This inspection took place on 10 and 11 May 2016 and was unannounced.

Accommodation for up to 78 people is provided in the home over three floors. The service is designed to meet the needs of older people. There were 70 people using the service at the time of our inspection.

A registered manager was in post and she was available during 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.

People felt safe in the home and staff knew how to identify and respond to potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe. Sufficient staff were on duty to meet people’s needs. Staff were recruited through safe recruitment practices. Safe infection control practices were followed, however; medicines were not always safely managed.

Staff received appropriate induction, training, supervision and appraisal. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate. The adaptation, design and decoration of the service could be improved to support people living with dementia.

Staff did not always protect people’s dignity and treat them with respect. Staff were generally kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the registered manager and that appropriate action would be taken. The provider and registered manager were aware of their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.

We carried out this inspection because we had received concerns about the service.

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, discussions with people using the service, the staff supporting them and looking at records. We also spoke with the manager.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

During our visit we spoke with 15 people who received a service and observed how staff supported people in each part of the home. We saw examples of good care and support during this time. Everyone that we spoke with said they felt safe.

We saw that care plans were in place to identify how people’s needs should be met. However it was difficult to find information on the three care plans that we reviewed in detail. For example we saw how changes had been recorded in the ‘update’ section of the plan but this was not reflected in the main text. This could lead to confusion and the registered manager acknowledged this. We also found that, on one file there was no information about health professional visits. One person, who was identified as being at risk of falls, had not had that risk assessed or safeguards recorded to reduce the likelihood. This meant that care and support had not been appropriately documented to ensure a safe and consistent approach. An external complaint investigation had made similar findings.

Is the service effective?

People who received a service told us that their needs were met in ways that they preferred. Everyone we spoke with said they were satisfied with the service that they received. One person said, “We have everything we need”.

Is the service caring?

People were supported by staff who cared about their work. We heard staff speak with people in a calm and reassuring way. They responded to requests for support in a timely manner. Staff offered people choices to help them remain in control of their lives as far as they were able. For example, at lunch time, they showed people both meal options. This enabled them to make an informed decision.

Is the service responsive?

We found that the registered manager had responded to feedback about the service provided. For example they had set up a support group for relatives. The registered manager also told us about residents’ meetings where people who received a service were able to share their views on the running of the home and make suggestions for improvements. For example they had suggested newspapers and a stereo in the lounge over recent months. These suggestions have been actioned.

Although we found that care plans were in the process of being redesigned and updated we found that some care needs were not being recorded or assessed appropriately and this had previously been identified following a complaint from a relative in July 2013.

The registered manager did not have records to reflect actions taken following investigations into alleged poor practice. This meant that they could not show how staff had been supported following the incidents or how practice had been improved and monitored.

Is the service well-led?

We saw how the registered manager did regular reviews and audits of systems and processes. They told us that they had effective monitoring tools that reassured them that they provided a good service. The manager also told us how the service provider worked with them to monitor and assess the quality of the service.

Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received an appropriate service at all times. Staff felt well supported by senior staff although supervision arrangements were informal. We could not see how the registered manager had followed up on staff performance issues when they had been bought to their attention. The registered manager was clear about their responsibilities in relation to reporting incidents to relevant agencies however they could not show us how they had followed procedure on all occasions.

Acer Court is registered with the Care Quality Commission to provide accommodation for up to 75 older people with varying support needs, including dementia care. The service is delivered over three floors. We inspected the service on 16 and 17 December 2014.

This inspection was carried out to see if improvements had been made to the service in relation to the care and welfare of people who used the service, staff support and supervision, safeguarding people from abuse and how the quality of the service was monitored. The provider sent us an action plan detailing how they were going to make improvements. When we carried out this inspection we found that actions had been completed and improvements had been made.

Since the time of our last inspection a new manager has been appointed and they had applied for registration with us. 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.

This inspection was carried out by three inspectors on day one and two inspectors and a specialist advisor on day two. The specialist advisor was a person who had specialist knowledge in relation to supporting people with dementia care needs.

People who used the service told us that they felt safe living at Acer Court. Throughout the inspection we saw staff treat people appropriately and with dignity and respect. We saw that staff were kind and caring when supporting people.

People told us that there enough staff to meet their needs. They said that staff responded to requests promptly and that they did not have to wait very long for call bells to be answered.

People who used the service told us that they were able to make choices about how they were supported and felt fully involved in making decisions that affected them. When people were unable to do this we saw that the provider worked with appropriate people to ensure that decisions made on their behalf were in the person’s best interest.

People told us that they liked the food at Acer Court. We saw that the monitoring of food and drink intake had improved since our last inspection. As a result staff could show that people received a varied and balanced diet.

We saw there were systems and processes in place to protect people and keep them safe. We spoke with staff who understood their role and responsibility in relation to offering safe and effective support. Systems were in place for staff to identify and manage risks and take actions when people’s needs changed.

Staff were recruited through safe recruitment practices and on-going monitoring had improved to ensure staff felt valued and effectively supported. Staff received training that was specific to meet the needs of the people who used the service.

Medicines were managed safely and people received their medication when they should.

People told us they knew who to speak to if they wanted to raise a concern and we saw that there were processes in place for responding to concerns. Staff knew the complaints procedure and people who used the service told us that they would be comfortable to make a complaint. A small number of relatives told us that they had not always been satisfied with how issues had been managed. Most told us that this had now improved. We found that communication had not always been effective however improvements had been made in this area. Some relatives told us that further improvement was still required. The regional manager (who was assuming day to day responsibility for the running of the home) acknowledged this and the newly appointed manager was aware of issues and had plans to address them as a priority.

There were effective systems in place to monitor and improve the quality of the service provided and these were now being used. Action plans, in response to audits and incidents, were now being shared with staff and senior managers to demonstrate improvements and identify areas where more work was required. This made staff more accountable for their actions.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The Deprivation of Liberty Safeguards are a code of practice to supplement the main Mental Capacity Act 2005 Code of Practice. We looked at whether the service was applying the DoLS appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these were assessed by professionals who are appropriately trained to assess whether the restriction is needed. The regional manager told us that no one currently using the service was having their liberty deprived. They were knowledgeable about criteria for requesting assessments and staff were mindful as to what constituted a deprivation.