We inspected Acorn Hove on 24 April 2018. Acorn Hove 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 Hove is registered to accommodate up to 12 people, some of whom were living with dementia, a learning disability and other long standing conditions. Acorn Hove is comprised over three floors, with a kitchen, lounge and dining area. There were 11 people living at the service during our inspection.

At the last inspection on 17 & 18 June 2015, we rated the service as good, However, we identified some concerns in relation to the way medicines were managed. We asked the provider to take action to make improvements and this action has been completed. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

A registered manager was 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.

We have made a recommendation about systems being implemented to comply with the Accessible Information Standards (AIS).

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including managing behaviour that may challenge others and awareness of autism. Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People’s end of life care was discussed and planned and their wishes had been respected.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people could give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People were encouraged to express their views and they said they felt listened to and any concerns or issues they raised were addressed. People's individual needs were met by the adaptation of the prem

During our previous inspection, on 11 July 2013, shortfalls were identified in the level of training and support that staff received, including inconsistency in the provision of formal supervision. We also found that staff meetings were not taking place, which further affected communication within the home. One care worker told us "I really can't remember the last time I had supervision – and I can't even remember when we last had a staff meeting".

The provider subsequently submitted an action plan detailing how the shortfalls would be addressed. This follow up inspection was carried out to monitor any changes and improvements made.

The manager told us that, in accordance with their action plan following the previous inspection report, regular formal staff supervisions had been resumed and staff meetings had been reinstated. This was also confirmed by care workers we spoke with and through supervision records and minutes of recent staff meetings that we were shown. One care worker told us “Things have improved and people feel more involved now. We do use the computer now for recording residents’ notes and we’ve all had supervision and at least one meeting since you were here last time”.

As part of the inspection process we spoke with three care workers and the manager. We looked at documentation including staff training records, supervision forms and minutes of recent staff meetings. We were given assurances by the manager that these improvements will be sustained and regular staff meetings and formal supervision will be on-going.

During our inspection we found that the premises were clean and well maintained and the atmosphere was relaxed, welcoming and homely.

As part of the inspection process we spoke with three people who used the service, four care workers and the provider who was also the registered manager.

Positive comments received from people using the service indicated satisfaction with the home and the services provided:

“I’m happy living here. It’s comfortable, the food’s good and the staff are very kind and caring”.

“I like it here and wouldn’t want to be anywhere else. I can go out when I want, which is important to me and there’s always someone around if I need anything”.

In accordance with their individual care plans, people were supported to make choices about their daily lives. We found that care workers had developed a sound understanding of each individual's care and support needs. This was evident from direct observation of individuals being supported in a professional, sensitive and respectful manner.

Shortfalls were identified in the level of training and support staff received, including inconsistency in the provision of formal supervision. We also found that staff meetings were not taking place, which further affected communication within the home.

Appropriate arrangements were in place in relation to storing, administering handling and recording medicines.

The provider had satisfactory systems were in place to deal with comments and complaints.

During our visit we spoke with three people who were using the service and three members of staff. People who used the service told us that they like living at the home and that the service met their needs. People told us that staff were kind and caring and that there was always someone around to provide help and support. Comments included the following: "I am happy here”, and, “it is a nice place to live."

We made observations throughout the visit and saw people being offered choices as to what they wanted to eat or what activities they wanted to take part in during the day. We saw people being addressed in a respectful manner. We looked at peoples individual care plans and saw that the information recorded enabled staff to plan and deliver the required level of care and support on an individual basis.

We saw that regular audits of the service were completed by the provider ensuring that people who used the service benefit from a service that monitors the quality of care that people received.

Staff told us that they had received regular training and that they felt that they were supported to carry out their roles and meet the needs of people who used the service.

People said that they had no complaints about the service and that if they did they would speak to the staff or the manager

During our visit, we found that people living in the home were settled and well cared for. This was reinforced by positive comments received and also evident from direct observation of effective interaction and of individuals being supported in a professional, sensitive and respectful manner.

We were told that, in accordance with their identified wishes and individual support plans, people are encouraged and enabled, as far as practicable, to make choices about their daily lives.

We inspected Loxwood House over two days on the 6 and 8 May 2015. Loxwood House is a care home located in Hove. It provides care and support for up to 12 people. At the time of the inspection the home had eleven people living there. Five people required specialised dementia care while six people were living with a learning disability. One person had a dual diagnosis. The youngest person was aged 49 though most people were aged over 60 years. One relative told us “It’s got a very good feeling. It may change over time I suppose as more people living with dementia move in but the changes have been well managed. They haven’t lost sight of the individuals that live here and it’s tailored to their individual needs.”

Accommodation was provided in a residential area of Hove. It was arranged over three floors. The first floor was accessible by a stair lift. The environment to support the needs of those with a learning disability and those living with dementia. The home had communal lounges, dining area and an attractive and fully accessible garden.

We saw there was an unacceptable delay between a visit by a health care professional and the person receiving the medicine they were assessed as requiring. People’s medicines were stored safely and in line with legal regulations.

There was a registered manager in post. They were also the registered provider. 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 and their relatives spoke positively of the home and commented they felt safe. They were complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. We were told, “The staff are kind and yeah I am happy here.”

Staff interactions demonstrated they had built a good rapport with people. Care plans and risk assessments included people’s assessed level of care needs and actions for staff to follow. Staff explained how they kept people safe. People told us that their room was kept clean and safe for them. One person said, “I am fine here. I do feel safe.”

Health and social care professionals from a range of disciplines visited the home on a regular basis. The provider and staff regularly liaised with GPs, physiotherapists and speech and language therapists.

Staff received training on the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They had a good understanding of the legal requirements of the Act and followed it in their practice.

Care and support plans contained information on people’s likes, dislikes and individual choice. Information was available on people’s life history and people and families were involved in the development and review of their care plans.

Six people regularly went to morning clubs and day centres on week days and to evening social clubs. A range of group activities were available in the home but were not always participated in by individual choice. One person said, “I have been to Eastbourne today. I went to the shops and had pasta for lunch”. As well as group activities, people were supported to maintain their hobbies and interests. People received 1:1 support in activities as part of their day.

There was a varied menu, which was planned and changed on a regular basis and reflected the time of year. Everyone we spoke with was happy with the food provided. Their dietary needs and preferences were recorded. People told us that their favourite foods were always available. People were supported to eat and drink enough to meet their nutritional and hydration needs. Staff used their knowledge of people’s likes and dislikes where they found it difficult to make an active choice.

Staff understood their roles and what was expected of them in terms of delivering good personalised care and support. There was sufficient day to day management cover to supervise care staff and care delivery. The management structure at the home provided consistent leadership and direction for staff. The provider carried out regular audits and monitored the quality of the service.

Management and staff were committed to a culture of continuous improvement. A healthcare professional told us, “There is always a welcoming environment and always someone to talk to. I have no negatives to say.” Feedback was regularly sought from people, relatives and staff. Meetings were held in which decisions relating to the home were discussed.