Acorn House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Acorn House accommodates six people living with a learning disability in one adapted building. At the time of our inspection there were four people living at the service.

The care service has been developed and designed in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

This announced comprehensive inspection took place on 31 October and 2 November 2018. The provider was given short notice because we needed to be sure that someone would be in.

At our last inspection in March 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

The service provided safe care to people. A relative commented: “(Person) definitely feels safe and secure.” People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Care files were personalised to reflect people’s personal preferences. People were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Relatives commented: “We continue to be delighted by the standard of care (person) receives” and “The staff really ‘get him’. (Person) is really settled and his adulthood is improving. Staff have worked really hard with (person) and he is doing more now.” Staff treated people with dignity and respect when helping them with daily living tasks. The service ensured people led meaningful and fulfilled lives.

There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.

Staff spoke positively about communication and how the registered and home managers worked well with them and encouraged their professional development.

A number of methods were used to assess the quality and safety of the service people received and continuous improvements were made in response to the findings.

Further information is in the detailed findings below.

This unannounced inspection took place on 17 March 2016. We returned on 21 March 2016 as arranged with the registered manager to complete the inspection. At our last inspection in July 2014 we found the service was meeting the regulations of the Health and Social Care Act (2008) we inspected.

Acorn House is registered to accommodate six people who have a learning disability and are within the age range of 18 – 65 years. At the time of our inspection there were three people living at Acorn House.

There was a registered manager in post. 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.

People were safe and staff demonstrated a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. They were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff were motivated and inspired to offer care that was kind and compassionate.

There were effective staff recruitment and selection processes in place. Staffing arrangements were flexible in order to meet people’s individual needs. Staff received a range of training and regular support to keep their skills up to date in order to support people appropriately.

Staff spoke positively about communication and how the registered manager worked well with them and encouraged their professional development. However, staff felt at times they were not listened to regarding people’s individual needs and routines. We fed this back to the registered manager as part of our feedback at the end of our inspection.

A number of effective methods were used to assess the quality and safety of the service people received and make continuous improvements.

Our inspection team was made up of a single inspector. We considered all the evidence we had gathered under the outcomes we had inspected. We used the information to answer the five questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking to people using the service, staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We know the service was safe because people were treated with dignity and respect by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. The home had proper policies and procedures in relation to the Mental Capacity Act, Deprivation of Liberty and Safeguarding vulnerable adults . Relevant staff understood when an application should be made and how to submit one. This meant that people were safeguarded as required.

The Registered Manager set the staff rotas, they had taken people’s care needs into account when making decisions about staffing numbers, qualifications, skills and experience required. This helped to ensure that people’s care needs were always met.

Is the service effective?

People's healthcare needs were assessed with them. Specialist needs and support had been identified in care plans where required to ensure people could be supported to live their lives the way they wanted.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. People commented, “The staff support me when I need it.”

People using the service, their relatives, friends and other professionals involved with the service completed annual satisfaction surveys. Where shortfalls or concerns were raised these had been addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care support had been provided in accordance with people's wishes.

Is the service responsive?

People regularly completed a range of activities in the home. People enjoyed having trips out. We were told other people were offered the choice of outings but declined.

People’s lives and choices were respected and staff worked to ensure that they were accommodated

Is the service well-led?

The service worked well with other agencies and services to make sure that people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls had been addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities.

On the day of our visit we were told that there were three people living at Acorn House. We spoke to all three people living at the home, spent time observing the care people were receiving, spoke to three members of staff and looked at all three people’s care files in detail.

Before people received any care or treatment they were asked for their consent and staff acted in accordance with their wishes.

We spent time talking with people living at the home and observing how people’s care and welfare needs were met. People did not appear rushed and the home was relaxed and homely. Comments included: “I am going out today” and “I have been on holiday to Center Parcs. I went to a disco with staff and got in at 1.00am!”

Medicines were safely administered. We saw the medication recording records which were appropriately signed by staff when administering a person’s medication.

Staff confirmed that people’s needs were met in a timely manner and felt that there were sufficient staffing numbers.

We saw the home’s complaints procedure stored in the staff office. The complaints procedure was not displayed in a communal area. The registered manager explained that Acorn House was people’s homes and so the displaying of leaflets and poster were kept to a minimum. They added that both they and their staff team worked very closely with people on a daily basis, which allowed for concerns to be raised.

We carried out an unannounced inspection visit on 1 May 2012. On the day of our visit there were three people living at Acorn House.

Comments included:

“I am happy here.”

“The staff are nice.”

“I go out regularly and buy things that I want.”

We saw that staff treated people with consideration and respect. For example, we saw that staff quickly responded to people’s care needs to ensure that they were kept informed about what was happening, such as when lunch would be ready and when trips out were going to happen.

Care plans that we saw reflected people’s health and social care needs and demonstrated that other health and social care professionals were involved.

We spoke with staff about their understanding of what constituted abuse and how to raise concerns. They demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have. Staff we spoke with felt confident about responding to changing needs and knew what signs of abuse to look out for during their daily practice.

Staff told us they received health and social care needs specific training which they believed helped to equip them to do their job. Staff said they received supervision and appraisals and that the management team provided close supervision, advice and support.

We saw that Acorn House sought the views of people living at the home about the quality of the service they received. This information was sought by questionnaires, which were also completed by family members and other health and social care professionals involved in people’s care. We were able to see that where improvements were needed they were followed up by the home.