All inspections: Little Acorns - Care Quality Commission

We carried out an unannounced comprehensive inspection of this service in March 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider is required to send us an action plan to show how they intend to improve the service and meet the identified breaches. We had not received this action plan until after the completion of this focussed inspection completed in July 2015.

This report only covers our findings in relation to those requirements we were reviewing from the previous inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

This inspection took place on the 8, 9 23 July and 25 August 2015 and was unannounced.

We wanted to check on any improvements made following our last inspection carried out in March 2015 where we found a number of breaches. These breaches were under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Since April 2015 we have been operating under new regulations, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 so for the purposes of clarity we have mapped the old 2010 regulations with the new 2014 regulations within the main body of the report.

Little Acorns is registered to provide accommodation with personal care for up to 11 people who have autism. Little Acorns is also registered to provide a personal care service to people who live in their own homes in the community. At the time of this inspection there were nine people living permanently in Little Acorns and there were also three people who regularly stayed there for shorter periods of respite care. Three people who shared a house received a personal care service, plus one person who had respite care at this service. One older person who lived in their own home received personal care visits from care staff five times a day.

The Nominated individual is also the registered manager of the service. Since our inspection of the service on 20 August 2014 the registered manager had ceased to provide day to day management of the service. When we inspected the home in February and March 2015, there was an acting manager who had been appointed. Currently the nominated individual remains legally responsible as the registered manager for the day to day management of the service. 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.

In March 2015 we found that people were at risk of receiving inappropriate and unsafe care. The delivery of care did not meet people’s individual needs or ensure their safety and well-being. People’s needs and risks had not been fully assessed or translated into care plans to address their needs and risks. There were not always enough staff to ensure people’s safety and well-being.

Concerns found during this inspection were so great that the service was, and continues to be, subject to a multi-agency safeguarding process. As part of that process, a multi-agency safeguarding protection plan was agreed with the provider, CQC, police and health and social care professionals to protect people’s safety and well-being. This process included health professionals visiting the home regularly as part of the support plan and in a protection role. There has also been further information of concern which is currently being followed up via the safeguarding processes.

We also found the quality of the service was poor because of a lack of governance systems. Insufficient actions had been taken to identify areas of poor service or to take actions to address them. Effective systems were not in place to monitor and assess the quality of provision. The systems to record, investigate and respond to incidents, accidents and complaints were poor. Medicines and access to medicines when needed was poorly managed.

There was a lack of respect shown by some staff when talking to people about personal matters. There was a lack of respect shown in the daily notes made by staff. People were restricted by rules and regulations which had not been agreed with them and there was no evidence these had been set up in people’s best interests.

Where people were subject to a number of restrictions and rules which they had not agreed to, there were no risk assessments, no best interest assessments and no Deprivation of Liberty Safeguards (DoLS) authorisations.

People’s views were not actively sought about the service and there were no systems in place to encourage people to raise concerns or complaints. People were not actively supported to raise complaints.

People’s records were not kept securely to maintain confidentiality. Records were not always accurate and some were poorly maintained.

During this most recent inspection completed in July and August 2015, there was still evidence that people were at risk of receiving inappropriate and unsafe care at Little Acorns. There were insufficient numbers of staff to meet people’s needs. Staff were expected to carry out duties away from Little Acorns, which meant they could not provide care to people. These duties included providing personal care to people at another location and a morning and afternoon chauffeur service for people attending day services at the home.

We found some improvements in the way people who received personal care in their own home were being supported. One person confirmed they had been involved in the development of their own care plan and others were able to describe how they were being supported to follow up on their aspirations for work and social activities as part of the care and support they had received. We had received some information of concern which suggested that one person receiving personal care was not getting what they needed. We found there were times this person had not received all of the visits which had been agreed. We also found staff who were allocated to work with people at Little Acorns were covering some of the visits to this person. This meant that managers were having to make a decision whether to reduce the number of staff who supported people at Little Acorns at times or the person missed a visit.

Some action had been taken to address the concerns which related to fire safety within the building but some other concerns regarding handrails on the swimming pool and the kitchen used by service users for activities had still not been addressed.

