This inspection took place on 5 January 2016 and was unannounced.

The service was registered to provide accommodation and nursing care for up to 72 people. Care and support was provided to people from the age of 18 years upwards. Accommodation and care was provided over two floors. People who used the service had physical health and/or mental health needs. At the time of the inspection, there were 52 people using the service.

We carried out an unannounced comprehensive inspection of this service on 17 October 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to protecting people from harm and abuse, staffing levels and assessing and monitoring the quality of the service provided. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements.

The service 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.

People felt safe and were protected from avoidable harm and abuse by staff who knew how to recognise potential signs of abuse and how to report them appropriately. We saw that systems were in place and were followed to ensure that safeguarding adult’s investigations took place when required. However, people were at risk of not receiving their medicines as prescribed because staff were not always accurately recording what medicines had been taken.

There were enough staff to meet the needs of people who used the service and staff were recruited safely. People’s risks were assessed and managed to help keep them safe and we saw that care was delivered in line with agreed plans.

People were encouraged to make their own decisions and support was provided in line with current legislation and guidance.

People with provided with enough food and drink to maintain a healthy diet. People had choices about their food and drinks and were provided with specialist support when required to ensure their nutritional needs were met. People’s health was monitored and access to healthcare professionals was arranged promptly when required.

People were treated with kindness and compassion and they were happy with the care they received. People were encouraged to make choices about their care and their privacy and dignity was respected.

Staff were responsive to the needs of people who used the service. People were supported to follow their hobbies and interests in the home as well as in the community.

People knew how to complain if they needed to. A complaints procedure was in place and we saw that complaints had been thoroughly investigated and responded to in line with the provider’s procedure. People and their relatives were encouraged to give feedback on the care provided via questionnaires and meetings and the registered manager had an 'open door' policy. The registered manager responded to feedback and changes were made to improve the quality of the service provided.

We saw that improvements had been made to the systems in place to monitor quality and that the registered manager took actions to make improvements when required. However, there were some issues that had not been identified during quality checks. Effective systems were not in place to ensure that staff had access to and time to complete suitable training.

People, relatives and staff felt the registered manager was approachable and responsive. The registered manager understood the requirements of their registration with us.

We inspected Acres Nook on 17 October 2014. Acres Nook is registered to provide accommodation and nursing care for up to 72 people. Care and support is provided to people from the age of 18 years upwards. Accommodation and care was provided over two floors. People who use the service had physical health and/or mental health needs.

The registered manager had recently resigned from the service and was not present on the day. However, the provider had not notified us of the absence of 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 and associated Regulations about how the service is run.

Care was not always provided as planned and risks were not always managed to reduce risks to people.

There was not always enough staff available to meet people’s needs in a responsive manner. This meant we saw that people did not always receive the support they wanted when they needed it.

People were at risk of receiving unsafe care because staff did not feel they had the knowledge and skills to meet the needs of people who required specific care interventions in order to remain well.

We observed that care delivery was task-led and staff told us that they were always rushed and therefore people did not always receive the care and attention they required. People’s dignity was not always maintained.

People’s mealtime experiences were not always pleasurable because people who required support during meal times did not always receive they support when they needed it.

We found that safeguarding procedures were not always followed when people were at risk of abuse. Staff did not recognise and take appropriate action when people were at risk of abuse or neglect.

Effective systems were not in place to support people who wanted to make complaints about the care provided. Concerns or complaints raised were not explored and responded to effectively.

The provider did not have effective systems in place for managing complaints.

The provider did not have effective systems in place to monitor the quality of the service. Staff told us that they felt that the organisation was not open and did not feel that their concerns will be listened to or acted on by the managers. There had not been consistent day-to-day management and direct leadership of the service.

Medicines were ordered, stored and administered safely. People were supported to take their medicines independently and safely.

The provider supported people to maintain their faith and beliefs. People and their relatives were given opportunities to meet regularly to express their views about the service.

When people were unable to make certain decisions about their care, mental capacity assessments were carried out to decide what decisions could be made in people’s best interest. The provider had not made any applications to deprive people of their liberties. The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) set out the requirements that ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. We were told and we saw that a majority of people who used the service were able to give consent to a variety of aspects of their care.

We identified that the provider was not meeting some of the Health and Social Care Act 2008 Regulations we inspect against and improvements were required. You can see what action we told the provider to take at the back of the full version of the report.

Before this inspection we had received concerns that people with dementia might not be having their needs met effectively. This inspection focussed on the care and welfare of people with dementia. We also met with other people who used the service.

We found that there had been some changes to the small dementia care unit by way of incorporating this into the rest of the home. We found that there was only a small number of people using the service with dementia care needs and that their needs were being met effectively. The manager told us that the provider would not be admitting new people to the home with dementia care needs. This was because they felt that the home was more suited to people with other care needs.

During this inspection we spoke with seven of the people who used the service and one set of visitors. We spoke with four staff members and met with the manager and the quality monitoring manager. We observed staff to be caring and attentive.

Most of the people we spoke with felt that they were being well cared for and that staff were caring and attentive to their needs. One person told us, "The staff are very good here, I cannot fault it." A visitor told us, "The care seems to be good here and the manager has been very helpful and accommodating." Two of the people we spoke with felt that there should be more staff available on occasions. One person said, "Sometimes it takes a while for the call bell to be answered. I think more staff would help."

During this inspection we spoke with eight visitors and nine staff members and had discussions with the manager of the service.

An expert by experience took part in this inspection and talked to people using the service and staff. An expert by experience is some one who uses services, or has had experience of services. They are people of all ages, with different experiences and from diverse cultural backgrounds. Our expert by experience took some notes and wrote a report about what they found. We have taken their comments into account whilst making our judgements about the service.

People using the service were happy with the care and support they received. They felt that staff treated them with respect and that staff delivered care and support in the way they preferred. A person said, "I am very happy here the staff look after me very well."

Since our last inspection a new provider had taken over this home and improvements had been made in all outcome areas. There had been major improvements to the environment and this meant that people were cared for in an environment which had been updated and adapted to meet their needs.

Staff were trained and supported to meet the needs of people. A staff member said, "We are very well supported with our training here. It is very good."

The manager ensured that management was open and inclusive and people who used the service were listened to and had a voice. A person told us, "The manager is very approachable."