Little Acre 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 remained good. This meant people were safe and protected from avoidable harm.

This service scored 62 (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 continually learnt following any incidents, or complaints, this enabled staff to embed good practice and take action to minimise the risk of reoccurrence. For example, action had been taken to refresh staff knowledge on moving and handling practices, and to assess people’s needs so any new equipment they needed was in place.

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.

One relative was very complimentary and said, “We were just saying what a change there has been since [person] moved. They are a lot happier than at the other home. They (the provider) keep me informed if anything goes awry.” Risks were identified, monitored and managed to keep people safe.

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 with relevant professionals and agencies.

A safeguarding log was in place, and concerns were reported. Action was taken to mitigate the risk of future incidents and lessons were learned. Deprivation of Liberty Safeguards (DoLS) had been applied for or considered. Mental capacity assessments and best interest decisions were not always recorded in relation to restrictions such as for the use of sensor mats. Records of relatives who held Lasting Power of Attorney for health and welfare and/or property and finance were not in place. The provider took action during the assessment to address this.

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.

Risk assessments were in place, were detailed and regularly reviewed. Changes to people’s needs were noted in reviews and some care documents included a dated addition reflecting the changes, however, this was not a consistent approach. The provider acknowledged the need to ensure all care plans were updated in relation to changes in people’s needs.

Relatives said they were kept informed of any risks or incidents, with one relative saying, “They have recently transferred to high/low bed for safety issues, but they talked to me about it before they did it.."

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

There had been a recent visit by the Fire Service and work was in progress to update and replace a range of fire equipment and door latches throughout the home. Fire exits were clear, and fire equipment checked and in date. Practical fire evacuation training needed to be more robust and Personal Emergency Evacuation Plans (PEEP’s) needed to be reviewed and updated.

Some improvements were needed, including ensuring anchors on wardrobes were securely fitted, the sluice room door needed to be locked at all times and the exterior of the home needed some renovation. The provider assured us a contractor was due to repair the storm damage to the exterior fence.

Safe recruitment practices were followed. A dependency tool was used to calculate staffing levels based on people’s needs. There were 2 care staff on shift at any given time. Ancillary staff, and office staff were available to provide support for people, as needed, particularly during busier periods of the day. One staff member said, “Two staff are enough, most of the time, as during the day office staff can help out. Evening is the pinch point.” The provider said, “Day staff say they don’t need extra staff on an evening. One member of night staff finishes at 8am to support the day staff.” Shift start and finish times were not evident on rotas and the provider confirmed there were times when only 2 staff were in the building. This meant when staff were supporting someone who needed 2 staff there were times when other people were left without access to any staff support or supervision, particularly during the evenings and weekends. We discussed this with the provider who assured us they would review rotas to ensure safe staffing levels. They also stated, “We all live locally and manage on call requests. There is no formal rota so we would all be contacted.” The provider confirmed they would formalise the on-call system so there was always a specific person who would be available, if needed.

All staff, including ancillary and office staff had completed the training the provider deemed mandatory. However, not all staff had completed training in autism and learning disability which has been a legal requirement for all services since 2022. Nor had staff completed skin integrity and pressure care training.

Staff said, “We have regular supervisions and can speak up. We have an annual appraisal, but you can just go to the office and say what’s needed to be said.”

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

During our assessment the home was found to be clean and tidy, with no malodours. Ensuite areas were clean. The laundry room was small, but items were stored in the laundry room which would make effective cleaning difficult. Staff were working with the Infection Prevention and Control team from Public Health to ensure effective IPC practices were in place.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Handwritten Medicine Administration Record’s (MARs) were detailed and accurate, although not always double signed, as per the provider’s policy. Controlled medicines were stored correctly and regular stock checks completed. Topical medicines (creams) were appropriately signed for.

Some records could have been more detailed in relation to the name of the prescribed cream and the area of application. PRN plans for ‘as required’ medicines were in place, and we noted one person’s care plan needed to better reflect when covert administration of medicines should be used, and a best interest decisions was needed to accompany the GP authorisation.