Acorns Health Care

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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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.

We observed staff listening to people and responding to their concerns. Staff knew what incidents to report and how to report them.

The service investigated incidents thoroughly and shared outcomes with people and relevant stakeholders. These included an analysis of all incidents, documenting themes and trends and providing behaviour support recommendations. We saw evidence of change as a result of incidents which had occurred.

The registered manager told us they received safety alerts from the government, local authority and CQC which informed them of upcoming risks along with themes and trends to ensure the provider could take appropriate action to mitigate these risks.

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.

The provider had an admissions policy in place. The registered manager was able to explain the process including assessing people’s needs to establish suitability, ensuring specialist equipment was available and staff had additional training if required.

People were consistently supported when they were distressed. There was a focus on planning for a good day and understanding what had caused people distress so positive changes could happen.

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.

People had access to easy read information to help them raise concerns.

Staff knew how to protect people from abuse and who they would report any concerns to both internally and externally.

The service shared concerns appropriately by following the correct process and ensuring these were reported to the relevant agencies. Where restrictive practices were in place Deprivation of Liberty Safeguards (DoLS) were in place to legally authorise, restrictions placed on people to keep them safe.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People were assessed for risks of falls, risk of choking and risks relating to medical conditions. When risk had been identified staff acted to keep people safe such as using specialist equipment to monitor their health condition.

Some risk, for example in relation to supporting people who were in distress or anxious had not been identified and comprehensively assessed to determine how people were to be supported to reduce the risk to their physical health and emotional wellbeing. We spoke with the provider about this who told us they would ensure care plans were updated to reflect this information.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety and fire safety risk assessments were completed and checks made of equipment to ensure it was safe to use. Regular audits were undertaken to ensure the environment in people’s homes and equipment remained safe to use. Any concerns were reported to the management team or appropriate person for further action.

The provider made sure there were enough qualified, skilled and experienced staff. They did not always work together well to provide safe care that met people’s individual needs.

The provider had recruitment processes which were fair and ensured there was no disadvantage based on any specific protected characteristic. However, we checked recruitment records and for previous employment related to health or social care, children or vulnerable adults, we found the provider had not sought satisfactory evidence of conduct in previous employment and failed to obtain satisfactory verification, so far as reasonably practicable, of the reason why the staff members employment in those positions had ended. This meant the provider was not following the principles of Schedule 3 of the Health and Social Care Act 2008. The provider’s recruitment policy did not detail the legal requirements in relation to required pre-employment checks. This increased the risk staff unsuited to care work, would be employed in the service. The provider told us, “We will ensure our head of Human Resources reviews our policy and makes sure it is in line with statutory guidance. We will also add to our audit process the need for ensuring we have the conduct or reason for leaving all previous care jobs for all staff.”

Staff and relatives told us there were enough staff and rotas confirmed this.

The registered manager had a training matrix in place which evidenced staff had completed all their statutory and mandatory training to ensure they were able to meet people's individual needs. The provider ensured staff attended bespoke training relating to supporting people with a learning disability and autistic people. Staff had attending fire training, however, not all staff attended regular fire evacuation drills to ensure they could safely support people out of their home in the event of a fire. We spoke with the registered manager about this who assured us they would ensure all staff attended fire evacuation drills.

Supervisions were taking place in line with the providers policy.

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.

The provider had a robust up-to-date Infection Prevention and Control (IPC) policy and staff attended IPC training.

Some people’s records evidenced they were involved in the cleaning of their home. Relatives told us the home was clean. One relative told us, “My relatives flat is always clean, guidelines are always followed.”

We reviewed cleaning schedules which were consistently completed. We observed the supported living services we visited were clean.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

‘As required’ (PRN) medicines protocols did not always contain clear information. Two people were prescribed a variable dose of medicines. There was no information detailing which dose should be administered. One person was prescribed medicines to help them during times of distress or agitation, there were no details of at what point this medicine should be administered and when further additional doses should be administered. The protocols did not detail when staff should seek medical advice if the concern persisted. We reviewed people’s records which confirmed staff were administering PRN medicines appropriately and seeking medical advice when needed. The provider told us, “We will go back to the GP re variable doses. We will ensure our positive behaviour support (PBS) practitioner updates the relevant PRN protocol. We will also review and ensure when to seek medical advice is documented.”

Staff received medication training, and their competency was checked to ensure they understood the requirements for the safe administration of medicines. Staff supported and involved people to manage their medicines. Records showed people had received their medicines as prescribed.

The registered manager told us, during people’s annual health reviews, Stopping Over Medication of People with a learning disability and/or autism (STOMP) plans were reviewed. This ensured people’s medicines were reviewed to ensure psychotropic medicines were not inappropriately prescribed or overused. We reviewed evidence of people’s medicines being reduced as a result of these meetings. This meant people were less likely to be at risk of medical restraint.