During this inspection, we observed some staff practices which showed there was still a lack of respect and dignity shown to people on occasions, although we also observed some staff showing a caring and positive approach towards people. There was evidence provided from health and social care professionals that Little Acorns staff were still failing to follow guidance they provided. This meant some people were not receiving the care they should have had.

We found there were some improvements as medicines were no longer stored in the upstairs cupboard. However we found that the systems to record medicines administration were not always completed fully. Systems to monitor and audit medicines and prescribed creams were not robust.

Some work had begun on looking at people’s care files and care plans and risk assessments. However, this was still work in progress and there were still gaps and lack of reviewing plans which meant staff did not always have accurate information on which to base their practice and how to support people. This placed people at risk of receiving inappropriate care and support as there were newer staff and agency staff who did not have the historical knowledge of how to work with people with complex needs.

Some improvements had been suggested to look at activities for people outside of the service, although these had yet to be put into effect. These included possible visits to a sensory park in Exeter and the use of an activities centre where they planned to look at boating, archery etc. No risk assessments had been undertaken to show the service had considered the risks associated with these types of activities. However there were still some people who had very rigid routines which had not been agreed as part of a best interest assessment. Staff were not following the support plans devised by healthcare professionals to enable them to have stimulating and enriched experiences. For example one person should have been doing sensory cookery sessions each day but this had only occurred once in a four week period. Another person was not supported to have regular opportunities to pursue their love of trains by undertaking a weekly individual train journey, although this had been recommended and had been agreed with the person concerned and staff at Little Acorns.

Where people had complex needs which had increased, there had been no analysis of these behaviours, what the triggers may be or risk assessments in place to protect the person and staff. For example one person had increased anxiety in the early morning period. There was one waking night person available during this time and there was no clear guidance as to how best to support this person through their anxiety.

Another person had increased challenging behaviour when out. There was no analysis of what may be causing this. There had been a recent incident where the person sustained bruising due to having to be supported to move to a safe place by two staff. Following this there had been no change to their support/care plan. On the first day of the inspection staff said this person was out on a trip with people, not employed by the service, who had known and worked with the person some years previously. There had been no risk assessment around this trip or any evidence that the people who took the person out had been made aware of changes in the way the person acted or behaved in recent times. Staff from Little Acorns had not accompanied the person on the trip which meant the person and the accompanying people were at risk of an incident which would not be managed according to the latest information available.

Although staffing levels had increased, newer staff did not always have a full induction or enough time to be fully supported before they were expected to be part of the staff team supporting people. We found two waking night staff who were inexperienced, had only received a very brief induction and had only shadowed one other shift before they were left to work independently. This placed staff and people at risk because new staff did not have the skills and training to understand the needs of people they were working with. One member of staff had been threatened and on some shifts, hit by a person who had woken early and been distressed. The member of staff said they had lost confidence in working at night.

There were not always enough staff available in sufficient numbers and with the right skills to meet people’s needs and ensure people’s safety and well-being. Staff were being used from the staffing levels from Little Acorns to cover transporting day care and respite people and to cover domiciliary hours for people living in their own homes in the community.

Recruitment was not robust, newer staff had started before all the checks to ensure they were suitable were in place. One newer staff member had given a very brief employment history and this was not followed up. References were received after the date of new staff commencing work, without any other checks to ensure their suitability to work with vulnerable people being in place..

Records relating to people’s finances had improved with receipts being kept and numbered. However there were still areas where people’s monies were unaccounted for. The registered manager agreed to obtain an independent audit of people’s finances and make a safeguarding alert.

There were recorded incidents of people needing to be restrained to prevent injury to themselves of others, but not all staff had received training in how to do this safely.

One person was at risk of choking as staff had not read their risk assessment relating to this risk had had been seen assisting them to eat food which presented a risk by a healthcare professional.

We found there had been some improvement that complaints were now dealt with effectively. For example we saw a senior member of staff had acknowledged a concern made by a family and had responded to this appropriately. However another relative said they had not received a response to a request to make a complaint.

Some staff showed a caring and positive attitude to people when working with them. However we also observed some less caring approaches by some staff.

