Acorn Care Solutions Ltd

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• 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. This is the first assessment for this service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (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 make sure people’s care and treatment were effective.

There was limited information available about how assessment processes were completed. We were unable to review records of assessments as the provider told us these were not available at the time of the inspection.

The registered manager had recognised where assessment processes needed improvement and was addressing shortfalls. This was in response to previous delays in starting care packages, which the registered manager was not aware of at the time due to a lack of oversight of the assessment process.

The registered manager told us the size of the business had grown rapidly, with many additional care packages being taken on, some involving complex care. They told us this had affected their ability to effectively operate and oversee the service. They said going forward they would take a more structured approach, where new referrals would be assessed to ensure they could meet people’s needs.

People told us senior staff assessed their needs before their first care visits started. They told us that they were asked about their preferences and routines around personal care. They felt happy with the assessments conducted and care plans were reflective of agreements made.

The provider did not always plan and deliver people’s care in line with legislation and current evidence-based good practice and standards.

People’s care plans did not always contain sufficient details around meeting their nutritional and hydration needs. For example, 1 person had been assessed as requiring food prepared to a soft and bite sized diet. Their care plan had limited information about how to prepare food to this texture. The care plan only included limited details about how the person’s preferred foods could be adapted to meet their dietary requirements. However, staff we spoke to were confident around preparing food to required texture, which helped reduce risks around choking.

People told us staff ensured there were drinks and snacks available to them between care visits. Staff had a good awareness around monitoring for signs of malnutrition and dehydration. One staff member told us, “If found client not eating or drinking well, I always assess the situation, see what is happening and always put on handover and update office.”

The provider’s policies did not always reflect best practice or agreed local procedures. We received feedback from the local authority that the provider’s safeguarding policy did not reflect local arrangements around safeguarding reporting and recording. This increased the risk safeguarding concerns may not be managed appropriately. The registered manager told us they were updating their policy in response to feedback.

The provider did not always work well across teams and services to support people.

The provider did not always promote effective information sharing agreements and working practices where people had multiple care providers sharing caring responsibilities. For example, 1 person had staff from both the provider and an alternative care company. The registered manager told us they were not aware of who the other provider was, their contact details, staff training details or when their staff were due. They had not considered developing information sharing agreements around care planning and care notes. This had a negative effect on the person as there was not a planned or coordinated approach to the 2 staff teams providing care. During the inspection, the registered manager sent CQC evidence that they had subsequently contacted the other provider to develop more effective shared working practices going forward.

In another example, a person was living in a shared accommodation setting where staff would go in and provide care calls. A social care professional involved in the person’s care told us, “We have no documentation as to what they (staff) are supposed to provide, no care plan. You never know when they are turning up”. This reflected a breakdown in communication between stakeholders which resulted in inconsistency in the care provided and occasions where the person did not engage in their care.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control.

Details around peoples’ healthcare needs were documented in their care plans. However, it was not always clear how staff should monitor healthcare needs, whether it was practical for them to do so and whether people had consented to these tasks. For example, 1 person’s care plan instructed staff to monitor the person’s alcohol intake. There was no record of the person consenting to this and no practical guidance around how alcohol intake should be monitored or measured. This reflected shortfalls in processes to assess and involve people in managing their healthcare needs.

However, staff had a good understanding of people’s healthcare needs. They told us they worked to understand the support individuals needed around promoting good health and living with long term health conditions.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent. For example, where 2 people often declined support with their personal care or medicines administration. There was limited evidence of the provider taking pro-active action to investigate issues or report the concerns to other stakeholders. However, the provider had pro-actively monitored 1 person’s condition which resulted in escalation to professionals. One relative told us, “They (staff) found a blister on (person’s) leg and sent a photo and have let district nurse know.”

The registered manager told us the limited functionality of their electronic care planning system meant only retrospective monitoring of care outcomes was possible. This meant people had an inconsistent experience and that the provider did not always monitor outcomes to maximise the effectiveness of care and support. In response, the registered manager had put in place a system where they manually checked care records to help ensure staff were completing key tasks as planned.

The provider told people about their rights around consent but did not always ensure agreements in people’s care were documented.

People told us staff sought consent and respected their rights to accept or decline care. However, the care plans we reviewed were not signed and there was limited evidence people had formally consented to the care. The registered manager acknowledged that they needed to make improvements to their processes to evidence valid consent to care was obtained.

The provider ensured they verified the validity of people’s appointed power of attorney. This helped to ensure only those legally appointed could act on people’s behalf.

The provider sought people’s permission to share their assessments with relevant others. This helped to document people’s wishes about how and with whom their care records were shared.

Staff had a good knowledge of The Mental Capacity Act 2005. They told us how they gained consent for individual care tasks and respected people’s right to make unwise decisions. One staff member told us, “I always assume a person has capacity unless proven otherwise. I support people to make their own decisions.”