Acorn Community Care

Acorn Community Care is a supported living service providing personal care to adults living with a learning disability and/or autistic spectrum disorder. The service was supporting seven people at the time of our inspection.

People lived in their own homes, either on their own or in a shared house for up to three people in and around the local area. People had support overnight. Staff had access to an on-call service 24 hours a day in the event of an emergency or unplanned situation.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

The provider had undergone change since the last inspection. A new registered manager and management team were working to improve systems for maintaining quality and safety across the service. A new system of audits had been developed to help monitor quality. Staff shared a commitment to providing high quality care to people. The provider was looking at ways to gather people’s views to drive further improvement.

People felt safe with the staff supporting them. Staff were safely recruited and trained to use medicines safely as prescribed. Accidents and incidents provided opportunities for staff to reflect on their practice and were used to support improvements across the service.

People received effective support from staff, who were skilled and familiar with their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We have made a recommendation about record keeping for mental capacity assessments and best interest decisions.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People and their relatives praised the caring approach by staff and felt confident in their care. Staff were aware of people’s emotional needs and provided support.

People’s care was person-centred and provided in flexible ways to adapt to their preferences. People were encouraged to pursue their interests and try new activities. People had opportunities to form new friendships and maintain their relationships with family members.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 01 January 2019). The provider had completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Acorn Community Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides support to younger adults, older adults and people living with learning disabilities or autistic spectrum disorder. Acorn Community Care is situated in the market town of Norton and provides large care packages to those living in the local area. At the time of inspection three people with a learning disability or autism were receiving a service from the provider. All three people received care over a 24-hour period in their own homes.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Since our last inspection the local authority had identified minor concerns with the provider following a visit from their quality assurance and contracting team. The provider had developed an action plan to remedy these issues and was still working to improve their practice.

At the last inspection in April 2016 the service was rated good. At this inspection the service had not maintained this rating and required improvement. This is the first time it had been rated requires improvement.

The provider did not consistently maintain complete records for staff and people that use the service. Records of staff interviews, identification documents, proof of their right to work in the UK and vehicle documents were not always kept showing how their suitability for their role had been assessed. Staff induction and probation reviews were not consistently recorded to show how they were introduced to their role and responsibilities and how this had been monitored. Staff completed training to provide them with the knowledge and skills required to support people. There were some gaps in training records, including Mental Capacity Act 2005 training. The staff we spoke with demonstrated an awareness of this legislation.

The provider had not always completed and recorded assessments prior to people receiving support from the service to consider their needs and how they would meet these.

The provider had started to introduce a system of audits to monitor safety and quality in the service.

Safe recruitment practices were not always followed. A member of staff had started work before their Disclosure and Barring (DBS) check had been returned. We have made a recommendation about this.

Processes were in place to support the proper use and safe handling of medicines. The provider had recently started to complete medication competency checks to assess staff’s knowledge and skill to administer medicines.

Risk assessments were used to identify and manage risks to people. They were reviewed to ensure they remained appropriate. New risk assessments were completed when new risks were identified. Positive behaviour support plans were in place to support people with behaviours that could challenge the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People received support to lead healthy lives. Care files contained details of the health professionals involved in people’s lives. Staff supported people to access support from health and social care organisations when needed.

People were treated with dignity and respect. They were encouraged to lead independent lives. People had their own tenancies; a contract between themselves and their landlord and were able to personalise their property.

People had the opportunity to pursue their hobbies and interests, accessing community amenities. They were supported to maintain their existing relationships and extend their friendship network with others accessing the provider’s services.

People and staff engaged with the provider through meetings and quality questionnaires. Relatives and representatives knew how to raise complaints and felt assured these would be listened to.

We found the provider was in breach of one of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Acorn Community Care is a local charity founded in 2008 and based east of Norton in North Yorkshire. The service is registered to provide personal care and support to younger people, older people and people with learning disabilities or autistic spectrum disorder. Support is provided in people's own homes. Acorn Community Care has been registered since March 2013. There is a registered manager employed at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’ On the day of the inspection the registered manager was unavailable and we spoke with the assistant manager.

People told us they felt the service was safe and staff had received the appropriate training to ensure care and support was delivered in a safe manner. Staff had been recruited safely and risk assessments were present in the care plan we reviewed. Medicines were administered safely, recorded and audits were carried out to monitor good practice in this area.

Staff had been trained appropriately and received timely refresher courses to maintain their knowledge. Specific training regarding restraint and de-escalation techniques had been completed by all staff. Staff meetings, supervision and appraisals were carried out regularly.

The service employed enough staff to meet the required care and support needs. Consent was sought by staff before any care interventions or support were provided, in line with the service policies and procedures.

People and professionals told us they felt the staff were caring in their approach and could see positive improvements being made by the people they supported. The respect and dignity of people was maintained and they encouraged independence and involvement of people through positive and caring relationships.

The interests and hobbies people enjoyed were encouraged, and their wishes to go to places they liked were acted upon. Forthcoming associated trips had been booked. The service also supported people in becoming involved with projects at their activity day centre.

People, professionals and staff were confident to go to staff and management if they had any concerns and felt the management were open and approachable.

The service worked with appropriate agencies to deliver support. Review meetings were held regularly to ensure all those involved were kept updated. Documents were presented in an easy read format, in line with the department of health government guidelines to promote people’s understanding.

Is the service safe?

The person was treated with respect and dignity by the staff. They told us that they felt safe. Staff had received training in safeguarding and understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risk to people and helped the service to continually improve. Risk assessments were in place in the individual care plan in relation to all activities of daily living.

Is the service effective?

The person told us that they were happy with the care they received and felt that their needs had been met. It was clear from what we saw and from speaking with staff that they understood the care and support needs of the person and they knew them well.

Staff had received training to meet the range of needs of the person and any potential new people who may use the service in the future. Health and care needs were assessed with the person and they were involved in writing their plan of care.

Is the service caring?

The person was supported by kind and attentive staff. We saw that staff were patient and gave encouragement. The person told us they were able to do things at their own pace and were not rushed. They told us, "I like to think I'm in charge, it's my house."

Is the service responsive?

The person completed activities regularly. There were plans in place for activities but these were flexible and could be changed. The person knew how to make a complaint if they were unhappy. The care provided was person centred and staff worked with the person to maximise their potential health and wellbeing.

Is the service well-led?

The service worked well with other agencies and services to ensure that the person received their care in a joined up way. The service had a quality assurance system which included planned audits, regular training and ongoing communication between staff. Records seen by us showed that identified shortfalls were addressed promptly and as a result the service was constantly improving.

We were told "The staff help me to make choices. I have a lovely home and I have six staff who support me. I have a care plan and I go out. I am going on holiday soon."

The staff and manager told us how they supported this person to make choices and decisions in all aspects of their daily living. We saw that detailed person centred care records were in place which recorded how staff should meet this individual's needs.

There were systems to safeguard people and all staff had received training in safeguarding adults.

Quality assurance systems were in the early stages of development so that people's views could be sought.