Acorn Lodge - Croydon 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. The service accommodates up to 39 older people in one adapted building. At the time of our inspection 24 people were using the service, many of whom were living with dementia.

At our previous inspection in April 2018 we found the provider was in breach of legal requirements relating to dignity and respect, need for consent, safe care and treatment, staffing and good governance. We rated the service 'requires improvement' overall and in each of the five key questions. Following the inspection, we asked the provider to complete an action plan to tell us what they would do to address the breaches of legal requirements we found.

At this inspection we found the provider had addressed the breaches of legal requirements relating to dignity and respect, need for consent, safe care and treatment and staffing. However, they had not taken sufficient action to address the breach of legal requirements relating to good governance. We also found an additional breach of legal requirements. The service remains rated 'requires improvement' overall and in each of the five key questions.

Appropriate recruitment checks were not made on staff to ensure they were suitable to support people. There were however enough staff to support people safely. Staff received relevant training to help them in their roles and they were encouraged to improve their working practices through supervision. But, there was no system in place to monitor that supervision took place at regular and appropriate intervals.

Some improvement had been made to the quality of information for staff on how people’s care needs should be met. However, the quality of information contained in people’s care records was inconsistent and variable by individual. Staff were still not maintaining accurate and complete daily records of the support provided to people.

Staff had access to improved information about how to manage risks to people’s safety. Staff understood the risks posed to people and how they should support them to stay safe. Staff were trained to identify abuse and understood when to report concerns to the appropriate person. However, they were not always consistent when recording and reporting accidents and incidents involving people.

Arrangements to support people with their health needs were not fully effective. However, staff liaised with visiting healthcare professionals and when people became unwell they sought appropriate support from them. People received their prescribed medicines as required. These were stored safely and securely. However, guidance for staff on when to administer ‘as required’ medicines was not easily available to staff. Recording forms with body maps were not used by staff when they applied topical creams or lotions.

People had more choice over daily decisions. Staff respected people’s privacy when supporting them with their personal care needs. But staff were sometimes not observant to people’s appearances to ensure this was appropriate. Communication between people and staff was still inconsistent.

People were supported to eat and drink enough to meet their needs. Menus had been revamped following consultation with people and their relatives to include more choice and options for meals that people preferred. But people did not always have a dignified dining experience.

Activities provision at the service had improved. However, some staff were still not providing the level of engagement and stimulation for people that was expected. Staff supported people with their social, cultural and religious needs and to be as independent as they could be. There were no restrictions placed on people’s friends and relatives about when they could visit the service.

The provider had act

Acorn Lodge – Croydon 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 Lodge does not provide nursing care. Acorn Lodge accommodates up to 39 older people in one adapted building. At the time of our inspection there were 19 people using the service, many of whom had dementia.

At our last inspection on 16 July 2016 we rated the service ‘good’ overall and for each key question. At this inspection we identified breaches of legal requirements and the rating for the service had deteriorated to ‘requires improvement’ overall and for each key question.

The registered manager remained 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 2008 and associated Regulations about how the service is run.

Care records did not always provide clear, accurate and complete information about people’s needs. Nevertheless, information was provided about people’s life histories and daily routines. Records were maintained about the daily support provided. The provider did not adhere to the Mental Capacity Act 2005 and had not followed process for legal authorisation to deprive a person of their liberty.

A safe environment was not provided. Environmental risks had not been appropriately assessed and mitigated. Individual risk assessments were in place but there were insufficient and inconsistent plans to manage and mitigate risks.

The provider had not ensured that staff received regular training to ensure their knowledge and skills were up to date to undertake their duties in line with best practice guidance.

A new governance framework had been introduced but this was not fully embedded and needed expanding to ensure it captured all areas of service delivery. There were no formal systems in use to capture the views of people and their relatives about the service or to use this to improve the quality of service provision. The provider did not always use feedback from local authority quality visits to improve service delivery.

There was rigid structure at the service which did not accommodate flexibility within people’s routines. People had a lack of choice over daily decisions. People were not supported to communicate, particularly if they were unable to speak English or were unable to verbally communicate. We recommend the provider adheres to the accessible information standard.

Activities were provided. However, these were repetitive and did not always take account of people’s interests and hobbies. We observed some people were isolated whilst activities were delivered. Activities did not always take account of people’s individual needs and we recommend the provider consults national guidance about activity provision and engaging people living with dementia.

The provider was in the process of completing a redecoration and refurbishment programme of the service. However, at the time of inspection the environment did not meet the needs of people living with dementia and we recommend the provider consults guidance for implementing a dementia friendly environment.

On the whole safe medicines management processes were in place. However, systems for maintaining accurate stock checks were not robust.

Staff followed procedures for safeguarding adults’ and adhered to infection control procedures. Staff adhered to the provider’s incident reporting process. Safe recruitment processes were followed and there were sufficient numbers of staff to support people.

