Acorn Lodge - Bournemouth

Acorn Lodge - Bournemouth is a care home providing personal care to nine adults with a learning disability at the time of the inspection. The service can support up to nine people.

The service was registered to support up to nine people. This is larger than current best practice guidance in relation to care homes for people with a learning disability. However, the size of the service having a negative impact on people was mitigated by the building looking just like the surrounding large houses. In other respects, the service had been developed in line with the principles and values that underpin Registering the Right Support. This ensures people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People told us they felt safe at the service, and that staff were available when they needed them. Staff understood their responsibilities for safeguarding people. New staff only started work after pre-employment checks to ensure they were suitable to work in a care setting. People’s individual risks were assessed and managed in the least restrictive way possible. Medicines were stored and managed safely. The premises and equipment were kept clean and were regularly maintained.

Everyone we met was comfortable to approach staff and clearly enjoyed their company. Staff were kind and respectful, and upheld people’s privacy and dignity. They also promoted people’s independence. Most had worked at the service a long time and knew people well. They understood how people communicated and tailored their approach accordingly. People’s protected characteristics, such as religion and sexuality, were respected.

The registered manager kept up to date with current good practice and ensured staff were aware of this. People’s care was planned and delivered accordingly. People had the healthcare they needed. They had a varied diet according to their preferences and health needs. The premises were adapted for people with limited mobility. Staff were supported through training and supervision, with regular refresher training in key topics.

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.

People’s care was tailored to their individual needs and preferences. People and their relatives were involved in planning and reviewing care. People led active lives, spending time out in the community doing things they were interested in. They had got to know some of the staff in local shops and cafes. People had any support they needed to keep in touch with their families. The registered manager had responded promptly and openly to the one complaint in the past year.

The service had an open and relaxed atmosphere. The registered manager and staff had an ethos of respecting people and prioritising their needs. A person commented of the service, “It’s very well organised.” The registered manager had a good understanding of their responsibilities. They had an open-door policy and spent much of their time with people and staff. Staff told us their colleagues were supportive and worked as a team. The registered manager oversaw ongoing quality checks. Any shortfalls found were promptly addressed.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

Rating at last inspection

The last rating for this service was good (published 22 November 2016)

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Acorn Lodge - Bournemouth on our website at www.cqc.org.uk.

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.

Acorn Lodge is registered to provide accommodation for up to nine people over 18 years old with learning disabilities. At the time of our inspection nine people were living there.

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 had person centred care plans which identified their likes, dislikes and preferences. This included how people liked to spend their day and what foods they liked as well as what was important for them and their aspirations. Staffing was provided according to people’s needs and their plans for the day. There was a well-established staff team who were knowledgeable about people. The registered manager told us they had enough staff and would not use agency staff to work in the home as they did not consider it appropriate.

The provider had a small holding which people could attend as an occupational or recreational activity. This gave people opportunity to spend time outdoors and we saw photographs of people enjoying the time they spent there. One person confirmed they enjoyed the small holding and during inspection two people attended it.

Staff told us they were supported through supervision and were provided with sufficient training to carry out their job roles. One member of staff told us about their most recent training in nutrition and how this was important in supporting and monitoring people to ensure they had enough to eat and drink.

Staff were recruited safely; the appropriate pre-employment checks were carried out prior to new staff starting. For example references were obtained and checks made with the Disclosure and Barring Service to ensure staff were safe to work with vulnerable adults. New staff went through a comprehensive induction and probation period in which they were observed in practice to ensure they were competent to work with people.

Medicines were stored and administered appropriately and there were checks in place to ensure people received the correct medicines at the correct time. There were protocols in place for medicines which were prescribed as required which provided staff with suitable guidance which they followed.

The registered manager was visible around the home and people were relaxed and comfortable approaching them. Staff told us the registered manager was approachable and one relative told us the home was well run they had confidence in management.

People had a comprehensive assessment which included if they were at risk in any way. For example risk of pressure sores or not having enough to eat as well as specific risks associated with social activities or people’s medical condition. Where risks were identified plans were developed to minimise the risk of people coming to harm.

Staff had completed training in safeguarding adults and were aware of their responsibilities in recognising and reporting actual or potential abuse. There was a whistleblowing policy and staff were aware of how to escalate concerns about poor practice.

People were asked what food they would like and the menu was planned with people, one person told us they loved the food and we saw people planning what they were having for lunch on an individual basis.

During our inspection people spent time involved in a variety of activities. For example two people went to the small holding, two people were planning to go out shopping using public transport one person was being supported by staff to go to a local coffee shop and another person was going out to the shop alone. One person was sat quietly and staff spent time on a one to one talking with them. People were able to use the garden or be involved in crafts or games or other activities of their choice.

Staff were kind and caring and told us they loved their work. One member of staff told us there was a homely atmosphere and they enjoyed their work and spoke warmly about people. Staff were able to describe to us how they supported people to maintain their privacy and dignity.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People experienced care, treatment and support that met their needs and protected their rights. People said they or their relative had plenty to do. One individual told us, '[Person's] very, very well looked after' and '[Person's] days are just full, full, full'.

People were protected from the risks of inadequate nutrition and dehydration.

People using the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and manage the quality of the service and risks to people's health, safety and welfare.

We saw that people were being treated with dignity and respect and people's independence was encouraged. People were spoken to in a respectful way. We saw staff speaking politely to people, and attending to needs in a calm and patient manner.

We saw detailed safeguarding policies were in place and mandatory training updates were undertaken by staff. This ensured that people were protected from the risk of abuse. In addition there was a complaints policy in place which ensured complaints were dealt with appropriately and timely.

We saw that people were offered choices about their day to day lives. During the inspection we saw that all the people were going out for the day, each doing a mixture of activities depending on what their interests were. We spoke with one person who informed us that the staff were "friendly". They said that they had many friends at Acorn Lodge and did everything they liked to do.

We saw evidence of well trained and qualified staff. We discussed the home with one staff member. They told us they "loved" their job and found the "management structure good" and "very supportive".