There was a lack of management leadership and lack of systems to check on the quality of care, which meant people were at risk of receiving care which was not appropriate to their assessed needs and did not follow best practice. There was no evidence of audits being completed to ensure the right staff with the right skills were being employed, supported and trained to do their job.

During the inspection, we identified a number of serious concerns about the care, safety and welfare of people who received care from the provider. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, now replaced by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In October we served notices to cancel the registration of the provider and the registered manager with CQC. Enigma Care Limited informed us that they had stopped providing regulated activities on 26 October 2015.

Since the original inspection on 28 February, health and social care professionals have been involved as commissioners, or in their safeguarding role, to ensure people’s safety and welfare was monitored. During this time, they arranged for people who were using this service to move to alternative provision

The inspection took place on 26 February, 3, 11, 15 and 16 March 2015. The first four of our inspection visits were unannounced. We informed senior staff that we would visit on the 16 March as the primary purpose of the visit was to pick up photocopies of documents we had requested to be made available. The inspection was carried out in response to concerns we had received about the service and was carried out by two inspectors. We also met with the provider, the acting manager and deputy manager on 18 March 2015 to discuss the findings of our inspection and the actions we proposed to take.

On 20 August 2014, we carried out an inspection of the home under the HSCA 2008. This was a follow up inspection to check whether outstanding compliance actions from an inspection in April 2014 relating to care and welfare, quality monitoring and consent had been met. During the August 2014 inspection we found that none of the outstanding compliance actions had been met and in addition there were new breaches in regulations regarding supporting workers and co-operating with other providers. We asked the provider to take action to make improvements and this action has not been completed.

Little Acorns is registered to provide accommodation with personal care for up to 11 people who have autism. Little Acorns is also registered to provide a personal care service to people who live in their own homes in the community. At the time of this inspection there were nine people living permanently in Little Acorns and there were also three people who regularly stayed there for shorter periods of respite care. Three people shared a house in Winkleigh who received a personal care service, with a fourth person staying regularly for respite care each week. One older person who lived in their own home received personal care visits from care staff five times a day.

The provider is also the registered manager of the service. Since our last inspection of the service on 20 August 2014 the registered manager had ceased to provide day to day management of the service. An acting manager had been appointed but at the time of this inspection no application to deregister the registered manager or to register the acting manager had been received by the Commission. Therefore the provider remained legally responsible as the registered manager for the day to day management of the service. 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.

Concerns found during this inspection were so great that the service is subject to a multi-agency safeguarding process. As part of that process, a multi-agency safeguarding protection plan was agreed with the provider, CQC, police and health and social care professionals to protect people’s safety and well-being. This included health professionals visiting the home regularly as part of the support plan and in a protection role.

People were not safe. There were insufficient staff to meet people’s needs. Staffing levels during weekdays were inadequate, and some people, who had been assessed as needing one to one support from staff, were left without support for significant periods during the day while staff were busy with other tasks. Staffing levels at weekends were often dangerously low, leaving people with insufficient support from staff. When we began this inspection there were no waking staff on duty at Little Acorns at night and support for people was provided by two sleeping-in staff. This meant people who woke during the night did not have staff readily on hand to give them the support they needed.

Staff recruitment records did not provide sufficient evidence to show new staff were recruited safely. New staff did not always receive a full induction before they were expected to work on their own. This meant people with complex needs were often supported by new or inexperienced staff who did not have the expertise, knowledge or training to understand their needs.

Staff did not receive regular supervision or support. Some staff said they had asked for supervision and guidance but this had not been given. Communication was poor. Some staff described divisions among the staff team and a lack of teamwork. They said there was a culture of bullying by the management team and concerns raised with them had not been listened to or addressed. Other staff said they were happy working at Little Acorns and had confidence in the management team. There was a high staff turnover.

People had not been involved in drawing up or reviewing their care plan. New care planning documents had recently been put in place for most people but we found these did not fully explain all aspects of people’s care needs. One person who received personal care had a care plan that had been drawn up in 2009 by their previous care provider. It had not been reviewed or updated and much of the information in it was no longer correct. This meant staff did not have the information they needed to understand how people wanted to be supported, or how to ensure people’s safety and welfare needs were met.

