Acorn Lodge - Surbiton 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 supports up to 10 people with learning disabilities, who also need support to maintain their mental health, in a large detached house in Surbiton.

This unannounced inspection took place on 24 October 2018. There were seven people living at Acorn Lodge – Surbiton when we visited. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager 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.

At our last inspection in March 2016, we rated the service good. 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. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People’s needs were assessed by the staff of the service and care and support was delivered to meet their assessed needs. Risks relating to people’s support were assessed and mitigated by staff, and the service had a flexible staffing rota to ensure there were enough staff to meet people’s needs.

People received their medicines as prescribed, by staff who were trained and assessed as competent to administer medicines. Staff were well-supported in their roles through training, appraisal and supervision.

The service had a strong, caring, person-centred culture in which people were empowered to lead fulfilling lives. The registered manager and senior management team had robust systems in place to ensure the service continually improved.

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.

Further information is in the detailed findings below.

This inspection took place on 23 March 2016 and was unannounced. At the previous inspection on 16 July 2014 we found the service to be meeting all the regulations we inspected.

Acorn Lodge - Surbiton provides personal care and support for up to ten people with mental health needs within a care home setting. There were eight people using the service at the time of our inspection.

There was a registered manager 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.

The premises and equipment were well managed with a range of checks in place to assess, monitor and improve health and safety. A maintenance team was in place to carry out repairs promptly.

Medicines management was safe with robust processes for checking people received their medicines as prescribed. There were sufficient medicines in stock for people and medicines were checked on receipt from the Pharmacy by two staff.

Staff understood the signs which could indicate people may be being abused and how to respond to this to keep people safe. Staff received training in safeguarding to keep their knowledge current.

Staff were recruited through robust procedures to check they were safe to work with people at the service. There were enough staff deployed to meet people’s needs. The registered manager supported staff through a programme of induction, supervision and appraisal. A training programme for staff was in place which the registered manager kept under review.

The service was meeting their requirements in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS), and staff had been provided training in these areas. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

People received choice of food and drink and were positive about the food they received. Staff monitored whether people were getting enough nourishment and took the appropriate action when there were concerns people were not. Staff also supported people to access a range of healthcare services to monitor and maintain their mental and physical health.

Staff supported people in a kind and caring manner and knew the people they were supporting well. People were supported to be as independent as they wanted to be. People were involved in making decisions and reviewing their own care and information about their background and their preferences was recorded in their care plans to guide staff in supporting them. Care plans were regularly reviewed and contained accurate information about people and so were reliable to staff. People, their relatives and staff were involved in the running of the care home and were consulted on in various ways.

The service provided people with sufficient activities they were interested in to keep them occupied. People's cultural, religious and spiritual needs were also catered for.

People were confident in how management would respond to any complaints they made and the complaints procedures had been made accessible to people. Details of complaints and the action which had been taken in response to them had been clearly recorded for auditing purposes.

There was a registered manager in post who had managed the service for many years. They were aware of their role and responsibilities, as were staff. A range of audits was in place to assess, monitor and improve the quality of the service. The registered manager encouraged open communication with people using the service and staff, consulting with them in various ways on the running of the service.

During our last visit to this home on the 10 April 2014, we identified essential standards of quality and safety were not being met in respect of three areas; the planning and delivery of care; responding appropriately to allegations of abuse and unsuitable storage of records of people using the service. These three areas are covered by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Following the inspection we asked the provider to take action to achieve compliance with the regulations. The provider sent us an action plan on 30 June 2014 setting out the steps they would take. During this visit we checked these actions had been completed.

This visit was carried out by an inspector who helped to answer one of our five questions: Is the service safe? Is the service caring? Is the service responsive? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection. We also looked at three sets of information about people who use the service and talked with a member of staff, the registered manager and a representative of the provider. There were nine people living at the home on the day of our visit.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans detailed that people’s needs were identified and met. These plans were now regularly reviewed and updated so that they were meeting people’s current needs. Any risks were assessed and reviewed regularly to ensure people’s safety was promoted whilst ensuring their independence.

The Care Quality Commission monitors the operation of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). The manager had received training and that the home knew how to make a referral to the local authority if a DoLS assessment was required. This could help to ensure that people’s human rights were properly recognised, respected and promoted.

We saw the provider had systems and checks in place to ensure that people were safeguarded from the risks of abuse by responding to allegations of abuse appropriately.

People’s privacy and confidentiality was maintained as care records were stored securely.

This inspection was carried out by an Inspector who helped answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were no Deprivation of Liberty Safeguards in place for any people using the service at the time of the inspection. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people were protected from the risks of having their freedom restricted unnecessarily.

Allegations of abuse were not responded to appropriately, and so people using the service were not always safeguarded against the risk of abuse. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safeguarding people from abuse.

The premises were generally clean. Monitoring of health and safety within the home was not always consistent, and health and safety risk assessments were not always regularly reviewed although the premises were overall safe and suitable.

There were sufficient numbers of suitably qualified staff employed by the service to meet the needs of people using the service. We looked at staff recruitment and found this to be satisfactory.

Is the service effective?

People’s health and care needs were assessed, but information in care plans and risk assessments was not always accurate or regularly reviewed. People’s personal records such as care plans and risk assessments were not held securely. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping an accurate record of each person using the service, documents relating to the management of the care home, as well as keeping personal records securely.

Is the service caring?

Staff knew the needs of people using the service well. People commented that they liked the staff. We saw that people spent time interacting in a respectful way with people using the service.

Is the service responsive?

The manager had recently reviewed staff numbers in response to the changing needs of people using the service. This meant that the service was responsive to people’s needs. However, the provider did not always submit notifications to the commission as required by law. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to notifying the commission of incidents of abuse, or allegations of abuse, in relation to people using the service.

Is the service well-led?

We looked at the training that the registered person had done and found that they kept their training up to date in order to manage the service.

The service worked well with other agencies, such as social services and local mental health teams, to make sure people received their care in a joined up way.

The manager monitored and assessed quality within the home in various ways, including seeking the views of people using the service, staff and family members.

People were able to tell us about their care and the support they received and we were able to see evidence that people were not treated as a group but had individual lifestyles within the home. For example, some people attended day centres, one person worked part time at a local restaurant, another preferred to spend time outside the home by visiting local shopping centres or parks.

Care records showed that people had had their needs assessed and their care planned taking into account their past experiences, life history, likes and dislikes. Appropriate agencies, such as health services and social services were involved in the care planning process and regular reviews of care were seen to have taken place. We found that staff and managers were aware of local safeguarding procedures and of the role of social services and health authorities.

The provider had an effective system to regularly assess and monitor the quality of service that people received and had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

People told us that they were happy living at Acorn Lodge and that the staff were friendly. Some people told us that they enjoyed the freedom to be independent and go to places alone. Others told us that they felt safe and that they felt staff would help them if they had any problems.