The inspection took place on 20 July 2016.

Acacia Lodge – Staines provides accommodation, nursing and personal care for up to 36 older people, some of whom are living with dementia. There were 19 people living at the service at the time of our inspection.

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 and associated Regulations about how the service is run.

There were enough staff deployed to keep people safe and to meet their needs promptly. People were supported by staff that had the skills and experience needed to provide effective care. Relatives told us that staff knew their family members’ needs well and provided consistent care. Staff had an induction when they started work and access to ongoing training. Staff shared information about people’s needs, which ensured they received their care in a consistent way.

The provider made appropriate checks on staff before they started work, which helped to ensure only suitable applicants were employed. Staff understood safeguarding procedures and were aware of the provider’s whistle-blowing policy. People told us they felt safe at the service and when staff were providing their care.

Risks to people had been assessed and measures implemented to reduce these risks. There were plans in place to ensure that people would continue to receive their care in the event of an emergency. Health and safety checks were carried out regularly to keep the premises and equipment safe for use. People’s medicines were managed safely. People were supported to stay healthy and to obtain treatment if they needed it. Staff monitored people’s healthcare needs and took appropriate action if they became unwell.

Staff were kind and sensitive to people’s needs. People had positive relationships with the staff who supported them. Relatives said that staff provided compassionate care and were professional and caring. The atmosphere in the service was calm and relaxed and staff spoke to people in a respectful yet friendly manner. Staff understood the importance of maintaining confidentiality and of respecting people’s privacy and dignity. Feedback obtained from healthcare professionals about staff was very positive. Healthcare professionals said that staff were friendly and caring and that they knew the people they cared for well.

The registered manager and staff worked closely with other healthcare professionals to ensure that people received good, individualised end of life care that reflected their wishes. People were given opportunities to discuss their wishes with staff and their next of kin and these were recorded in an advance care plan. A healthcare professional told us they and the registered manager regularly reviewed practice in this area to identify any ways in which improvements could be made. Healthcare professionals provided positive feedback about the care provided by staff. They said staff were skilled and knowledgeable about the people they cared for, which enabled them to provide people’s care in a consistent way.

People’s needs were assessed before they moved to the service to ensure their needs could be met. Staff understood the importance of treating each person as an individual and ensuring that the care they received reflected their needs and wishes. Care plans were person-centred and provided clear information for staff about how to provide care and support in the way each person preferred. Relatives said staff monitored their family members’ health and welfare closely, which meant they identified any concerns promptly. Healthcare professionals provided positive feedback about the responsiveness of staff when people’s needs changed. They said staff always responded promptly and were proactive in seeking advic

During our inspection we spoke with people and to staff. We were told that people and family members were involved in decision making regarding their care and treatment. They were encouraged to express their opinions, preferences and views.

We spoke with two people living in the home. People told us that ' staff were friendly' and that ' they liked living there'. Staff told us that 'they provided tender loving care'.

We observed people being cared for by nursing staff with care and compassion.

We found that care was person centred, planned and delivered safely with regular reviews.

We saw that the provider had effective systems in place to monitor and assess the quality of the service, which took into account the views of the people, relatives and staff. We saw that the provider used this feedback to make service improvements.

This was a follow up inspection to ensure that the home had completed the actions required following the compliance actions that we set during our inspection in October 2012. We spoke in detail to the deputy manager and by telephone to the registered manager. On this occasion we did not speak to the people who used the service.

We found that improvements had been made to the environment which resulted in a more pleasant and homely environment in which to live. The manager told us that these improvements would continue and a refurbishment plan was in place for this year.

The manager had also appointed an infection control lead person. We looked at the infection control audit that was near completion. The deputy told us any shortfalls that had been identified would have an action plan to ensure they would be addressed.

We were unable to obtain directly the views and experiences from the people living at the home as they had varying cognitive impairments, associated with Alzheimer’s or dementia. The home was also providing care for some people with palliative care needs on the day of inspection.

We used a range of alternative methods to gather this information, including observations, discussion with staff, discussions with family members and reviewing care records.

Family members that we spoke with following the inspection told us how happy they were with the care and treatment their relative was receiving at the home. We were told that the staff were very kind and always kept them informed about what was happening with their relative.

All family members told us that the staff were very helpful, kind and caring and could not do enough for you.