Acorn Meadow

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• 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

We assessed 4 quality statements under this key question. Our rating for this key question remains good. Overall, we found the service was keeping people safe and had systems in place to manage risks, however records relating to risk management and best interest decisions could be improved. There were effective systems in place to ensure concerns relating to abuse were reported. There was an open and transparent culture at the service, with people and staff feeling able to raise any issues or concerns. Systems were in place to ensure there were suitably qualified, skilled, and experienced staff and safe recruitment practices were followed. The provider had identified that staff supervision meetings had not always been carried out in line with their policy and there was a plan in place to address this.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Overall people and their relatives were very positive about the support they or their relative received. However, a concern was shared about how the service had managed the risk of falls for a person, which we reviewed further. Generally, relatives said managers were accessible and willing to listen and address any concerns. They told us they were kept informed about any changes or issues.

There was an open and transparent culture at the service and staff felt able to raise any issues or concerns. Staff understood the systems in place to report and review any accidents or incidents. However, records related to these needed to be more robust. Managers held a meeting every month to review any falls or incidents, which was now part of an organisational learning meeting with other departments. They also reviewed areas such as weight loss or any wounds /pressure ulcers. Managers were open and able to reflect on feedback and consider areas for improvement.

The provider had an improvement plan in place which staff were working towards, including actions from wider learning identified and shared throughout the provider’s organisation. The provider said there was a focus on learning in the home and organisation and had implemented a new electronic governance tool. The aim was to ensure any issues were identified and actioned quickly. Some actions we identified were in progress. Staff were however still using paper records to report incidents and some of these were not always fully completed to confirm all actions taken in response. Managers were new to the electronic system and needed further support to use this, including creating reports for themes and trends. The registered manager said in future they will incorporate a review of all accidents into their monthly meetings. A new process was being implemented in relation to monitoring fluid intake and urine infections, to help reduce the risk of falls.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Overall, people felt safe living at the service and their families felt they were safeguarded. People told us, “I do feel safe, there’s always someone around’ and “It feels safe, but I didn’t like it when someone came in my room at night”. Family members commented, “Staff go the extra mile”; “Staff are kind’ and “I don’t worry when I leave”.

Staff understood their duty to report any concerns and felt these would be acted upon. They knew how to access a contact number for whistleblowing, should this be required. Staff were able to explain processes they would follow if they had any safeguarding concerns. Staff comments included, “I would go straight to my manager” and “Kindness and care is the main value”. Managers understood the procedures they would follow for reporting any safeguarding concerns locally.

Overall, we found the staff to be friendly, pleasant and open. Staff were observed to be patient and treated people with respect. One person had bruising to their elbow, and we reviewed their records. We saw this had been recorded and consideration given to the cause, which had been accidental. Staff were able to describe the action they would take if they saw any bruising which was unexplained, ensuring this was reported through local procedures

There was a safeguarding policy and procedure in place. Staff had received training in safeguarding. Managers kept a log of any safeguarding referrals and how these had been dealt with. They liaised with the local authority and notified CQC as required. DoLS authorisations were appropriately undertaken. Managers worked in collaboration with the local authority to ensure these were kept under review. However, we saw a best interest decision made had not been reviewed for some time, managers needed to ensure best interest decisions were reviewed in a timely way to ensure people’s care/support continued to be provided in the least restrictive way.

People said they felt they had everything they needed to support their mobility and comfort. One person commented, “Staff check in on me very regularly, I always have my door open so they can see me, and I can see them”. However, feedback from one person raised concerns about the way their relative was supported around the risk of falling. The registered manager agreed to review and address this further.

Managers told us they regularly reviewed incidents and accidents, held a monthly meeting where any falls were reviewed and considered where further action could be taken to reduce risks. They worked in partnership with a local GP and were now able to access occupational therapists and physiotherapists more easily. Staff spoken with were knowledgeable about the people they supported, and action needed to manage certain risks. They had access to people’s care plans, which contained such information and told us they were kept up to date with any changes to people’s needs.

We observed some people using walking aids, all of which were kept within range of the person and staff appeared to support people appropriately. People had access to call bells and some had sensor mats in place and we observed staff responding to these quickly when alerted. However, for one person we observed their sensor mat was not in a suitable position from where they were seated to be effective, as the person tried to avoid it. This was not reflected in the person’s risk assessment and the measures in place were not fully reviewed to ensure they were effective. Managers subsequently took action to address this. Drink stations and items in fridges were accessible to people throughout the building, to encourage good hydration. However, a risk assessment had not been undertaken to assess any potential risk this may pose for people who required modified drinks. The registered manager confirmed a risk assessment was carried out following our feedback.

Processes were in place to help manage risks. The provider had a falls prevention and management policy. Staff completed various risk assessments and management plans to mitigate risk. We saw some actions were taken to manage risks, such as sensor mats, crash mats and low beds. Whilst various risk assessments were undertaken these were not always person centred and/or considered all relevant risks and the effectiveness of management plans in place. The provider was in the process of transferring people’s care records including risk assessments onto a new electronic system. Risk assessments were being reviewed. As noted previously there had been an incident where a person had tried to avoid their sensor mat and therefore this may not be an effective way to mitigate the risk of falls. The reviews of their care plan did not sufficiently analyse the risk/effectiveness of measures in place. In another example, one person, was now being cared for in their bed. However, a risk assessment had not been undertaken for the potential risks of falls from bed. The registered manager confirmed this was undertaken following our feedback.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People spoken with were generally positive about staffing and the care they received. They told us staff were usually available to respond to their needs. Comments varied but included, “Staff check in on me regularly”; “There’s always someone to talk to” and “They could always do with more staff.”

Staff told us they felt supported and were able to seek guidance through regular contact and discussion with managers. Some staff said they occasionally received a supervision meeting or were involved in group meetings. Overall, staff felt there was usually enough staff to meet people’s needs and said things had stabilised with less agency staff being used following a recruitment drive. They told us, “There is generally enough staff” and “Overall there is enough staff, you could always do with extra member of staff.” Staff were positive about the training they received, which included eLearning.

There were sufficient staff available to meet people's needs. Staff were seen around the building and stayed with people in communal spaces. Staff were able to engage with people and responded quickly to call bells/sensor alerts. Overall, we observed positive interactions between people and staff, for example staff were singing and dancing with people. During our observation we found one staff member could have been more engaged and responsive and we shared this with the registered manager.

Systems were in place to ensure there were suitably qualified, skilled, and experienced staff and safe recruitment practices were followed. The provider used a dependency tool to guide staffing levels. Staff received some individual and group supervision meetings. However, supervision/appraisals had not always been carried out in line with the provider's policy. The registered manager did not have full oversight of when these had been undertaken. The area manager had identified that supervisions were not fully up to date and there was an action plan to address this. Managers needed further support to ensure they understood the electronic system for recording supervision meetings. Staff received an induction and ongoing training. Staff compliance in completing eLearning was monitored. Records relating to the training completed by individuals during the 3 day induction needed to be more robust.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.