This unannounced inspection took place on 1 November 2018. At our previous inspection in April 2016 we found the provider was meeting the fundamental standards and we rated the service Good. At this inspection we found standards had deteriorated and we rated the service Requires improvement.

Acacia Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Acacia Care Centre provides nursing care. CQC regulates both the premises and the care provided and both were looked at during this inspection. The service provides care for up to 62 older people requiring residential or nursing care. There were 57 people using the service at the time of our inspection.

The home had 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.

There were not always enough staff to care for people safely and in a compassionate and personal way. The provider lacked a robust system to assess the staffing needs of the service at the time of our inspection. Some people raised concerns about the length of time it could take staff to respond to call bells and the provider lacked a suitable system to monitor this.

We received mixed feedback about the meals and a person's dietary needs were not met well by the service. Staff sometimes rushed when supporting people to eat and mealtimes were not always used as an opportunity to encourage social interaction. People were not always supported to maintain their independence as far as possible. Although formal complaints were investigated and responded to appropriately, informally raised concerns were not always dealt with well.

The provider carried out recruitment checks on staff. The provider did not always store people's confidential records securely. Care plans were accurate and reliable for staff to following in caring for people.

Most people received their medicines safely although improvements were required to assess risks when a person self-administered their medicines and in relation to covert medicines for one person.

The provider responded appropriately to safeguarding allegations raised during our inspection. However, some staff were unaware of their responsibilities in relation to safeguarding.

Most parts of the home were clean although some areas required more attention. The provider monitored infection control practices in the home we identified an infection control risk which the provider had overlooked.

People's capacity to consent to their care was not always assessed in line with the Mental Capacity Act 2005. The provider did not always promptly identify when people coming to the service required legal authorisation to deprive them of their liberty. The provider had not notified CQC of the outcome of applications to deprive people of their liberty as required by law.

The provider used a number of audits and checks to assess whether the care provided was of good quality. Although these were comprehensive and detailed, they did not always identify shortfalls in quality and were not always effective at driving improvements within appropriate timescales.

People were supported in relation to their day to day health. The premises were well adapted to meet the needs of people with dementia. Staff received a programme of training and supervision to help them understand and meet people's needs. People were supported to plan how they would like to receive care at the end of their lives and the provider followed an accredited end of life care programme.

Most people were positive about the staff who supported them and staff knew people, although people fed back that managers were not very visib

This inspection took place on 14 and 15 April 2016. Day one of the inspection was unannounced.

Acacia Care Centre is a purpose built care home providing nursing care for up to 62 people who may have poor health, dementia, or other needs including mental health and learning disabilities. The service has a designated dementia unit. At the time of the inspection 59 people were using the service.

The service was last inspected in March 2015, it met all the regulations we inspected it against.

The service had a registered manager in post; they were available at the time of 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.’

Policies and procedures including appropriate risk management processes were in place to make people were protected from the risk of harm. Staff were trained and understood safeguarding procedures. Appropriate robust recruitment checks were undertaken to make sure only suitable staff were employed.

Staffing levels were suitable with an appropriate skill mix deployed to meet the needs of people who used the service. Staff employed were appropriately supervised and supported, staff morale was good. There was an on-going training and development programme to enable staff continue with their professional development. It was acknowledged that additional training was needed in dementia care.

Acacia Care Centre was a well maintained premise, furnished, clean and hygienic, and provided a safe environment for people to live in and staff to work in.

Staff responded promptly to individuals seeking advice and consulting with relevant health professionals if there were any concerns. The number of general practitioners involved with people at the home has been reduced to five, this has helped people experience improved outcomes as they regularly consult with the same GP.

People consented to the care and support they received. Staff supported people in line with the principles of the Mental Capacity Act (MCA) 2005, holding best interest meetings when required.

People’s preferences and choices were known and respected; they received care and support as planned. Staff knew the people they cared for well and could respond to their individual care needs and preferences. Staff were kind and patient, they were mindful to take into account people’s privacy and dignity and consider their individuality.

The registered manager and staff were clear about their roles and responsibilities; staff were motivated and worked well as a team. They were committed to providing a good standard of care and support to people who lived at the home. The home had a complaints system which addressed any complaints within the agreed timescale. The service had developed a quality assurance system; driven by the views of people, and combined with quality audits to make improvements.

Our inspection team comprised an inspector and an expert by experience. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:-

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, looking at records and speaking with people using the service, their relatives, and members of staff.

Please read the full report for evidence that supports our summary.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. One person told us, “It’s a lovely clean place. They keep it nice and clean.”

We found that staff were supported with regular training and supervision to provide safe and appropriate care. One person told us, “The staff are very special, they are very caring.” A visitor commented, “No qualms about this pace at all. I would have my mother stay here.” We saw people were treated with dignity and respect by members of staff.

We looked at a random selection of care plans for people using the service. We found that they were person centred and reflected the individual needs of each person. We saw that they covered a comprehensive range of care and healthcare needs including individual risk assessments. We found that care plans had been audited, regularly reviewed and were up to date which supported staff to deliver safe and appropriate care.

We found that appropriate checks were undertaken before staff began work at the home and there were enough qualified, skilled and experienced staff to meet people’s needs.

We found that there were procedures in place to deal with foreseeable emergencies. For example, people had a personal emergency evacuation plan. In addition to the trained nurses that were on duty each shift members of staff were first aid trained. All staff had fire safety training once a year.