People were not fully consulted about the choice of meals. Staff did not have sufficient information about the foods people could eat safely, or about their likes and dislikes. The quality of food was sometimes poor.

Serious incidents were not reported to the local authority safeguarding team, the Care Quality Commission or to professionals who had responsibility for commissioning people’s care. This meant external professionals were unaware of the extent of issues or concerns, and there had been no external overview or scrutiny to ensure serious incidents were investigated or actions taken to prevent recurrence.

Staff demonstrated kindness and compassion but lacked specialist skills and training needed to understand and support people with autism. A lack of clear and consistent guidance from managers on current good practice often resulted in staff acting in an uncaring way. This was because staff imposed rules and restrictions without recognising people’s right to make their own decisions and choices about their lives. Staff failed to recognise people’s human rights and failed to seek people’s consent before providing care or treatment. At times this resulted in people becoming agitated or angry.

People were not been consulted or involved in the management or daily life of the home. Rules had been imposed without consulting the people who lived there. For example, there were rules about where people could eat or drink in the home, which they did not agree with. People’s views on the quality of the service had not been sought, and there were no systems in place to seek the views of other people involved in the service, for example relatives, or other professionals.

Staff did not have the skills or knowledge needed to meet people’s needs safely. For example, some people were able to communicate using sign language but no staff had received training on the use of sign language. Although the level of training had increased in the last year, some of the training had been of poor quality. Approximately half of the staff team had completed each training topic.

Risks were not managed safely. Risks had not been fully assessed and staff had not received sufficient guidance on how to support people to minimise risks where possible.

Medicines were not managed safely. Staff had not received adequate training on safe administration of medicines. People had not been consulted, or their needs assessed, to ensure each person’s individual medication needs were fully met. Some medicines supplied on an ‘as required’ basis such as pain relief or medication to control anxiety were stored in the administration office and staff did not have access to these at all times.

The home did not have robust systems in place to ensure people’s cash or savings were managed safely. This meant people were at risk of financial abuse.

People’s capacity to make choices and decisions about important matters relating to their care and treatment had not been assessed. Four applications had been made to the Deprivation of Liberty Safeguards (DoLS) team to restrict people’s liberty. However, we found restrictions and restraints were in place for many other people where no DoLS applications had been made.

We found the service was not well-led. There were inadequate systems in place to monitor the quality of the service. The provider had failed to make sure daily management tasks were carried out effectively and regularly monitored. Concerns, complaints and requests for information raised by staff and relatives had not always been listened to, investigated or addressed satisfactorily. Records were poorly managed and were not always held securely to maintain confidentiality. There were no systems in place to learn from incidents or accidents. Practice was not questioned, and guidance from external professionals was not actively sought where problems or issues were identified.

During the inspection, we identified a number of serious concerns about the care, safety and welfare of people who received care from the provider. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, now replaced by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

People continued to be at risk of harm because the provider’s actions did not sufficiently address the on-going failings. This was despite the significant amount of support provided by the multi-agency team to address those failings. There has been on-going evidence of inability of the provider to sustain full compliance since November 2013. We have made these failings clear to the provider and they have had sufficient time to address them. Our findings do not provide us with any confidence in the provider’s ability to bring about lasting compliance with the requirements of the regulations.

In October 2015 we served notices to cancel the registration of the provider and the registered manager with CQC. Enigma Care Limited informed us that they had stopped providing regulated activities on 26 October 2015.

Since the original inspection on 28 February 2015, health and social care professionals have been involved as commissioners, or in their safeguarding role, to ensure people’s safety and welfare was monitored. During this time, they arranged for people who were using this service to move to alternative provision.

This responsive inspection was carried out to check on outstanding compliance actions in; consent to care, care and welfare and quality assurance. These outcomes had been looked at when we inspected this service at the end of April 2014.

We asked the provider to send us an action plan and following receipt of this asked for some further information about how they intended to ensure full compliance with all areas needing improvements. We had also received some information of concern from a number of sources. This information included evidence to suggest the manager/provider was not working in conjunction with other providers. We also heard from ex members of staff that they had felt they had not been well trained or supported to do their job.

