Acorn Lodge Care Centre is a care home. People in care homes receive accommodation and nursing or personal care 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.

Acorn Lodge Care Centre can accommodate 98 older adults who may have dementia in a purpose built four storey building. At the time of this inspection, 94 people were using the service.

This inspection took place on 16, 17 and 23 July 2018 and was unannounced. At the last inspection in April 2017, the service was rated as Good. During this inspection, we found one breach of the regulations and the service is now Requires Improvement. This is the first time the service has been rated Requires Improvement.

The service did not have 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.

Staff were knowledgeable about safeguarding and whistleblowing procedures. Safe recruitment checks were made before new staff began employment. There were enough staff on duty to meet people’s needs. Building checks were carried out in line with building requirements. Risk assessments were carried out to mitigate the risks of harm or abuse people may face. People were protected from the risks associated with the spread of infection. The provider analysed accidents and incidents and used this as a learning tool to improve the service.

People’s care needs were assessed before they began to use the service to ensure the provider could meet their needs. People and relatives were confident staff had the skills to work with their family member. Staff were supported with training opportunities, supervisions and appraisals. People were supported to eat a nutritionally balanced diet and to maintain their health. The provider understood their responsibilities under the Mental Capacity Act (2005). Staff understood the need to obtain consent before delivering care.

People and relatives told us staff were caring. Staff described how they developed caring relationships with people. Relatives were kept updated on the wellbeing of their family member. Staff were knowledgeable about equality and diversity. People were supported to maintain their independence and their privacy and dignity was promoted.

Care plans were personalised and contained people’s preferences. Staff understood how to deliver a personalised care service. The service was meeting people’s accessible communication needs. People were offered a variety of activities in accordance with their preferences. The service had a complaints procedure and kept a record of complaints. People’s end of life care preferences were recorded.

Relatives and staff gave positive feedback about the leadership in the service. The provider had a system to obtain feedback about the service in order to make improvements. People had regular meetings so their views about the service could be heard. Staff had regular meetings to keep updated on service development and to contribute their views on the running of the service. The provider had several quality audit systems to identify issues to improve the service. The manager worked in partnership with outside agencies to share examples of good practice.

We have made one recommendation about the continued monitoring of staff suitability.

This inspection took place on 5 April 2017 and was announced.

At our previous inspection on 5, 6, 7 and 8 April 2016 a breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to notifications.

We undertook this focussed inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breach found. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Acorn Lodge Care Centre’ on our website at www.cqc.org.uk’

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.

Acorn Lodge Care Centre provides accommodation for up to 98 people who require nursing or personal care. At the time of our inspection 95 people were living in the home.

At our previous inspection we found that the provider did not always notify the CQC of notifiable incidents.

At this inspection, we found that improvements had been made.

The provider was aware of the type of incidents that they were required to notify the Care Quality Commission (CQC) of and had reviewed their notifications procedure with the management team. A new log record had been created to correlate safeguarding incidents with their notification reference.

This inspection took place on 5, 6, 7 and 8 April 2016 and was unannounced on the first day. We told the registered manager we would be returning over the next few days. At our previous inspection on 17 January 2014 we found the provider was meeting the regulations we inspected.

Acorn Lodge Care Centre provides accommodation for up to 98 people who require nursing or personal care. At the time of our inspection 95 people were living in the home.

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 (CQC) 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 told us they felt safe using the service and registered nurses and healthcare assistants had a good understanding of how to protect people from abuse. Staff were confident that any concerns would be investigated and dealt with. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns.

People’s risks were managed and care plans contained appropriate and detailed risk assessments which were updated regularly when people’s needs changed. Staff worked with all people across all floors to ensure they were aware of the needs of each person. The service had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service. Sufficient numbers of staff were employed to keep people safe and meet their needs.

People who required support with their medicines received them safely from staff who had completed in-depth training in the safe handling and administration of medicines, which was refreshed annually. Staff completed appropriate records when they administered medicines and these were checked after each medicines round on the same day to minimise medicines errors.

