This inspection took place on 4 January 2018 and was unannounced, this meant the provider and staff did not know we would be visiting.

Acorn Grange is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Acorn Grange accommodated 37 people at the time of the inspection.

The service was last inspected on October 2015 and the rating for this inspection was Good. At this inspection we found the service remained Good.

Risks to people arising from their health and support needs as well as risks associated with the premises were assessed, and plans were in place to minimise them.

People received their medicine safely and were supported to access the support of health care professionals when needed. People were protected from the risk of abuse because staff understood how to identify and report it.

There were enough staff to meet people's needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff told us they received training to be able to carry out their role. Staff received effective supervision and a yearly appraisal.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received a varied and nutritional diet that met their preferences and dietary needs.

The interactions between people and staff showed that staff knew the people well.

Care was planned and delivered in way that responded to people’s assessed needs. Care plans contained detailed information about people’s personal preferences and wishes as well as their life histories.

The management team were approachable and they and the staff team worked in collaboration with external agencies to provide good outcomes for people. People, relatives and staff felt any concerns would be taken seriously and acted on. Processes were in place to assess and monitor the quality of the service provided and drive improvement.

Further information is in the detailed findings below.

This inspection was carried out by one inspector. We met with eleven people who used the service and observed their experiences of care to support our inspection. We spoke with the deputy manager, nine staff, seven relatives and two healthcare professionals.

We considered our inspection findings to answer 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. If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. People told us that they were happy living at the home and were supported to remain independent as safely as possible.

Appropriate risk assessments were in place, and the registered manager had suitable arrangements to safeguard people from foreseeable emergencies.

People told us that they felt safe living at the home and their relatives confirmed this. At the time of the inspection, there was no one at the home subject to an authorisation made under the Deprivation of Liberty Safeguards.

There were regular quality checks and audits completed to make sure that the home provided a safe and suitable environment for people to live in.

Is the service effective?

All of the people we spoke with, told us that they were happy with the care that was delivered and their needs were met. Staff had received training to meet the needs of the people who lived at the home.

We saw that care records held specific information on health conditions, for example diabetes or vascular dementia which further supported staff to care for people who lived at the home.

Is the service caring?

We asked eleven people if they had any concerns about the care provided by the home and those that could told us they were happy with the care provided and that the staff were caring. One relative told us, “I am happy with the care provided here.”

Observations during the visit showed staff were compassionate and caring to the people they supported. During the day we found positive interactions taking place and staff responding in a thoughtful and kind manner to people who lived at the home.

Is the service responsive?

Regular reviews were carried out with the people who used the service and their representatives to make sure the person’s care and support needs had not changed. This helped ensure staff supplied the correct amount of care and treatment.

Information collected by the service also gave staff an insight into the interests, likes and dislikes and areas of importance to the people in their care. This meant that it helped staff to provide social activities that people could choose to be involved with.

Regular meetings took place with staff to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people who used the service.

People who lived at the home held regular meetings with staff to discuss their views on living at the home. This meant that people were involved in communications about the running of the home and staff listened and took action. People we spoke with confirmed they felt that they were listened to and knew who to contact if they had a problem.

Is the service well-led?

There was a registered manager in post at the home and a deputy manager too.

People who used the service had regular contact from the registered manager and other senior staff to check their wellbeing. The quality of service provided by care staff was monitored and this was done through quality audits and also through meetings arranged with the people who used the service.

One relative told us that they were kept regularly updated by the staff team if any changes occurred to their family members health. The relative told us, “Staff will ring me if they need to tell me anything, they are very good like that.”

People were involved in making decisions about their support needs. People told us they could express their views as to what was important to them.

The arrangements for supporting people to make decisions about their daily lives and preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

The relationships between staff and the people who they supported were good and personal support was provided in a way that people had consented to. This promoted and protected their privacy and dignity. This was confirmed when we spoke with six people who used the service.

Suitable arrangements were in place for handling complaints and for protecting people from abuse.

There was a competent staff team who had been appropriately recruited and had the training, skills and experience to meet the specific conditions of the people who they supported.

There were a range of effective systems in place to monitor the quality of the service that people received.

The arrangements for supporting people to make decisions about their daily lives and preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

Suitable arrangements were in place for people to take part in activities in line with their needs and preferences.

The relationships between staff and the people who lived there were good and personal support was provided in a way that promoted and protected their privacy and dignity.