People were supported with their dietary requirements and staff arranged for healthcare professionals to visit and for people to attend appointments in order to

This inspection took place on 31 May and 17 June 2016. Our first visit was unannounced. The purpose of the inspection was to carry out a full comprehensive review of the service and to follow-up on the four requirement actions made at the previous inspection in March 2015. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements. At this inspection we found the provider had followed their action plan and improvements had been made in the required areas.

Acorn Lodge – Croydon provides residential care for up to 36 older people. The service changed its registration with CQC in 2015 and no longer provides nursing care.

The home still did not have a registered manager in post at the time of this inspection however the acting manager had submitted an application to be registered with CQC. 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 felt safe living at Acorn Lodge - Croydon and spoke positively about the care provided to them. They said staff treated them with kindness and respect. Relatives and friends were welcomed and people were supported to maintain relationships with those who matter to them. Visitors spoken with were positive about the service being provided and said they could visit at any time.

Staff had received training around safeguarding vulnerable people and knew what action to take if they had or received a concern. They were confident that any concerns raised would be taken seriously by the acting manager and acted upon.

People were protected against the risks associated with the unsafe use and management of medicines. Improved arrangements were in place for the recording, safekeeping and administration of medicines.

Improvements had also been made to make sure that people’s care and support needs were fully assessed, documented and reviewed at regular intervals.

There was a system in place for dealing with people’s concerns and complaints. People using the service, staff and visitors said that the home had benefited from the leadership provided by the acting manager. This view was shared in the feedback received from health professionals who had involvement with the service.

Improved quality assurance procedures had been introduced including regular audits of medicines, infection control, care plans and falls.

We spoke to three people using the service. They told us that staff respected their privacy, dignity and independence. They told us that they felt they could talk to staff, staff were friendly and staff listened to them. They told us there were lots of activities to participate in if they wished to.

Staff told us they had received lots of training, they attended staff meetings and they received supervision. A visiting National Vocational Qualification assessor told us that twelve staff was progressing in completing Qualifications and Credit Framework courses.

We found there were appropriate arrangements in place to manage medicines.

We observed positive interactions between staff and people using the service during the course of our visit.

We spoke to nine people who use the service, four members of staff and the registered manager during our unannounced visit.

‘It’s alright, they are good to you’, ‘it’s pretty good’, ‘I enjoy it here’, ‘very good’, ‘it’s not bad’ and ‘helpful’ were all comments from people who use the service about Acorn Lodge.

The people we spoke to said that they were treated with dignity and respect. Comments included ‘respectful – yes, they’ve got to be’, ‘they treat me nicely’ and ‘very respectful’. One person told us that ‘we never get told off here’. A visitor told us that their relative was ‘well looked after’ at Acorn Lodge.

Comments about staff included ‘they are nice’, ‘they work hard’, ‘very caring’, ‘I get on alright with them’ and ‘very nice’.

‘The food is nice’, ‘I enjoy it’, ‘it’s quite nice’, ‘the food’s alright’ and ‘I like it’ was representative of the feedback received about the food provided at Acorn Lodge. One person said ‘I do like the food and I don’t get indigestion’. We saw people received one to one support to take their meals if they required it.

We used our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s daily experiences were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff.

We saw people spending time participating in activities including making a Jubilee collage, reading, exercise and interacting with dolls and soft toys. We saw a very positive reminiscence session take place in the afternoon with lots of interaction between staff and people who use the service. Levels of interaction with staff were generally good although there may be opportunities to further increase these.

The home was clean and satisfactorily maintained at the time of our visit however the premises could be enhanced to further promote the wellbeing of the people living at the home.

This inspection took place on 3 and 4 March and was unannounced.

Acorn Lodge - Croydon provides nursing and residential care for up to 39 older people, some of whom may have dementia.

We last inspected Acorn Lodge - Croydon in June 2013 . At that inspection we found the service was meeting all the regulations that we assessed.

A registered manager was not in post at the time of our inspection. A temporary acting manager was present at the time of this inspection along with a newly recruited manager who had just commenced work at Acorn Lodge - Croydon. 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 using the service said they felt safe and well cared for at Acorn lodge – Croydon. There were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these. Staffing numbers on each shift were sufficient to help make sure people were kept safe.

Safe practice was not being followed when giving medicines to people and keeping up to date accurate administration records.

Risks to people’s safety and welfare were not always being managed appropriately. Care plans were not all up to date and did not fully document the care and support being provided to each individual.

Staff were caring and treated people using the service with dignity and respect. They received training and support to help them carry out their role effectively.

We have made a recommendation about improving the mealtime experiences for people using the service.

People were not being consistently supported to follow their own interests and take part in social activities.

The systems in use to monitor the quality of the service or to drive improvement were not effective. There were few opportunities for people, their relatives or friends to be involved in or consulted about the way the service ran.

You can see what action we told the provider to take at the back of the full version of this report.