We found that there were appropriate measures in place in relation to the security of the service. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

There was evidence from the records we examined and our conversations with staff that learning from incidents / investigations took place and appropriate changes were implemented.

The Care Quality Commission monitors operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We identified that recent changes resulting from the Supreme Court in March 2014 could apply to some people using the service. The manager informed us that they were about to review whether people required DoLS applications to comply with the recent changes.

Is the service effective?

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We were told that an assessment of people’s needs was carried out before people came to the service.

We found that there were two activities’ coordinators for the service six days a week. We saw a number of activities taking place in communal areas. A hairdresser visited twice a week. Most of the people we spoke with commented favourably about activities in the home. One person told us, “There seems to be enough to do to suit most people.”

Staff received appropriate professional development. We were provided with information and records to show that staff received regular training. Staff were able, from time to time, to obtain further relevant qualifications

Is the service caring?

We saw that there were regular interactions between staff and people using the service that were positive and friendly. People and staff referred to each other on first name terms. Care was delivered in a kind and caring manner. One person told us, “The care has been fine.” Another said, “The staff are always very kind.” One person commented, “Most of the staff are very nice.” One person told us, “I am very positive about the care delivered here.”

Is the service responsive?

People expressed their views and were involved in making decisions about their care and treatment. We saw that care plans were person centred and recorded how people preferred their care and treatment to be delivered. People’s care and treatment reflected relevant research and guidance. For example, the service was an accredited member of the Gold Standard Framework for end of life care and worked closely with St Christiopher's Hospice.

Is the service well led?

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

We spoke with people using the service, visitors and members of staff who told us that the manager had an ‘open door’ policy and was approachable. The provider had systems in place to assess and monitor service provision.

When we inspected Acacia Care Centre there were 44 people living there. The majority of them were older people, some with dementia. The service also provides care and support for up to 11 younger people with physical disabilities. There were four people receiving this service when we visited.

We were able to speak with people who used the service and also to three relatives who were visiting. All of them were very happy with the care and support they received. Comments from people included “I like it very much here”, “my care needs are dealt with” and “the staff treat me with dignity”. People told us they were able to choose how they spent their days and that activities were arranged for them. Their care plans showed that their healthcare needs were identified and reviewed regularly so that any changes were addressed.

People enjoyed their meals at Acacia Care Centre. They told us that they always had a choice and said “the quality of food here is very good”, and “I always get enough to eat, portions are good, sometimes too much”.

We saw that medication was kept safely and administered and disposed of appropriately.

We saw that there were sufficient staff on duty to meet people’s needs. An on-going training programme made sure that staff had the skills they needed to support people. People confirmed that staff were very kind and respectful towards them.

Acacia Care Centre was a new purpose built home which opened in October 2012. The service had relocated from another home in Croydon. When we undertook our inspection the homes manager had recently left. The service was actively recruiting to find a person to take on this role. The service had a head of care who was a nurse and support was being provided by senior managers within the organisation.

At the time of our inspection there were 31 people living on the top two floors. The second floor was occupied by people who had cognitive impairment or dementia. People we spoke with told us “it’s very nice here”, “the staff are very nice” and “they are very good to me”. People all had their own rooms with en-suite facilities, including a shower. They told us that they had been able to bring possessions from home in with them such as photographs and ornaments to make them more personal. There were also assisted baths on each floor. The home had a library, a bar and two hairdressing salons.

People said that they enjoyed the meals at Acacia Care Centre. They told us that they were always offered a choice and there were drinks and snacks available as well. When we visited, we saw that the home was very clean and tidy and free from unpleasant odours.

On the day of the inspection there were some activities arranged for those people who wanted to join in. There was a fulltime activities person and care staff told us that they help provide activities as well.

We visited Acacia Care Centre on 24 and 25 March 2015.

The service provides nursing and residential care for up to up to 62 people who may have poor health, dementia, or other neurological needs. At the time of our inspection there were 60 people using the service. At our previous inspection the service was meeting all the regulations we reviewed.

The service had a registered manager. 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 at the service felt safe and secure. Staff knew how to recognise and respond to abuse and had completed safeguarding of vulnerable adults training. They knew how to report safeguarding incidents and escalate concerns if necessary. People’s needs were assessed and corresponding risk assessments were developed. There were sufficient numbers of staff to meet people’s needs and safe recruitment procedures were followed. We saw that people were receiving their medicines safely and as prescribed.

Staff had the skills, knowledge and experience to deliver effective care and treatment. Mental capacity assessments had been completed to establish each person’s capacity to make decisions and consent to care and treatment. Where it was necessary to deprive people of their liberty the service was obtaining appropriate authorisations under the Deprivation of Liberty Safeguards. People were supported to have a healthy diet and to maintain good health.

People and visitors commented positively about relationships with staff and we observed numerous examples of positive interactions. People and their representatives were supported to express their views and were involved in making decisions about their care and treatment. There were meetings for people and relatives where they could express their views and opinions about the day to day running of the home. Staff respected people’s privacy and dignity.

People received personalised care. Care plans were person centred and addressed a wide range of social and healthcare needs. People were involved in the development of their care and treatment. Care plans and associated risk assessments reflected their needs and preferences. People were encouraged to take part in activities that helped enhanced their lives and reduced the risks social isolation. People were confident that they could raise concerns with staff and those concerns would be addressed.

We found the service did not have an effective system in place to audit and monitor their service provision at all times. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have asked the provider to take action details of which can be found in the full version of this report.