The inspection was completed over one day by an inspector and specialist advisor who had experience in working with people with learning disabilities and complex needs.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found there had been some improvements to the way care and support was being planned and delivered which helped to ensure people's safety. However we found gaps in staff training, particularly in aspects of health and safety which could place people and staff at risk.

We found there were enough staff to ensure people's needs were being met and we heard from staff that they now felt more involved in the planning and reviewing of people's care plans and risk assessments.

Is the service effective?

We found the service was not always effective because they had not always worked in collaboration with other professionals to achieve the best outcomes for people. For example, we found evidence of health care professionals providing comprehensive reports to assist staff in working with people to ensure they were stimulated and fully engaged. These reports had not been actioned.

Is the service caring?

We found the service was caring. All the observations we saw staff interacting with people in a kind and respectful way. We saw staff waiting for people to respond to the questions and allowing people to have their personal space when needed.

We heard from several parents about how staff had worked with people in a sensitive way and this had helped with visits to the parental home for some people.

Is the service responsive?

We found that overall the service was being responsive to people's needs. We heard since our last inspection several people had been referred for deprivation of liberty safeguard assessments to ensure they were working in a way which was responsive but also respected people's rights.

Is the service well led?

We found some improvements in the way the service was being led and we heard how the registered manager had promoted two staff members to be deputy managers to help ensure a consistent well led team, however this new system and management team was new and therefore it was too early to make a judgement about its impact.

We will meet with the provider to discuss their action plan following the publication of this report.

This planned scheduled inspection was brought forward in view of some information of concern received via safeguarding processes relating to one person. We also wanted to check compliance of two outstanding compliance actions we had set at the previous inspection: staff support and records. The inspection was completed over two days and on the first day the lead inspector was accompanied by a specialist advisor who had expertise in working with people with Autism and complex needs.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found there were aspects of the way care and support was being delivered which was not well planned and therefore could be unsafe for both the people living at the home and for staff. For example, we found care plan information was not detailed enough to explain people's complex needs, what may trigger behaviours which may challenge the service and how staff should work with people to reduce these behaviours. Details about people's complex healthcare needs were not always specific enough or clear for staff to understand.

We found access into the home meant some people may be at risk. On the first day of the inspection we were unable to find a door bell and entered the building via the conservatory where the doors were open. One person who used the service was sitting in this area. They were aware we had entered but were unable to communicate with us to direct us to staff. We know from previous safeguarding alerts one person had left the premises and was found wandering around the road area outside of the home.

We found there were sufficient staffing levels to ensure people's safety throughout the day. Some people had been funded to have one to one support for large parts of the day and evening. We were less clear about whether people were safe during the evening as we heard the current arrangements were for two sleep-in staff to be available in each of the two houses. We spoke with the registered manager and to staff about this arrangement and heard they were flexible about the night arrangements and would have waking night staff when people were unwell or needed extra support. The manager told us during the feed back session, she was reviewing staffing levels in light of people's changing needs and would be having waking night cover in the near future.

There were inconsistent reports from different members of staff we spoke with about the use of restraint/breakaway techniques and occurrences of physical aggression that might require staff to intervene in this way. We found staff had not received updated training in this type of intervention, which could mean both staff and people using the service were at risk of harm. The manager addressed this as a matter of urgency following our feedback. She arranged for staff to have training in breakaway techniques and for people's care plans to be updated to give clear instructions to staff about how to work with people in the least restrictive way.

Is the service effective?

We found the service was not always effective because not all staff we spoke with had a reasonable understanding of people's needs and the agreed ways of working with people to enhance their independence. For example, we found incident reports showing staff had used punitive measures in response to a behaviour which challenged. One person was denied their cigarette as a consequence of being aggressive to another person. This is a restriction of their liberty and was not an agreed action within their care plan. We spoke at length to the manager about this and she advised all staff in writing, this was unacceptable practice.

We found where someone had shown increased distress and behaviour which may challenge, staff were inconsistent about why this was occurring. The person had not been referred back to the specialist healthcare team for support and guidance.

Is the service caring?

We found the service was caring. We observed staff interact with people in a kind and respectful way when we visited. We heard how people were supported to follow their interests and hobbies. Staff we spoke with said people were given opportunities to do a variety of activities both on and off site. Staff described the service as a good place to work and most showed a good understanding of working with people with autism and complex needs. We saw examples of where people were being supported to make choices and be independent in their daily lives. We saw the manager spent a great deal of time talking with people about their hopes and wishes for the future.