There was a comprehensive induction and a six month probation period for new staff. Staff members also took part in a training programme to support them in meeting people’s needs effectively. New staff shadowed more experienced staff before they started to deliver personal care independently and received regular supervision from management. They told us they felt supported and were happy with their input during the supervision they received.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were aware of the importance of asking people for consent and the need to have best interests meetings in relation to decisions where people did not have the capacity to consent. The provider was aware when people had restrictions placed upon them and notified the local authority responsible for assessment and application.

Staff were aware of people’s dietary needs and food preferences and provided support to those who required it during mealtimes. People had regular access to healthcare services as a GP visited six times a week and recorded information in a visit book. Registered nurses and healthcare assistants told us they contacted other health and social care professionals, such as occupational therapists and speech and language therapists, if they had any concerns about people’s health. We saw evidence of this in communication books and people’s care plans.

People and their relatives told us staff were kind and compassionate and knew how to provide the care and support they required. All staff understood the importance of getting to know the people they worked with and showed concern for people’s health and welfare in a caring manner.

People were spoken with and treated in a respectful and kind way and staff respected their privacy and dignity, and promoted their independence

We carried out a follow-up inspection visit at Acorn Lodge Care Centre in October 2013. We found the service was non-compliant in Outcome 1 (Respecting and involving people who use services) as we identified some practices which did not promote people's dignity and individuality. At this inspection visit we saw that improvements had been made. People using the service told us that staff supported them in ways that acknowledged their individual preferences and interests. One person using the service said, "they [care workers] come into my room and chat, they tell me about their hobbies and we have a laugh." A visitor told us their relative was, "happy and well looked after."

We saw that the manager was working directly with staff to assist people with more complex needs, which meant staff were supported to provide individualised care that reflected people's choices and best practice.

During this inspection visit we spoke with twelve people using the service and the visitors (relatives and friends) of three other people. We also spoke with one visiting healthcare professional, as well as the home's manager, area manager and other staff.

Most people we spoke with told us they were happy with the quality of the care and support they received. One person using the service told us, "everyone is nice to me and they are so kind. I like to chat so the staff come in and give me all the news. It really cheers me up." The relative of another person said, "here they understand people's behaviour and I can't fault them. There is not one nurse we don't like, they are all very kind."

People were consulted about the care and treatment they received, although some of the care plans needed to be updated in order to show that people and/or their representatives were consulted when their health and social care needs changed. Most of the care plans we saw did not show that staff knew about people's lives and interests, in order to provide individualised care.

Safe systems were in place for the management of people's medications.

Staff were provided with mandatory training and other relevant training, although the level of dementia training did not reflect the needs of people using the service.

Appropriate measures were in place to monitor the quality of the service, including actions to seek the views of people using the service and their representatives.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a practising professional and an Expert by Experience; people who have experience of using services and who can provide that perspective.

People and their relatives told us that the home is “comfortable” and “homely”. People told us that the food is usually good and that they get a choice. All the people and relatives we spoke with said they had no concerns about abuse in the home. People said that they are confident they can raise concerns with the manager. People and relatives told us that there were always enough staff around to talk to and raise any concerns. One person said, “I am very grateful for the help staff give to me and they are so kind”, another remarked, “they are so respectful”.

This service was non-compliant in Outcome 4, Care and Welfare, at the previous inspection in July 2013. This follow-up inspection took place over two days and was carried out to check whether the service had made improvements.

People using the service and their representatives told us they were happy with the quality of the care. One person using the service told us, "they look after me well". We saw positive interactions between people who use the service and staff. However, there were incidences when staff did not consistently promote people's right to their privacy and dignity.

The five care plans we looked at showed that people's capacity to make decisions about their care was assessed and we saw staff seek people's verbal consent as they supported people with their daily care.

The care plans contained more detailed information about people's needs and wishes, including risk assessments to promote their safety and minimise risk. The involvement of families with planning and reviewing care was demonstrated in the care plans. Staff demonstrated better knowledge of people's backgrounds and interests. The recording of care provided had improved in many of the care plans we looked at.

Staff had received training and guidance in regard to safeguarding people and how to support people in a non-institutionalised manner.

The staffing levels were sufficient for people to receive individualised and safe care.

Systems were in place for the service to seek the views of people and improve upon care through the use of audits and observations by the manager and clinical lead nurse.