Acorn 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 safe care and treatment.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Systems were in place designed to promote a culture of safety and learning; however, these were not always used consistently and robustly to improve practice and reduce risks. Evaluation of incidents affecting people’s safety and welfare did not consistently include an analysis of the particular incident, or a review of the control measures in place to ensure these strategies remained effective. Staff understood the importance of reporting safety concerns and told us the management team were responsive and supportive in dealing with any matters raised. Relatives knew who to contact if they had any concerns about people’s care and spoke positively about their family member’s care. A relative told us, “We are always informed of any health issues or concerns relating to my family member.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. There were systems in place for the continuity of care, including when people moved between different services, or to hospital. Information was obtained from people, and others involved in their care, about people’s individual needs and risks to their safety. This was used to develop individualised care and risk management plans to ensure people received safe and appropriate care. Staff told us they had access to relevant information about people’s care and support needs.

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 appropriately. People were comfortable and at ease with staff. The atmosphere at the service was calm, relaxed, friendly and homely. Staff were attentive and alert to any changes that might indicate people needed support for any anxiety or discomfort they might be experiencing.

The provider had a safeguarding policy in place, and safeguarding concerns and complaints were investigated and responded to. The required statutory notifications had been submitted.

The provider had processes in place designed to enable them to identify and mitigate risks to people; however, these were not always effective.

Some care records lacked detail about how people were supported with health conditions, including epilepsy. Some people’s care plans lacked information for staff to follow about their epilepsy diagnosis and how this condition was monitored and managed.

Risks associated with ligatures were not robustly managed. Where people had been assessed as at risk, we saw some potential ligature materials and ligature points. This included trailing lead, curtain tie backs with hooks, trailing shower hose and trailing television lead. The risk assessment for the potential risk of ligatures did not provide staff with clear information or guidance on the adaptations made to the care environment to minimize the risk. This included the related checks which staff were to complete on ligature materials andpoints, how they were to address or escalate any related concerns, or the rationale for potential ligature material and points to remain in people’s bedrooms.

Staff told us about the training and strategies they used to understand and support people at times of distressed behaviour. However, we found some care plans needed additional information and guidance about how to manage and mitigate risks. Also, it was not always clear that the measures in place to manage a risk had been reviewed following an incident, to ensure they remained appropriate.

Staff had developed good relationships with the people they were supporting and had developed a real empathy for the people in their care. Staff were aware of where people were within the home and remained present and available in case people required their assistance.

People were generally settled and relaxed. Different activities were taking place and people were encouraged to join in. We saw staff intervened quickly, when needed.

A professional told us, “Staff manage risk correctly in a timely manner, and there is plenty of staff on hand to support effectively.” Another professional told us, “I don’t know what staff could do better.”

The provider did not always detect and control potential risks in the care environment. Arrangements to monitor the safety and upkeep of the premises were not always effective to support the delivery of safe care. Some people were assessed as high risk of absconding. The rear garden, in parts, was not fully secured which placed people at an increased risk of harm. We saw some further potential hazards to people’s safety in the garden. We saw 4 concrete pillars with protruding bolts which presented as a potential risk if a person was to fall against them. There were 2 screws protruding from a fence that presented a potential risk of injury if a person fell against them. There were a few broken paving slabs which presented as a trip hazard and some broken garden seating which presented as a potential risk of injury if people were to use them. The provider took immediate action, and all hazards had been addressed by day 2 of the inspection.

A number of windows above ground floor level had restricted hinges that limit the opening of a window. These are now deemed not suitable in health and social care premises where people are identified as being at risk of falls from windows. The provider’s regular checks on window restrictors had not identified they were no longer compliant. We shared the current guidance with the provider and they told us they would be taking prompt action.

Despite the issues raised, the garden provided a lovely space for people to enjoy. We saw people well supported by staff members to enjoy the garden space, and we saw people enjoyed spending time with and attending to the pet animals living in the garden.

The premises had some adaptations and modifications to meet the specific needs of the people living there. Bedroom doors were very person centred with people’s names on and pictures of what each person is interested in, for example pictures of country of origin flags and different sporting teams that people supported.

There were recruitment practices in place. However, there were some inconsistencies in how the provider’s policy was implemented. For example, information relating to staff employment dates was not clear on 2 staff records. In addition, it was not clear whether the references obtained for some staff, had been requested from their last employer, in line with the provider’s policy.

The provider made sure there were enough qualified, skilled and experienced staff. Staff had enough time to provide people with the care and support they needed. The provider confirmed to us that updating of staff training was taking place and they were also working on improving the frequency of staff supervision. Staff told us the management team and the provider were approachable and supportive.

Most people told us they were happy with their care, and they liked the staff. A few people told us that at times staff were too busy to sit and talk with them or to support them outside of the home. One person told us, “I get on very well with the staff they are kind and friendly.”

Professionals told us staff were caring, supported people well, provided them with time to explain issues and, where possible, did what they could to help. One professional told us the following about a senior staff member they frequently dealt with, “They know all the residents, communicate well and this has helped with a smooth relationship.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies. Staff responsible for general cleaning were on duty each day. All staff were trained in infection control and effective hand hygiene. There were sufficient supplies of personal protective equipment. The home was visibly clean and fresh.

The provider did not always make sure that medicines were safe and met people’s needs and preferences. Some people were prescribed rescue medicine and the emergency medicine management plan in place lacked detail about what dose should be given and when, and what monitoring took place. Staff supporting people with emergency rescue medicines had not been specifically trained to administer the medicines. In addition, a protocol was not in place to guide staff when to administer PRN medicines. PRN medicines are those administered as and when required. This meant there was not clear guidance for when staff should administer the medicine. The provider told us they took immediate action on all these matters to ensure the records were reviewed and clarification provided.

We found the majority of people’s day to day medicines were well managed and regular audits and checks were in place.