Archived: Little Acorns

We found the following examples of good practice.

Measures had been implemented to ensure people entering the home, including healthcare professionals, did so following current guidance regarding Personal Protective Equipment (PPE) and social distancing. This included temperatures being taken on arrival and a series of questions asked to monitor risk from people entering the home. The provider was not currently taking new admissions.

Regular Covid-19 testing was taking place for people and staff. Some people found the process of being swabbed too distressing and they were unable to be tested. Staff had access to guidance and policies regarding Covid-19 and infection prevention and control.

Covid-19 risk assessments had been completed for people.

The provider had maintained good stocks of PPE. Social distancing rules were being followed where possible.

Further information is in the findings below.

Little Acorns is a residential care home providing personal care older people, male and female, who are living with dementia. People’s dementia is at different stages and therefore needs vary. The service can support up to 20 people and at the time of the inspection there were 19 people living at the home.

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

Staff were kind to people and treated them with compassion and respect. A relative told us on visiting the home for the first time, “I stood in the hall and heard laughter. That made up my mind this was the place.” Staff understood people’s day to day care and support needs and provided these in a calm and supportive way. People’s privacy and dignity were supported, and people’s independence encouraged.

People received person centred care and the registered manager and staff knew people well. Activities were provided at the home and people were given the choice of what they would like to join in with. A complaints policy was in place and was accessible. Complaints were dealt with in a timely and appropriate way. Most people had end of life care plans and people were supported with dignity at this time of their lives. Staff were supported by the registered manager.

The registered manager knew people well and they responded positively when she spoke with them. The registered manager said, “It’s the atmosphere here that brings people in.” Auditing processes were in place to ensure trends could be identified and errors dealt with. The home had a positive relationship with professionals such as GP’s district nurses and occupational therapists.

People were safe and were protected from abuse and harm. Staff received safeguarding training and were able to describe examples of what constituted abuse. They were able to tell us what they would do in those circumstances. Staff were aware of the whistleblowing policy. At the time of the inspection the home was undergoing some redecoration but remained clean, tidy. Fire and other safety checks had been carried out and accidents and incidents reported. Risk assessments had been completed and people were supported to take their medicines.

Staff training was up to date. Staff were able to describe their induction and how this was supported by ongoing supervision meetings. People were supported to access health and social care professionals. People were supported to maintain a healthy diet and were given choice. Staff sought consent from people. People were supported in the least restrictive way and evidence was seen of best interest meetings to support people who lacked capacity to make certain decisions.

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.

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

Rating at last inspection

Good. (Report published 25 November 2016)

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.

The home is a converted older building, with bedrooms on three floors, a chair lift enables people to access all parts of the home and people used the secure garden to the rear of the building. The registered manager is also the owner/provider.

The registered manager was present during the inspection. 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.

This inspection took place on the 13 and 14 October 2016. It was unannounced and carried out by one inspector.

At the last inspection on 7 and 8 April 2015 we found the provider had not met the legal requirements with regard to medicines, nutrition and hydration, records and notifications. We found at this inspection that these legal requirements were met. The legal requirements with regard to the provision of an effective quality assurance system had been partially met and had not yet been embedded into practice.

Risk had been assessed and guidance had been included in the care plans for staff to follow, including supporting people to move around the home safely. However, staff did not consistently follow moving and handling guidelines when supporting people using walking aids.

A quality assurance system had been introduced and had identified areas where improvements were needed, including record keeping, care plans and risk assessments. Work had commenced to review and update these with the involvement of people and their relatives and, audits about aspects of the services provided had been developed.

There were systems in place to manage medicines. Staff were trained in the safe administration of medicines. Staff followed relevant policies; they administered medicines safely and completed the administration records appropriately.

People told us the food was very good. Staff asked people what they wanted to eat, choices were available for each meal, and people enjoyed the food provided. Meals were a relaxed and sociable time for people and records were kept of how much people ate to ensure they had sufficient food and drinks.

A safeguarding policy was in place and staff had attended safeguarding training. They had an understanding of recognising risks of abuse to people and how to raise concerns if they had any.

There were enough staff working in the home to meet people’s needs, and recruitment procedures were in place to ensure only suitable people worked at the home. Staff said they were supported to deliver safe and effective care, and demonstrated they knew people well and felt they enabled people to maintain their independence.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People had access to health professionals as and when they required it. The visits were recorded in the care plans with details of any changes to support provided as guidance for staff to follow when planning care.

A complaints procedure was in place. This was displayed on the notice board near the entrance to the building, and given to people, and relatives, when they moved into the home. People said they did not have anything to complain about, and relatives said they were aware of the procedures and who to complain to, but had not needed to use them.

Care and support was personalised to meet each person’s individual needs. Care plans had been reviewed regularly; with the involvement of people living in the home and/or their relatives if appropriate, these reflected people’s needs and included guidance for staff to follow to meet them. People told us they decided what they wanted to do, some joined in activities while others chose to sit quietly in their room or communal areas.

People, relatives and staff said they management were very approachable, and they all felt involved in decisions about how the service developed with on going discussion through daily conversations and staff meetings.

Staff we spoke with had a good understanding of abuse and how to raise a safeguarding alert if they needed to. The home had robust policies in place regarding safeguarding vulnerable adults.

There were safe storage, administration and recording policies and practices in place at the home in relation to medication. One person told us, "They know how I like to take my tablets."

We examined staff files and records of recruitment procedures. We also spoke with staff and found that the home took appropriate steps to ensure to keep people safe by employing suitable and qualified staff.

The home had a transparent and responsive complaints system. People we spoke with told us, "I've nothing to complain about but if I did, I would be happy to speak directly to staff or the manager."