Acorn Care Solutions Ltd

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. This is the first assessment for this service. This key question has been rated requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The provider was in breach of 1 legal regulation relating to good governance.

This service scored 54 (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 have a clear shared vision, strategy and culture, which meant that systems and processes did not always promote good quality care.

The service had grown significantly in size without fully considering how to adapt systems and processes to accommodate the increased workload. The provider did not have a clear vision about the scope of people’s needs they could accommodate, which meant they struggled to always meet the needs of the people they supported. The registered manager acknowledged the service may have grown too rapidly, with some new packages involved complex care needs, which the service did not specialise in. They told us existing systems and processes were suitable for a smaller service but had proved to be a struggle to sustain on a larger scale.

In response the provider had invested in a new electronic care planning system and commissioned an external quality consultant to improve systems and processes. The registered manager also told us going forward, they would take a more gradual approach to growing the size of the service, focussing on taking on packages which suited their specialism.

Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

Leaders did not always demonstrate the knowledge or understanding to ensure the service provided safe and effective care in line with best practice guidance. At the time of our assessment there were shortfalls in systems to oversee staff training, incidents, monitoring of care, consent, assessing people’s needs, and overseeing the review of care plans. These issues affected the provider’s ability to consistently deliver good quality care.

The registered manager had recognised the need to assign clearer roles and responsibilities to senior staff. They were developing a new leadership structure, where key tasks were delegated to senior staff. However, time was needed to determine how effective the new structure was in promoting effective oversight of the service. We found shortfalls in the governance of the service which meant leaders required some skills and knowledge development.

Staff were positive about the leadership team. They said that were a that visible and supportive presence. The registered manager held regular team meetings where updates and feedback were shared with staff. They had used meetings to help address quality issues and actions resulting from staff, people and professional’s feedback.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. There were policies and procedures in place around whistleblowing, which helped to ensure staff understood how and to whom they could concerns. Staff told us they felt comfortable in raising issues to senior staff. Comments included, “I feel I can raise concerns or ask for guidance without hesitation.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. The provider had policies and procedures in place to promote workforce equality and diversity. Staff told us they were treated fairly at work and felt happy and supported by senior staff. One staff member told us, “I can honestly say I’ve never felt treated badly at work.”

Governance systems were not always effective in identifying key risks or quality issues. There was limited evidence that auditing and governance processes promoted quality, effective oversight or drove sustained improvements. This included systems to check care call timings, care tasks and duration of care visits. Due to limited functionality of the provider’s electronic system, there was no meaningful way to check care calls had been completed as planned. The registered manager had put a procedure in place to manually check care calls. However, systems had not been effective, as shown by recent missed calls, where a person’s care calls were accidently cancelled.

Other auditing systems did not promote pro-active oversight of the care. Audits were not completed comprehensively or effectively. There was very limited evidence that auditing identified issues or promoted actions to address shortfalls. Medicines audits were in place, but they did not always reflect where there had been recorded medicines errors. The provider’s audits of people’s medicines administration records had not identified errors in care planning, documentation or administration. This meant these audits had not been effective in monitoring key risks or driving improvement.

There were shortfalls in the provider’s oversight of care planning and record keeping related to people’s care. This included systems to ensure care plans were accurate and fully reflected how to support people to manage risks. Systems to oversee record keeping around incidents and safeguarding concerns were ineffective in demonstrating how timely action was taken to help keep people safe. This put people at increased risk of receiving poor quality care.

Implementation of new systems to improve the oversight of care were not always thoroughly planned. For example, the provider was planning to implement a new electronic care planning system, which would help improve their oversight of care. However, implementation plans lacked detail around the specific steps needed to introduce the new system and to phase out use of the old electronic system. This included considerations around how key risks would be managed to ensure the service ran safely during the transition. This reflected that the provider did not always fully consider how to optimise effectiveness and reduce risks. After the inspection, the registered manager sent CQC an updated version of the action plan, which included more detail around how the transition would be managed.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

We received feedback from the local authority detailing ongoing concerns about the quality of the service. They said information requested from the provider was not always available or complete. This resulted in them commissioning alternative providers for several people, due to concerns around quality and safety of care. These transitions to new providers were in progress at the time of our inspection.

The provider did not always focus on continuous learning, innovation and improvement across the organisation.

The provider had developed actions plans in response to feedback raised by people and professionals. However, actions plans were not always sufficiently detailed about; how changes would be made, who was responsible for actions and how these actions would be measured. The provider could not show evidence improvements were implemented quickly or effectively, with concerns found at this inspection being long standing or ongoing. Their systems to identify and implement improvements were mostly reactive and driven by feedback from external stakeholders. The provider’s internal systems did not always address key risks or develop strategies to make improvements needed.

The registered manager was open and responsive to our feedback. After the inspection, they sent CQC evidence of improvements around staff training and engagement with other providers. They told us they had recently commissioned the services of an external care consultant, who was helping to develop policies in line with best practice. This work was in progress at the time of our inspection.