for support where required.

The registered manager safeguarding referrals were made promptly to the local authority and the CQC. They worked collaboratively with external agencies, and ensured requests related to safeguarding investigations were responded to in a timely manner. This allowed outcomes to be reviewed promptly, which ensured any recommendations made could be embedded into practice.

The provider ensured people were supported in line with the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions about their care was assessed and where people were unable to express their wishes, relatives or representatives were consulted to support best-interest decision making. When people were subject to restrictions to keep them safe, authorisation was sought in line with the Deprivation of Liberty Safeguards (DoLS).

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The service supported people to effectively manage known risks. All areas of risks identified for people were clearly assessed and planned for. We found care plans contained best practice guidance for staff to follow. For example, where people were at risk of falls or choking. Staff told us they had time to read risk assessments, to allow an individualised approach. The service had access to a ‘de-choker’ suction machine on each floor of the building. This equipment allowed the staff to respond to an emergency event where a person was choking, and standard first aid protocols have not been successful in clearing a person’s airway.

People we spoke with did not share any concerns about being unsafely handled by staff. We observed examples of people being transferred from a lounge chair into a dining chair, with the use of a hoist. These moving and handling procedures were carried out by staff in a calm and safe manner. Staff explained to the person what was happening throughout. One person said, “They use the rotunda to get me up and assist me into my wheelchair or back to bed. I’ve not had any falls here.”

The registered manager and nominated individual used robust incident analysis records which had led to improvement measures being implemented, where required. The management team ensured they actively listened to feedback or concerns from people and their relatives to improve care quality.

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

Feedback on call bell responses was mixed, with some people feeling they had not always received a timely response. Although people did tell us that staff explained any delays to them. One person said, “I try and use it less. If staff are free, they come quite quickly or will pop in and say they’ll be back.” While another person said, “Oh yes, I’m very safe. I press a button and they help me.” We reviewed the day and night records for these people and could find no evidence of any staff delay in responding to their call bells. We shared their views with the management team, who spoke with people individually to provide assurance and completed a review of staff deployment if this was needed. We observed some bedrooms where sensor and call bell equipment had trailing wires, which posed a risk to people. The management team promptly reviewed these and submitted evidence of reconfigured equipment, to reduce any potential risk of harm for people.

The service employed a full-time maintenance person to oversee the safety of the environment at the service. The service had a robust maintenance schedule, which ensured required environmental checks were all completed. We saw there had been regular checks and practice drills, to ensure the service was safe in the event of a fire. Staff had allocated roles during an emergency evacuation, each considered the unique needs of people. People had detailed Personal Emergency Evacuation Plans in place, specific to their identified needs. On the first day of our assessment, we were accompanied by a Fire Safety Officer, from Nottinghamshire Fire and Rescue Service. They were following up on a previous action plan, shared with the provider. The Fire Safety Officer confirmed all required actions had been completed by the provider.

Windows were fitted with restrictors by the provider, so they were unable to be opened wide. This safety feature prevents people from falling or climbing out and was in line with guidance from the health and safety executive (HSE). Furniture was secured to walls to prevent any risk of this falling over and injuring people. Where people required specialist equipment, for example, falls sensors or air mattresses, these were in place and well maintained.

The kitchen was managed in a hygienic way to ensure people did not get food borne infections. The most recent rating from the food standards agency was 5 stars, very good, with the last inspection completed on 20 May 2026.

The service was purpose built, with full consideration given to supporting people living with dementia or mobility needs. Bedrooms and en suite bathrooms were spacious, which allowed ease of access for people and staff using equipment. Corridors were wide, well-lit and allowed people to mobilise using walking aids without fear of clutter or threshold strips. Pictorial signage was in place throughout the service, to help orientate people to their bedrooms, communal toilets and bathrooms. The lift to the upper floors was spacious, allowing ease of access for people using equipment, or for emergency services to transfer people to hospital when required.

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.

Rotas showed the management team carried out regular reviews of dependency and allocation tools within the service. Where people’s needs had changed, staff were redeployed to enable timely support. Staff exhibited a high level of understanding of people’s needs along with a person-centred approach to care delivery. Staff competency was regularly assessed, with peer support available amongst the team.

The majority of people and their visitors told us there were enough staff, and their needs were responded to. However, some people and relatives expressed that on occasion, they experienced a shortage of staff. They described these as being at peak times and felt this had impacted on their care routine and call bell response times. One person said, “I only use it in the day for personal care things. I can be ready for bed at 6.30/7pm and ring my bell, but it might be half an hour before anyone comes. Other times they come fairly promptly.” We shared these concerns with the management team, who arranged to discuss these with people individually.

The staff training matrix showed staff had completed training in subjects which the provider deemed as essential, along with extra subjects to enhance people’s care experience. Staff displayed a high level of competence and understanding and were able to demonstrate how their skills and knowledge improved care outcomes for people. The service followed a dignity in care approach, and the whole staff team were invested in ensuring the service was a safe, welcoming space for people.

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

The service was maintained to a very high standard, which enabled the experienced domestic team to be able to deep clean effectively. Robust standards of infection, prevention and control, (IPC) practice were followed by the whole staff team. The registered manager regularly completed IPC audits, which were used to identify any areas of concern at the earliest opportunity.

People told us they were supported by staff to maintain their personal hygiene and bedroom areas. One person said, “I’ve no issues with the general hygiene of the place and you see staff in their aprons and gloves when helping us. The laundry people do well, and I get my own clothes back.” Another person said, “The home is lovely, the cleaning staff do a great job.”

There were clear processes and policies in place to ensure the environment was kept clean and hygienic. This protected people from the spread of infection. If an infection outbreak occurred (for example diarrhoea and vomiting), there were clear processes in place to reduce the risk of this spreading to other people at the service.

Staff had received training in infection control, how to put on protective equipment, correct disposal processes and how to keep people safe in the event of an infection outbreak.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff kept clear records of when they had given prescribed medicines. Medicines were given as prescribed. Two people we spoke with gave feedback about their medicines being left with them by staff and not observed as required. We discussed this with the management team, who promptly reviewed the processes on the relevant floor, and reiterated the importance of observing with the staff team. The majority of people gave positive feedback about their medicines. One relative told us, “I see my family member being given hers at lunch and they stay beside her to make sure she swallows them.”

Some people required ‘as needed’ medicines, staff had clear guidance on how these should be administered. Staff had guidance on symptoms the person may show, what dose should be offered, steps to take prior to administering the medicine and the person’s preferred way to receive the medicine. Where people were prescribed medicines to be administered covertly, we saw appropriate decisions were in place. Covert medicines are given when staff administer a person’s medicine without their knowledge or consent, usually by mixing medicine into food or drink.

Suitable medicine stock levels were in place, so more could be ordered from the pharmacist as needed. Staff knew where to report medicine concerns, if they felt a person’s medicine was no longer effective, they documented this and knew who to contact.

Where medicines needed to be stored at a certain temperature, this had been done. Staff checked the fridge temperatures regularly to ensure it was working as expected.

Where people were prescribed creams for healthy skin management, there were body maps in place and instructions regarding application sites and frequency. People were encouraged to apply their own creams after personal care, where they were able to. Staff recorded this on the related body maps.

Staff received training on administering medicines safely. Staff competency was regularly assessed, to ensure best practice was followed.