We carried out this inspection on 23 and 24 August 2017. The inspection was unannounced on the first day but the provider knew we would be attending on the second day.

We last inspected this home on 14 and 15 August 2015 when we rated the service as providing a good service. At this inspection we found that the service continued to provide a good service but there were some improvements to be made in the auditing and monitoring of the quality of the service.

Acorn Care Home is registered to provide accommodation and nursing care for 22 people who have

nursing or dementia care needs. There were 17 people living at the home when we visited.

There was a registered manager in post at the time of our 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.

There were some quality monitoring systems in place but they were not always effective in identifying shortfalls in the service.

People received a safe service, because the provider had procedures in place to reduce the risks of harm to people. Staff were trained to help keep people safe and knew the procedures for ensuring people did not suffer abuse or harm.

People received their medicines as prescribed and were cared for in an environment that was maintained to ensure they were safe.

People were supported by sufficient numbers of staff that were suitably recruited, trained, supervised, supported and monitored to ensure they cared for people effectively.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People had a choice of meals and were supported to eat and drink enough to maintain their health and well-being. Staff knew how to support people that may be at risk of not eating or drinking sufficient amounts to maintain their health. People had access to health care professionals when they were unwell so their health care needs were met.

People and their relatives were happy with the care they received and felt that staff were caring and compassionate towards them. People’s privacy and dignity was maintained and staff encouraged people to be as independent as possible.

People and their relatives were involved in planning and agreeing their care needs, so they knew what care was being provided. Where people had concerns about their care, there were effective procedures in place to handle these concerns. People were confident that any concerns they raised would be acted on.

Social activities were provided for people who wished to take part.

People received a service that was well managed, by a stable management team. People had the opportunity to comment on the quality of the service they received.

On the day of our inspection 21 people lived at the home. We spoke with four people who lived there and five of their relatives. We spoke with five members of staff, the registered manager and the director. Several people who lived there were unable to verbally tell us their experiences, so we spent time observing how staff interacted with people.

At our last inspection in April 2013 we found that improvements were needed in a number of areas and we set compliance actions in our report for improvements to be made. At this inspection we saw that overall improvements had been made in all of the areas previously identified.

We found that people were treated with respect and dignity. One person said, "I’m happy here, staff are very friendly and treat us with respect.” One relative told us, “Staff are very respectful and look after people they way I would I like to be after.”

The provider had systems in place to support staff to enable them to provide care and support that met people's needs and kept them safe.

We found that people were asked for their views about the home and people were listened to. The provider had an effective system in place to ensure the quality of service provision was monitored so that any necessary improvements could be made.

There were twenty two people living at the home when we visited. Some people needed help with all their care needs whilst others needed minimal support from staff. We spoke with four people living at the home and four staff members during our inspection. One person living in the home said, “They leave you alone if you ask, they are not at you all of the time.” Two other people told us they were happy with the support they had received.

We saw that people were involved in making some choices about their care. This meant they could maintain some control over how their care was provided.

We found that people's needs were appropriately assessed and planned to ensure that care received was safe and appropriate however, care plans were not kept up to date to reflect people’s changing needs.

People were provided with alternatives at mealtimes but there was no evidence to show that the meals had been chosen by people. Culturally appropriate foods were not available for people on a regular basis to meet people's dietary needs.

People were protected from harm because staff had the skills and knowledge to protect them.

We saw that people’s health and welfare needs were generally met by staff however there were some gaps in staff training which had impacted on how well this was done.

The provider had systems in place to monitor the service provided, but these were not always used and monitored effectively.

There were twenty two people living at the home when we visited. Most of the people were independent with their personal care needs while others needed some support from staff. We spoke with three people living at the home, four staff members and a relative who was visiting at the time of our inspection. One person living in the home said, ''I am very very impressed” with the home. A relative we spoke with said, “There is good care here”.

We saw that people were involved in making choices about their care. A visitor we spoke with said that they had been involved with the care of their relative. However, we found that the home did not always uphold and maintain the privacy and dignity of people living in the home.

On the whole we found that people's needs were appropriately assessed and planned to ensure that care received was safe and appropriate. On one occasion we saw that care was not delivered appropriate to need and care planning.

The service took steps to prevent abuse by ensuring that staff recognised the signs of abuse, understood safeguarding processes and whistle blowing procedures.

We saw that people’s health and welfare needs were not always met by competent staff. We saw that there were some gaps in staff training which had some negative impact on the people living in the home.

There was a system to monitor the quality of service people received through regular surveys, feedback and reviews.

We last inspected Acorn Care Home on 13 February and 04 March 2015. At that inspection we found there were four areas where the service was not meeting regulations. These related to the risk to people of unsafe care, people’s consent to care had not always been sought, people were not always protected against the risk of abuse, the management of medicines did not ensure people received their medicines as prescribed and the monitoring of the service was not effective. The provider sent us an action plan detailing what action they had taken. During this inspection we found the provider had made applications to the local authority as required. Improvements had been made to medicine management and on how the service was monitored.

Acorn Care Home is registered to provide accommodation and nursing care for 22 people who have nursing or dementia care needs. There were 22 people living at the home when we visited.

A registered manager is required to manage this service. 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. A registered manager was in post.

People were protected from the risk of abuse because the provider had systems in place to minimise the risk of abuse and staff were trained to identify the possibility of abuse occurring. Staff understood their responsibility to take action to protect people from the risk of abuse and how to escalate any concerns they had.

People received their medicines as prescribed by the doctor and immediate action was taken to improve the monitoring of medicines that needed to be stored in a fridge.

There were sufficient staff to meet people’s identified needs. Staff received the necessary training and support to carry out their role. Staff knew how to protect people in an emergency situation such as illness, injury or fire.

Interactions between people and staff were friendly, relaxed and polite. People who could speak with us told us they felt safe and secure in the home.

Staff had a good understanding of how to ensure that consent was obtained and how people’s rights were to be protected if they did not have the ability to make decisions for themselves.

People’s health care needs were met and they were supported to access both social care and healthcare professionals to ensure their needs were met.

Improvements had been made to the management systems in place to assess and monitor the quality of the service provided. We saw that improvements had been made to the service so it was a safer home for people to live in. All previous breaches of the regulations were met.