Little Acres

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

The provider logged accidents and incidents, and we saw that the registered manager reviewed these to identify any themes and trends. Any areas of concern, or good practice, were identified and shared with the wider staff team.

This practice of continued learning and ongoing improvement was embedded and supported ongoing improvement of practice which supported the safety of people living at the service.

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.

The registered manager carried out assessments for people referred to the service. They worked in conjunction with the person, relatives, the current care provider and other professionals. This ensured the person’s needs could be met by the service, and compatibility with existing people living at Little Acres was carefully considered to ensure people were suitable to live in the same environment and minimise the risk of any conflict.

People had a detailed hospital passport in place, this supported with a smooth transition if a person needed to attend hospital and provided medical professionals with details about their clinical needs, communication style and personal preferences. People were engaged in the process of planning to move between different services together with relatives and professionals.

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.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making 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 make 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. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

Mental capacity assessments had been consistently completed for people, and the registered manager was addressing a change by updating a persons care plan in relation to covert medicines. Where people needed to be deprived of their liberty to keep them safe, the provider ensured a Deprivation of Liberty Safeguard (DoLS) was applied for through the relevant local authority.

Staff had access to policy guidance on safeguarding and demonstrated good knowledge, so people were supported to ensure their safety. The registered manager gave examples of supporting people through safeguarding events and how they had rebuilt this person’s confidence and empowered them to move back into a community living setting.

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. People were supported to do the things that mattered to them including attending day services and various outings which were risk assessed. For people with limited verbal communication care plans emphasised people’s preferred means of communication to support their understanding and ability to make informed choices by providing information in a way that they understood.

We saw examples of positive outcomes for people including support one person received with weight loss to address a risk to their health which the person also told us about.

Risks were assessed and mitigation was in place which kept people safe whilst promoting them doing things they wished to do.

The provider had detected potential risks and requested input from the maintenance team to address these and control potential risks in the care environment. We found the stair carpet in one place was not appropriately secured presenting a risk of slips and trips. We also found a radiator cover upstairs which was not secured to a wall awaiting removal from the building as part of ongoing renovation work. The management team responded quickly and removed items and secured the carpet, we noted the issue with the carpet was already highlighted by the registered manager for the maintenance team to address and floor coverings were due to be replaced. We saw that staff carried out health and safety checks and the management team carried out daily walkarounds to check the environment and they could evidence where issues had been reported to the maintenance team to support with maintaining a safe living environment for people.

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

We reviewed documentation that evidenced staff received regular supervision to support their development which staff confirmed. Staff received an induction and shadowed experienced staff. Training was available to ensure staff had the right skills to safely support people. The providers mandatory training had been completed but we found a gap in some additional service specific training which the registered manager assured us was being addressed. Staff completing the right training for their role meant people were supported by staff who had the right skills to meet the needs of people to enable them to work towards and achieve their aspirations and potential.

Staff told us they felt supported and were encouraged to develop their skills and knowledge. We did not observe any concerns regarding staffing levels and people and relatives did not highlight any issues.

The provider followed a safe recruitment process and had an appropriate supporting policy.

The provider had not consistently assessed and managed the risk of infection.

We identified that the environment was not always hygienically clean. Pull chords did not have an appropriate covering and paintwork was chipped meaning they could not be kept hygienically clean. Food items were not always stored and labelled appropriately to ensure they were not consumed past the expiry date. Staff had access to personal protective equipment, but this was not always used in line with infection prevention and control guidance. This meant people were not consistently protected from the risk of infection or illness. The provider had a current infection prevention and control policy to guide staff. Staff ensured people were supported with their personal hygiene and clothes were clean. The home was undergoing a refurbishment at the time of our assessment and issues identified with the environment were being addressed as part of this.

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

Systems and processes were in place to support staff to administer people’s medicines safely however, they were not always being followed. Medicated patches were not being applied in line with manufacturer’s instructions, which could lead to people experiencing unwanted side effects. People who were prescribed medicines with special administration instructions were not always receiving their medicines correctly. For example, one person was prescribed a medicine which needed to be given 30 minutes before food or any other medicines, but records showed it was given at the same time as other medicines. Staff were not always following protocols and the prescriber's instructions when administering when required (PRN) medicines.  Risk assessments and care plans were in place to support staff to administer people’s medicines safely but medicines administration records [MAR] and care plans did not always contain the same information, which could cause confusion for staff or other healthcare professionals. Where people experienced distress and agitation there were detailed, person centred behaviour support plans and PRN protocols in place. Medicine reviews were being undertaken by GPs, specialists, and psychiatrists.  

 Regular medicines audits were carried out but these had failed to identify the issues found at assessment. This meant people were at risk of harm from medicines not being administered appropriately.