Acorn Lodge

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 inspection we rated this key question requires improvement. At this inspection the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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. Improvements had been made to systems of reporting which now allowed the registered manager to review each incident and accident alongside body maps and photographs. Investigations were conducted when required, measures were put in place and lessons learnt were shared with staff to minimise similar occurrences. The registered manager reviewed incident logs to establish any trends and patterns and where needed, escalated concerns to appropriate health care professional teams. For example, a person had a series of falls, a medicine review was conducted and a referral made to the falls prevention team. A staff member told us, “Feedback is shared with staff so we understand what has been learned and what changes have been made to reduce the risk of reoccurrence.”

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. People and their relatives were involved in the initial assessment process. Healthcare professionals were consulted and referrals were made when a health need had been identified at the initial assessment. For example, a person was admitted to the service with a pressure ulcer, the tissue viability nurses (TVNs) were engaged to provide support. Documents were made available should a person require a hospital admission or if they moved to a different setting. These were completed with detail to ensure the person received a continuity of care.

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. Systems of incident reporting had improved which provided the registered manager with a more thorough oversight of potential safeguarding concerns. Incidents had been appropriately reported to the local safeguarding team and a safeguarding log was held to track any patterns. Staff demonstrated an understanding of what constituted abuse and when they should raise concerns. A staff member told us, “I am trained to recognise signs of abuse, including unexplained injuries, sudden changes in behaviour, emotional distress, neglect, poor hygiene, or withdrawal. Any concerns are escalated immediately to the manager, and where necessary, reported externally to the local safeguarding authority or the CQC in line with policy.” The registered manager had identified some senior staff required additional learning around direct reporting to the local authority and had held workshops to increase their understanding, this included sharing safeguarding thresholds and policies. Further education sessions had been arranged for the coming months.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. Any imposed DoLS conditions were included in people’s care plans, monitored and met.

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’s risk assessments in relation to choking had been updated to ensure clarity regarding meal preparation. There was now consistent advice provided to care and catering staff; we observed meals were prepared to the assessed consistency. Risk assessments were in place for people who required bedrails, reviews had been conducted to ensure the decisions were based on safety, with people’s involvement and in their best interests. In some instances, the decision to use bedrails had been revoked, instead other measures were in place, including the use of a low profile bed and sensor mats to alert staff if a person required support. People’s care records had been updated to include advice from health and social care professionals in relation to behaviours of distress or anxiety. Care plans provided staff with techniques on how to reduce incidents and when to escalate concerns. We observed staff were working within the guidelines for a person and had noted their incidents had reduced. A staff member told us, “If I notice changes in someone’s needs, I report this to the manager or senior nurses so care plans can be updated. I have provided feedback when people’s mobility, behaviour, or health needs have changed, and this has been acted upon.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. There had been some upgrades and refurbishment in people’s bedrooms and communal spaces. The provider had installed new window restrictors to maintain people’s safety. Additional safety measures had been introduced, for example, coded doors and removable barriers for stairwell safety. Health and safety checks and audits had been conducted, staff reported concerns in the maintenance log or called contractors when needed. During our visit, an engineer was present as staff identified an issue with the call bell system. The fire risk assessment was up to date and people had personal emergency evacuation plans (PEEPS) for the event of an emergency.

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. Staff available included registered nurses, care staff and support staff, such as, housekeepers and activity workers. A relative commented, “Staffing levels are marvellous now. They have definitely improved. I visit 3 times a week or daily if needed. I visit at different times. Staffing is fine on weekends.” However, another told us staffing could appear stretched in the later afternoon to early evening. Most staff shared this opinion, a staff member told us, “While peak times such as mornings and evenings can be demanding, rotas are adjusted accordingly and additional staff are arranged when required. I actively monitor workloads and reallocate staff during shifts to ensure care is not compromised.” The registered manager told us of contingency plans to cover busier periods at the service. Improvements had been made to recruitment processes which now included full documented employment histories for new staff. Staff received training relevant to their role and received regular supervisions with the registered manager.

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. Housekeeping staff followed schedules to ensure the service was clean. Following some feedback from relatives, the provider had replaced the flooring in some corridors and people’s bedrooms to minimise the risk of odours and allow for effective sanitising. We received positive feedback from most people and relatives about the cleanliness in the home, comments included, “Cleanliness is absolutely fine. The cleaner is marvellous. There’s an occasional smell of urine and I mention it. They deal with it. But, it is only occasional.” However, some relatives felt further improvements were needed. The registered manager told us they were aware of some areas of the service which required regular cleaning and had a programme of deep cleaning in place. Staff were seen to be following the provider’s infection prevention and control policy and wore personal protective equipment (PPE) appropriately.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. However, medicines were not always stored and documented in line with best practice guidance; we observed a person’s prescribed paracetamol had been stored in another person’s medicine box. The paracetamol box had not been opened and staff confirmed it had not been administered. We fed this back to the registered manager who arranged a full audit and stock take where no other anomalies were found. We saw a tub of drink thickener was unattended in an open cupboard, this could cause a risk if ingested by accident. The registered manager responded to our concern immediately. They explained it was there due to very recent use, however, arranged alternative, locked storage. Other aspects of medicines were managed safely; people received their medicines in a person-centred way and medicines to calm people during moments of distress were used as the last resort. Staff reported to the prescriber if medicines were ineffective or presented any adverse side effects. A visiting healthcare professional told us, “We discussed about trying techniques without medication. We are always trying, medication is not always the answer. We put behaviour strategies in place, like positive behavioural support and talk about what can be better for the patients, like engaging more and looking for alternatives. They (staff) are quick to inform of any changes, if something is not working well. We meet again and look into reviewing this.”