We inspected Acorn House on 15 December 2015. It provides accommodation and support for up to ten people. Accommodation is provided over three floors in a large semi-detached Edwardian building. The building is located within a residential area.
People living at Acorn House range in age from 54 to 81 years. The home provides care and support to people living with a range of learning disabilities and a variety of longer term healthcare needs such as dementia and diabetes. Several people had lived at the home for a number of years and were in a settled friendship group. There were the maximum permitted ten people living at the home.
We last inspected Acorn House on 15 April 2014 where we found it to be compliant with all areas inspected.
A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The deputy manager had applied to be a second registered manager and the application was in process at the time of our inspection.
Potential risks to people’s health, safety and well-being were not consistently well managed. A relative of the provider was lodging at the home. Suitable checks into the background of the individual to protect people were not carried out. The arrangement had implications for the provider’s home insurance. We have identified this as an area of practice that requires improvement.
The maintenance of an area of the home had not been maintained to a high enough standard. People were exposed to an environment where cleanliness was not maintained across all areas, increasing risk from poor hygiene maintenance. We have identified this as an area of practice that requires improvement.
People appeared happy and relaxed with staff. It was clear staff and the management had spent considerable time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. A relative said, “Staff are friendly and patient. It’s like a family home. I have nothing but praise.”
There were sufficient staff to support people. When staff were recruited, their employment history was checked, references obtained and an induction completed. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. A range of specialist training was provided to ensure staff were confident to meet people’s needs.
People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.
People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. For example, a person had a risk assessment around using public transport and this had changed as their needs evolved. People consistently received the care they required, and staff members were clear about people’s individual needs. Care and support was provided with kindness and compassion. Staff members were responsive to people’s changing needs.
People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance. A healthcare professional told us, “My experience has been that the staff and management are good at seeking appropriate input with regards to individuals health needs, be that from specialist learning disability services or mainstream services.”
Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.
The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the deputy manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.
People were provided with opportunities to take part in activities ‘in-house’ and to regularly access the local and wider community. People were supported to take an active role in decision making regarding their own routines and the routines of their home. One relative said, “[My relative] has been in one previous home but here they really look after her. [The manager] brings her down her to visit me and I can see that they get on famously. I am very impressed.”
Staff had a clear understanding of the vision and philosophy of the home and they spoke enthusiastically about working at the home and positively about the management of the home. The registered manager or their deputy undertook regular quality assurance reviews to monitor standards in the home and drive improvement.
We found a breach 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.