Little Acorns provides accommodation and support for up to 20 older people living with a dementia type illness. Some people are independent and require little assistance, while others require assistance with personal care, daily living and moving around the home. There were 18 people living at the home during the inspection.

The home is a converted older building, with bedrooms on three floors, a chair lift enables people to access all parts of the home and people used the secure garden to the rear of the building. The registered manager is also the owner/provider.

The registered manager was present during the 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.

This inspection took place on the 13 and 14 October 2016. It was unannounced and carried out by one inspector.

At the last inspection on 7 and 8 April 2015 we found the provider had not met the legal requirements with regard to medicines, nutrition and hydration, records and notifications. We found at this inspection that these legal requirements were met. The legal requirements with regard to the provision of an effective quality assurance system had been partially met and had not yet been embedded into practice.

Risk had been assessed and guidance had been included in the care plans for staff to follow, including supporting people to move around the home safely. However, staff did not consistently follow moving and handling guidelines when supporting people using walking aids.

A quality assurance system had been introduced and had identified areas where improvements were needed, including record keeping, care plans and risk assessments. Work had commenced to review and update these with the involvement of people and their relatives and, audits about aspects of the services provided had been developed.

There were systems in place to manage medicines. Staff were trained in the safe administration of medicines. Staff followed relevant policies; they administered medicines safely and completed the administration records appropriately.

People told us the food was very good. Staff asked people what they wanted to eat, choices were available for each meal, and people enjoyed the food provided. Meals were a relaxed and sociable time for people and records were kept of how much people ate to ensure they had sufficient food and drinks.

A safeguarding policy was in place and staff had attended safeguarding training. They had an understanding of recognising risks of abuse to people and how to raise concerns if they had any.

There were enough staff working in the home to meet people’s needs, and recruitment procedures were in place to ensure only suitable people worked at the home. Staff said they were supported to deliver safe and effective care, and demonstrated they knew people well and felt they enabled people to maintain their independence.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People had access to health professionals as and when they required it. The visits were recorded in the care plans with details of any changes to support provided as guidance for staff to follow when planning care.

A complaints procedure was in place. This was displayed on the notice board near the entrance to the building, and given to people, and relatives, when they moved into the home. People said they did not have anything to complain about, and relatives said they were aware of the procedures and who to complai

We spoke to people living at the home, relatives, members of staff and examined care plans. People told us, "It's very good here. They look after you well," and "The food is very good and if I press my call-bell I get a quick response." We found care was person centred, regularly reviewed and tailored to people's needs.

Staff we spoke with had a good understanding of abuse and how to raise a safeguarding alert if they needed to. The home had robust policies in place regarding safeguarding vulnerable adults.

There were safe storage, administration and recording policies and practices in place at the home in relation to medication. One person told us, "They know how I like to take my tablets."

We examined staff files and records of recruitment procedures. We also spoke with staff and found that the home took appropriate steps to ensure to keep people safe by employing suitable and qualified staff.

The home had a transparent and responsive complaints system. People we spoke with told us, "I've nothing to complain about but if I did, I would be happy to speak directly to staff or the manager."

People at the home were not able to tell us what they felt because of their complex needs, but we spoke with relatives who told us that the staff were "very supportive"’ and that it was a lovely home. One person said the staff never made their relative do something they didn’t want to.

The majority of people who lived in the home were unable to engage in the inspection process due to issues of capacity. However two people we spoke with said they liked living at the home.

Little Acorns provides accommodation for up to 20 older people. The home is a converted house and bedrooms are spread over three floors. There were 15 people living at the home on the day of the inspection who required a range of care and support related to living with dementia.

There is a registered manager at the home who is also the provider of the home. 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 inspection took place on 7 and 8 April 2015 and was unannounced.

People were supported by kind and compassionate staff who had a good understanding of their individual needs. We saw care delivered met people’s needs and was person centred. However, there was a reliance on verbal communication to update staff and people’s care records did not always demonstrate the care the required or received.

Medicines were not always managed safely as there was no guidance for staff about ‘as required’ (PRN) medicines. Medicine policies had not been reviewed and did not support the practice at the home and therefore placed people at risk from uninformed staff .

Risk assessments were in place but these did not include all identified risks. Although personal emergency evacuation plans were in place there was no guidance for staff on how to commence evacuation of the premises to ensure people were safe.

Staff had a good understanding of the safeguarding procedure and what steps they would take if they believed someone was at risk of abuse of harm.

There were enough staff who had been safely recruited to meet people’s needs. The registered manager had identified staff training and updates did not always take place in line with policy and had taken steps to address this. Staff received a period of induction and shadowing when they started work at the home. They told us they felt supported to meet people’s needs.

Staff understood their responsibility in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We observed staff asking people’s consent prior to providing any care or support. However, there was a lack of evidence about how staff obtained consent from people on a day to day basis.

People were supported to maintain a balanced and nutritious diet and people told us they enjoyed their food. However, mealtimes appeared noisy and not consistently well managed.

People were supported to receive appropriate healthcare to meet their needs. Healthcare professionals we spoke with were positive about the support staff provided.

There was not an effective system in place to assess the quality of the service provided; therefore the registered manager had not identified all of the shortfalls we found.

Care plans did not include information about people’s hobbies and interests. However, staff knew people well and supported them to do things they enjoyed.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.