This inspection took place on 18 December 2017 and was unannounced. At our last inspection in July 2015, we found the provider was meeting the regulations we inspected and the service was rated "Good". At this inspection, we found that the service continued to be rated "Good".

Acorn is a care home. People receive accommodation and personal care support as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. The service is registered for four people. At the time of our visit four people were using the service.

The provider of the service is an individual who is responsible for the day-to-day management of the service. Therefore they are not required to have a separate registered manager. Therefore, the provider is the registered manager of the 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.

People continued to receive safe care. There were enough staff to meet people's needs. Staff were appropriately recruited. Sufficient staff were available to provide care and support to meet people's needs. People were protected from the risk of harm and appropriate risk assessments were in place to provide safe care. People received their prescribed medicines from competent staff who were trained to administer medicines safely.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. The policies and systems at the service support this practice. People continued to receive care and support that was responsive to their needs.

The care that people received continued to be effective. Staff had access to the support, supervision, training and on going professional development they required to work effectively in their roles. People had access to healthcare professionals as needed and were supported to maintain good health and nutrition.

People and their relatives felt staff were kind and caring. Staff supported people to maintain their independence and respected their privacy and dignity. People were supported to take part in activities based on their own interests.

People, relatives and staff felt the service was well run and the registered manager was approachable. The registered manager worked well with other organisations to ensure people received the care and support they needed.

The registered manager had systems in place to monitor the quality of the service provided to people. People and their representatives were able to raise concerns or complaints if they needed to and felt these were listened to and acted upon.

Further information is in the detailed findings below.

The inspection took place on 21 July 2015 and was unannounced. Our last scheduled inspection at this service was in July 2014, when one breach of a legal requirement was identified. This was in relation to medicine management. The provider sent us an action plan and we saw at this inspection, that the service was meeting the Regulation.

The provider of the service is an individual who is responsible for the day-to-day management of the service. Therefore they are not required to have a separate manager. Therefore, the provider is the registered manager of the 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 and associated Regulations about how the service is run.

People were safe at the service and were cared for by staff who were knowledgeable about safeguarding people. They knew how to report concerns. Medicines at the home were managed safely. There were sufficient qualified and experienced staff to meet people’s needs.

The care plans we looked at included risk assessments which identified any risk associated with people’s care and guided staff about how to minimise these in order to keep people safe.

Staff received the support and training they needed to provide an effective service that met people’s needs. The staffing levels were flexible to support with planned activities and appointments.

The recruitment process was robust to make sure that the right staff were recruited to keep people safe. Staff personnel records showed that appropriate checks were carried out before they began working at the home.

Staff understood the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were provided with a balanced diet and sufficient food and drink to promote their health and wellbeing.

People were supported to see healthcare professionals in order to ensure their general health and well being were maintained.

People were looked after by staff who were caring, compassionate and promoted their privacy and dignity.

People’s care plans were based upon their individual needs and wishes. Care plans contained detailed information about people’s health needs, preferences and personal history.

There were effective systems in place for responding to complaints and people and their relatives were made aware of the complaints processes.

Quality assurance systems were in place and were used to obtain feedback, monitor service performance and manage risks.

A single inspector carried out this inspection. 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?

This is a summary of what we found.

Is the service safe?

We met all three people who used the service and observed how they were supported by the staff. After the visit we spoke to three people's relatives. We saw that staff treated people with respect and dignity. Relatives told us that they were very happy with the service provided. They said people were safe and well cared for. One relative told us “I do indeed feel that it’s a safe service.”

Staff had received training to ensure that they supported people safely and appropriately. People’s individual files indicated the risks to the person and how these could be minimised to ensure that they were supported as safely as possible.

Staff had received training in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was aware that in some circumstances decisions needed to be made in a person’s best interest.

The building was appropriately maintained and serviced to ensure that people lived in a safe environment.

The systems for the administration of medication were not robust and this placed people at risk of not receiving their prescribed medicines safely.

Is the service effective?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that as part of a quality assurance questionnaire a relative had commented “staff take excellent care of [my relative].”

People were supported to receive the healthcare that they needed and a member of staff told us that they had good support from the local GP practice.

People's care needs were assessed and plans of care developed from these. Staff had a good understanding of how to meet people's individual and assessed needs and of individual preferences.

Is the service caring?

Relatives we spoke with were very positive about the care provided by the staff team. One relative told us “[my relative] is very well cared for." We saw that staff supported people in a gentle, respectful and kind way. They offered people choices and talked to them about what was happening or what they needed to do.

Is the service responsive?

Care staff we spoke with were knowledgeable about the needs of people they supported and how to meet them. The service was responsive to people’s changing needs and wishes and changed the level of support provided accordingly. One relative told us “they are proactive. They assessed [my relative] in hospital and then arranged for the district nurse to visit as soon as [my relative] moved in.” This was a three bed home for older people and all those we spoke with felt that people got a lot of individual attention that met their needs.

Is the service well led?

The provider was also the manager of the service. Staff we spoke with said they felt the home was well managed and that they received the support and guidance they needed to carry out their duties and to meet people’s needs. In addition to working with people for most of the week the provider also carried out spot visits at different times to ensure that people received an appropriate service that met their needs.

At the time of our visit there were two people living at the home who had been there for a number of years. We spoke with them, their relatives and three members of staff including the owner-manager. People told us they liked living there. One person said, “it is nice here, I can choose how I spend my time here.” Relatives were happy with how their family member was cared for.

People confirmed they consented to things on a daily basis. Their records showed they consented to the care they received and it was reviewed on a regular basis. Relatives told us their consent was sought for anything their family member was unable to understand.

We saw staff had a good understanding of people’s individual care needs. One relative said, “the staff always make my family member look nice, she has always cared about how she looks, and the staff maintain that.” Another relative told us the staff supported their family member in attending their temple.

The people living there were cared for in a clean, tidy and safe home which was accessible for people who used wheelchairs.

Staff felt supported and received training relevant to the care and support of the people living there.

The home manager actively sought the views of people that lived here and their families as to how this home was run.

People that lived at this home said they ''Liked living here and the staff that cared for them were nice''. They can choose how to spend their days and were able to access various events in the local community. If they needed someone to support them outside the home staff would accompany them. They were taken to visit local shops to do personal shopping if they wished.

The care plans had recently been reviewed involving each person their family and staff. This ensured care was, individualised and personalised. Choices were available at all mealtimes and a range of diets were catered for.

Relatives that we spoke to liked this home and were very happy with the care their family member received. They knew who to speak to if they had any concerns and found the staff to be approachable and caring.

Staff had worked here for a number of years and had received relevant training to provide care and support to people living at this home. The home manager actively sought the views of people that lived here and their families as to how this home was run.

People said they felt supported by the staff team and that they were included in decisions about their care as far as possible.

People told us they were happy with the choice of food at the home. One relative said,

“They go out of their way to cook her indian meals and take her to the temple.”

They told us they were happy with the general environment of the home and their rooms. One person told us, “I like my room.”