Acacia Mews is registered to provide accommodation and personal care for up to 65 older people, who have dementia or a physical disability. At the time of our inspection 63 people lived at the home.

At the last inspection in July 2015 the service was rated good. At this inspection we found the service remained good.

People told us they felt safe living at Acacia Mews. Risks to people’s health and wellbeing were appropriately managed. Staff had received appropriate training, support and development to carry out their role effectively.

Safe and effective recruitment practices were followed to help ensure that all staff were of good character, physically and mentally fit for the roles they performed. People told us there were enough competent staff to provide them with support when they needed it.

People received appropriate support to maintain healthy nutrition and hydration. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). People were supported to make daily choices by staff that understood the importance of promoting people’s independence.

People and their relatives told us and our observations confirmed that people were treated with warmth and kindness by staff that respected their privacy and upheld their dignity. People told us they knew how to complain and were confident they would be listened to if they wished to make a complaint.

People’s views and opinions were sought by staff. People received care that met their individual needs and were given appropriate support and encouragement to access meaningful activities.

The management team promoted an open, transparent and inclusive culture within the service. There was a quality assurance system in place and shortfalls identified were acted on to improve the service.

Further information is in the detailed findings below.

This inspection was carried out on 23 July 2015 and was unannounced.

Acacia Mews is registered to provide accommodation and personal care for up to 65 older people, who are living with dementia or a physical disability. There were 60 people living at the home when we inspected.

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.

When we last inspected the service on 25 September 2014 we found them to not be meeting the required standards in relation to the administration of people’s medicines. At this inspection we found that they had met the required standards.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service and were pending an outcome. Staff were fully aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty.

People received care that met their individually assessed needs and preferences.

People received their medicines safely and had regular access to health care professionals. There was a good choice of food and drink and people received support where required.

People felt safe and staff were knowledgeable about how to protect people from the risk of abuse and other areas where they may have been assessed as being at risk. Falls, accidents and incidents were monitored to ensure the appropriate action had been taken. There were regular quality assurance checks carried out to assess and improve the quality of the service.

Staff received regular training and knew how to meet people’s individual needs.

People were provided with appropriate food and drink and staff had access to accurate and up to date information to help them meet people’s needs.

Staff were kind and people appreciated the positive relationships they had with staff. This was also true for relatives. People were complimentary about the staff providing the service. Choices were given to people at all times. People’s privacy and dignity were respected and all confidential information about them was held securely.

Care plans were personalised and included information about people’s history and interests. Staff were knowledgeable about how to manage people’s individual needs and assisted people to take part in appropriate daily activities.

The service was well led by a manager who promoted a fair an open culture. They encouraged staff to take responsibility and supported their professional development. The manager also had a support structure in place from area managers. There were regular supervisions and appraisals to support staff.

We inspected Acacia Mews in response to information of concern that we had received. The information related to the management of medicines and staffing. We spoke with the manager and the deputy manager who told us that they had identified medicines to be an area that required improvement and were already working internally to improve this. There also told us that recently staffing had been a challenge but this was now settling down.

At our inspection we found that there were shortfalls in relation to how people’s medicines were managed and control measures that had been implemented were not yet working effectively.

We found that the service was managing the staffing effectively. We saw that people's needs were being met in a timely fashion. The home was calm and relaxed and we saw people receiving assistance in a way that was person centred. People who used the service, their relatives, staff and a visiting healthcare professional told us that they felt the service was adequately staffed. One person told us, “The staff are lovely. It’s like home from home.” The healthcare professional told us that they had seen improvements over the last 12 months.

During our last inspection of August 2013, we had found that the provider was not meeting some of the standards we had inspected. The majority of people had not consented to care and treatment. People's risks assessments had not been carried out and that the system for the management and administration of medicines was not effective.

During this visit, we found that the provider had made changes and improvements to ensure that standards were met and people's needs were met. People had consented to the care and treatment they had been provided with and that the risk assessments had been carried out and reviewed regularly so that people's needs were met. There were systems in place to ensure that people received their medicines regularly and on time.

The people we spoke with said that they were happy with the care and support they received. They were complimentary about the staff and felt that their needs were met. One person said “I do like it here, food is nice, staff always take their time when providing care and they are very friendly.” Another person said “We are well looked after and I have no complaints.”

The people we spoke with said that they were happy with care and treatment they received. One person said “I am very comfortable here. The staff are caring and helpful. The food is good. I have no concerns.” Another person said “It’s very good here. The staff are excellent.” A relative said “My husband is getting to know others now. The food is good and they do provide choices. The staff are helpful.”

The provider and staff demonstrated they were aware of people’s cultural needs and for ensuring equality and valuing diversity.

We found that the provider was meeting two of the five standards we had inspected. There were no evidence to indicate that people and their relatives had consented to the care and treatment provided because they had not signed to give their agreement. People did not receive care and treatment that were safe and appropriate because risk assessments had not been carried out. There were shortfalls in the management and administering of medicines which meant that some people did not receive their medicines regularly and on time.

There were systems in place to support staff in a manner that allowed them to deliver effective and safe care. The majority of the staff received formal supervision but not on a regular basis and some of them did not receive specific training such as dementia. There was a system for assessing and monitoring of the quality of service.

The people who use the service told us that they were very happy in the home and if they were not they would move to another home. They said that the staff were 'beyond caring' and that they made them feel 'very special' and 'nothing was too much for the staff to do for you'.

We saw very good interaction between the staff and the people. We saw that staff had good communication skills and took time to offer comfort to people.

Following information we had received, raising concerns about the care home, we looked at the care and welfare of the people. We found the home was caring for people in a manner that promoted their health, welfare and dignity and respected them as individuals.

The people we spoke with said that a number of new staff had started and some had left. They felt that the staff team had been supporting them appropriately in meeting their needs. One person said, “I have no complaints. I am being well looked after.” Another said, “There are enough staff to look after us. I have regular blood tests done. They give me my medicines every day.”

At our previous visit, in September 2012, we found that the provider had not met one of the standards we inspected. This related to insufficient numbers of staff on duty to care adequately for people using the service.

We had also received information that people had not been receiving prescribed medicines regularly and on time.

When we visited the service on 07 November 2012, we found that the provider was now meeting the standards we inspected.

The staffing levels had been reviewed, and a number of care staff had been recruited, including the deputy manager. We noted from the duty rota that a senior member of staff had been rostered to work on each shift, supported by a team of care staff. This meant that there had been sufficient numbers of staff on duty to care for people using the service.

We found that people had been receiving their prescribed medicines regularly and on time. At the time of our visit, the provider was made fully aware of the importance of carrying out regular audits of the management and administration of medicines, to maintain safe practice.

People we spoke with during our visit, on 05-06 September 2012 were generally complimentary about the staff. A person commented that the staff were ‘good and kind people’.

A relative commented that they were ‘delighted about the care and the service provided’ and added that nothing was too much trouble for the staff. This was echoed by another relative who said that the staff were friendly and caring.

However, a person commented, “Sometimes I don’t know who the staff are; they keep changing.”

The people we spoke with said that they were happy with the quality of care and support they received and that their needs were met, their privacy and dignity were respected and felt that they were cared for and supported by a caring and competent staff team.