Is the service responsive?

We found the service was not always responsive to people's needs. We saw people had been assessed prior to moving into the service and a care and support plan put in place. These were not always reviewed in line with changing needs and did not include enough detail for staff to provide a consistent approach.

People told us they enjoyed the range of activities they were assisted to do each week. The provider had gone to great lengths to provide space and equipment for people to enjoy music and was in the process of building a sensory room and adapted kitchen.

Is the service well led?

We found the provider/manager was very passionate and caring about the people she supported, but some aspects of how the service was being monitored meant it was not always being well led. For example, we found the manager had not had time to look at and review and monitor important incident forms. This meant she was not aware that poor practice had been occurring. We also noted she had not picked up on trends about the number of incidents recorded by the same staff members.

The manager told us, she had delegated other staff to complete some of the overseeing management tasks but that found these were not done. The manager said she was ensuring all staff had recorded supervisions and regular staff meetings so they all understood their role and could feed back about their ideas for improvement. Where previously we had found improvements were needed and set compliance actions, the manager had implemented changes to achieve compliance. This showed us the manager listened and acted on the information from the last inspection to improve the service.

This planned inspection was brought forward because we received information about an incident in the home resulting in an injury to a person who lived there. During our visit we saw evidence to show staff had sought appropriate medical attention following the incident and the person had not suffered lasting injury. The provider took action during our visit to make sure locks on bedroom doors were safe and allowed people safe exit in an emergency.

This inspection focussed on the residential accommodation only. We will check on the personal care service when we carry out our next inspection.

During our visit we spoke with the manager, seven members of staff and two people who lived in the home. We also observed interaction between staff and people with limited verbal communication. We looked at records including care plan files. People told us they were happy living there. One person told us "It's the best place in the world!" We found people received care and support from staff who knew them well and understood their needs. People lead active lives in the home and community to suit their individual interests. However, staff did not always have access to up to date care and treatment plans.

People told us they enjoyed the meals provided by the home. We saw people received nutritious and balanced home cooked meals to suit their individual preferences and needs.

In a tour of the home we found all areas were bright, clean, spacious, comfortable and homely. People had been supported to decorate and furnish their rooms according to their individual tastes and preferences. There were a range of communal areas people could use for a variety of leisure activities including arts and crafts, music, computers, therapy rooms, and also lounges and dining rooms. There were large grounds providing grazing and stabling for a variety of animals.

There was a stable staff team who told us there were good informal systems of communication and support in the home. However, we found there were no formal or structured systems in place to supervise staff and assess their performance, skills or training needs. There were no regular staff meetings held.

Records were not always kept up to date. Some files and documents could not be located during our inspection.

We talked with five people who lived in the home, seven staff from the home, the manager and three visiting professionals. One of the professionals told us 'Staff respond well to people's changing needs.' We looked at the care records of the people living in the home and the records of four staff.

There were eleven people living in the home at the time of our inspection. People were able to move freely about the home and outside and were comfortable in each others company as well as with the staff who supported them. One person told us 'I really like living here' whilst another said 'This is the best place I've lived in.'

People using the service were involved in all aspects of daily living where they were able and were consulted about the support they needed. People were treated with respect and their care and welfare was managed by staff who were aware of the needs of the people they supported.

The home was clean and tidy with hygiene and infection control processes managed appropriately.

Medication was generally well managed. Medicines were securely stored and administered in line with the GP's advice.

There were appropriate recruitment arrangements in place with staff having the right skills and knowledge to fulfil their role.

The provider had appropriate quality assurance processes in place to monitor and improve the services they provided.

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Little Acorns

All Inspections

8, 9, 23 July and 25 August 2015

During a routine inspection

26 February, 3, 11, 15 and 16 March 2015

During a routine inspection

20 August 2014

During an inspection looking at part of the service

28 April and 1 May 2014

During a routine inspection

27 November 2013

During a routine inspection

15 January 2013

During a routine inspection

Reports under our old system of regulation