Suitable arrangements were in place for handling complaints and for protecting people from abuse. One person told us they could share any concerns with the staff and felt their views were listened to. Another person said “This place is just wonderful. I like living here because all my needs are taken care of and I feel safe.”

There was a stable and competent staff team who had the training, skills and experience to meet the specific conditions of the people who lived there.

People who live in this home told us that they were treated with respect, privacy and dignity. They said "staff always knock on my door before they come in", and "they are very good when they help me with a bath, giving me dignity". One male told us that at their request they were able to have a male member of staff help them with their personal hygiene needs.

One person told us that they had weekly residents meetings and that they were the chair of the meeting. They said "we bring to the table any complaints and talk about them, we also talk about the entertainment we want". The chair of the meeting told us they were responsible for looking after the minutes.

People we spoke with confirmed that there were trips out into the local community, for example, “we went to see Cinderella at Christmas time".

People told us there were two choices at mealtimes. They said there were lots of snacks, "you don't go starved". One person told us that they had raised concerns about the presentation of the meals and as a consequence of this this it had much improved. We observed the experiences of people with dementia during lunch. We found that staff knew about people's likes. Those people who needed support to eat their meals were offered support discretely and sensitively by staff. People told us that recently, because this had been discussed in their residents meeting, individually wrapped butter and jams were provided at breakfast time so that people could butter their own toast.

People told us "the Doctor and Nurse come to see us", "the Optician also comes in to see us" and "if you mention you are not well they (the staff) are very kind and get the Doctor".

When asked if they felt safe living in the home people said "oh yes, safe as houses", "you are well looked after" and "the lasses are very good, I'm very forthright and would tell them if things were not right". People said "the home is spotlessly clean", "it smells really fresh", "the staff regularly change the bedding" and "I'm very particular about cleanliness and I haven't needed to grumble once".

We asked people who used the service if they felt there were enough staff on duty. They said "oh yes, there are enough staff to look after me", "and if you ring the bell for attention they come to you".

The inspection took place on 14 and 15 October 2015. The inspection was unannounced.

Acorn Grange is a residential care home for up to 48 people based in West Cornforth, County Durham. The home provides care to older people and people with dementia. It is situated close to the town centre, close to local amenities and transport links. On the day of our inspection there were 41 people using the service.

The home had a registered manager. 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.

We spoke with a range of different staff members; care, domestic, senior , kitchen and maintainencestaff who told us they felt supported and that the registered manager was always available and approachable. Throughout the day we saw that people who used the service and staff were comfortable and relaxed with the registered manager and each other. The atmosphere was relaxed and we saw that staff interacted with each other and the people who used the service in a very friendly, positive and respectful manner.

From looking at people’s care plans we saw they were written in plain english and in a person centred way and made good use of pictures, personal history and described individuals care, treatment and support needs. These were regularly reviewed and updated by the care staff and the registered manager.

Individual care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary for example: their GP, mental health team, community nurse or Chiropodist.

Our observations during the inspection showed us that people who use the service were supported by sufficient numbers of staff to meet their individual needs and wishes.

When we looked at the staff training records they showed us staff were supported and able to maintain and develop their skills through training and development opportunities. The staff we spoke with confirmed they attended a range of learning opportunities. They told us they had regular supervisions and appraisals with the registered manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs. We also viewed records that showed us there were robust recruitment processes in place.

We observed how the service administered medicines and how they did this safely. We looked at how records were kept and spoke with the registered manager about how staff were trained to administer medication and we found that the medication administering process was safe.

During the inspection we witnessed the staff rapport with the people who used the service and the positive interactions that took place.. The staff were caring, positive, encouraging and attentive when communicating and supporting people.

People were being encouraged to participate in activities that were personalised and meaningful to them. For example, we saw staff spending time engaging with people as a group and on a one to one basis on activities and we saw evidence that other people were being supported to go out and be active in their local community.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered a selection of choices of drinks and snacks. The daily menu that we saw also offered choice.

We saw a complaints procedure that was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. People also had access to advocacy services if they needed it.

We found an effective quality assurance survey took place regularly and we looked at the results. The service had been regularly reviewed through a range of internal and external audits. We saw that action had been taken to improve the service or put right any issues found. We found people who used the service; their representatives were regularly asked for their views at meetings.