Acorn Lodge Residential Care Home

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 changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to governance.

This service scored 59 (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 did not always have a proactive and positive culture of safety as managers did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The provider’s incident records did not always include information about the necessary actions needed post incident, or evidence information was shared with the appropriate agencies. It was not always clear from incident records whether incidents had been reviewed fully, to help identify any learning and prevent reoccurrence.

Staff confirmed debriefs were held during handovers to share information about incidents which had occurred.

Following feedback, we were assured a new incident form would be developed, to ensure more robust information was captured.

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.

Pre-admission assessments had recently been improved, to help the service capture more detailed information about people and share this with staff, before people moved into the home.

The manager explained how considerations were given to compatibility prior to placements being agreed, to reduce impact on others living at the home. When placements were at risk of breaking down, the manager worked closely with healthcare partners and other agencies to support people’s transition between services.

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 received safeguarding training to help them understand the signs of abuse and how concerns should be escalated, with safeguarding information displayed in the entryway for ease of access. A staff member told us, “I feel comfortable raising concerns because safeguarding is taken seriously within the home.”

The provider had systems to manage and monitor people’s finances, to help protect people from financial abuse. Staff recorded any spending and records were checked regularly. The manager had recently raised a safeguarding on behalf of a person who had been subjected to financial abuse.

The home ensured people were only deprived of their liberty with the correct legal authorities to do so. The manager worked closely with the local authority to ensure DoLS applications were completed for those who needed them. If people were subject to DoLS, a matrix was in place to track conditions and renewal dates.

The provider did not always work well with people to understand and manage risks. We could not be assured staff always provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider did not always ensure information about risks to people were adequately detailed. For example, a person had asthma but there’s was no information about how this affected them, the support they needed to manage their condition or the signs and symptoms of an asthma attack.

Where people’s needs fluctuated due to their mood or health conditions, there was not always enough information available to staff about the extra support needed to keep them safe and well.

Staff had very little written guidance about people’s behaviour and the strategies needed; to help them respond in an agreed, consistent way. One person could express agitation and be verbally abusive towards staff and others living at the home, but there was no guidance about preventative or reactive strategies needed. Detail in behaviour records was limited, and incidents were not always fully analysed to help understand any patterns of behaviour, or determine what approaches worked well.

The home had worked closely with the local authority to trial positive risk taking with a person. Staff supported them to do something that mattered to them by facilitating a visit to their hometown; factoring in known risks to manage the outing as safely as possible.

Following feedback, the manager implemented more robust records around behaviours, and care plans were reviewed to include more information about people's moods, behaviours and support requirements.

The provider did not always detect and control potential risks in the care environment or make sure facilities supported the delivery of safe care.

The provider did not ensure fire safety measures were robust. Whilst fire safety checks were in place, there was no recorded checks to fire doors and we found several fire doors did not fit flush in their casings, rendering them ineffective in the event of a fire. During our visit, we also observed several fire doors to be manually wedged open against best practice guidance.

A fire risk assessment had been carried out around 12 months ago and identified issues with fire doors and compartmentalisation needed to stop the spread of fire. At the time of our visit, the necessary works had not been carried out.

We found a call bell missing to the downstairs shower room and an upstairs window did not have a window restrictor to prevent any falls from height, these issues had not been identified as part of the environmental audits.

Maintenance staff completed other health and safety checks routinely and were available to carry out any planned or ad-hoc repairs at the home. External servicing had been carried out within the expected timeframes.

Following feedback, the provider organised for works to be completed to the call bell, window restrictor and compartmentalisation. They sought advice from the local fire and rescue service and work was carried out to improve the safety of internal fire doors. The door wedges were immediately removed, and a message was sent to staff about their use.

The provider did not always make sure staff were safely recruited, skilled and experienced, or received effective support, supervision and development.

We received positive feedback from staff about the level of training and ongoing support from the manager, but there were some small gaps noted to training and formal supervisions had not been carried out regularly in line with best practice guidance. Several staff had not had a supervision for over 7 months.

The provider’s recruitment systems were mostly safe, with the required pre-employment checks in place. However, we identified gaps in the employment history for 2 staff, which had not been identified or investigated further as required.

Staff confirmed there were enough staff to meet people’s needs. A staff member said, “Staffing levels are generally good, and staff work well together to meet people’s needs. Sometimes, like mornings can be busier but the team supports each other.”

Following feedback, the provider assured us a prompt would be added to the interview form about gaps in employment and the manager confirmed additional training was scheduled for staff.

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

The home was clean and tidy at the time of our visit. Cleaning rotas were in place and night staff completed deep cleans regularly. The manager carried out daily checks on cleanliness.

Staff followed food hygiene best practice with colour coded equipment, appropriate food labelling and temperature checks to hot and cold food.

The provider developed an annual infection prevention statement which referenced arrangements for governance, training, reporting and outbreak management. An infection prevention and control policy was in place, and personal protective equipment (PPE) was available to staff.

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.

The provider ensured medicines were managed safely, with systems in place for the safe ordering, storage, recording and returning of medicines. Medication profiles detailed people’s administration support needs and preferences; and if people needed homely remedies, the GP or pharmacist was consulted to ensure these did not counteract with prescribed medicines.

Senior staff received medication training and had their competencies checked at least annually in line with best practice guidance. A staff member told us, “You are on training until you are confident enough (to administer medicines).”

The manager explained alternative approaches were used before people were given ‘as required’ medicines for their mood or anxieties. For example, offering distractions such as a hot drink, a chat or time outdoors. Staff requested medication reviews if they noticed a change to people’s mental health.