What life is like for people using this service:

•People received care and support based on their needs and preferences. Staff were aware of people’s life history and preferences and they used this information to develop positive relationships and deliver person centred care. People had good health care support from external professionals. Where staff noted a concern they quickly involved healthcare professionals, to achieve positive outcomes for people.

•Some people were concerned about the use of agency workers in the service because they felt that they did not receive the same level of care and dignity that they received from permanent staff, whom they all described positively. The registered manager and provider were aware of this concern and were working to reduce the impact on people of using agency staff. They tried to book in advance and ensure the same staff were used so they could get to know people and build relationships, while they recruited for new staff.

•Staff spoke positively about working in the home, telling us they ‘loved’ it. They were confident the service put people first while supporting staff to deliver good care. Management of the service were open to suggestions and keen to make positive developments. Following a recent safety concern, they reviewed their processes and implemented new systems to ensure staff had the knowledge and skills to prevent a reoccurrence.

•The service met characteristics of Good in all areas;

•More information is in Detailed Findings below.

Rating at last inspection:

Good (report published 23 June 2016)

About the service:

Acacia House Nursing Home is a residential care home that was providing personal and nursing care to 22 people aged 65 and over at the time of the inspection.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The inspection was prompted in part by notification of a serious medicines error. The information shared with CQC about the incident indicated potential concerns about the management medicines. We checked this in looking at the quality and safety of the service.

Follow up:

There is no required follow up to this inspection however we will continue to monitor the service through information we receive.

The inspection took place on the 27 and 28 April 2016 and was unannounced.

The home had a registered manager in place. 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 registered manager also managed another service close to Acacia House Nursing Home and shared their time between both services.

There were sufficient numbers of staff deployed to meet the needs of people who used the service. Staff had appropriate skills and knowledge to support people.

People told us they felt safe living at the home. Staff were knowledgeable about reporting any harm. Recruitment procedures ensured that only suitable staff were employed.

Medicines were stored and secured appropriately. People told us that they received their medicines on time.

The registered manager was knowledgeable about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). When people were assessed as unable to make decisions for themselves the MCA process had been followed. DoLS are put in place to protect people where their freedom of movement is restricted to prevent them from possible harm. The registered manager had taken appropriate action for people who needed their movement restricted.

People were supported to eat and drink enough to keep them healthy and were offered choices at mealtimes. Staff were aware of people's individual dietary needs and how to support people. People were supported to access a variety of healthcare professionals to ensure their health care needs were met and were assisted to see their GP as and when required.

People were supported to maintain relationships. People living at the home and their relatives told us that they felt the staff were kind and caring.

People living at the home all thought that the home was well-led. They all spoke positively about the registered manager and the staff group.

There were a number of quality audits in place to assist the provider in assessing and reviewing the delivery of care in the home.

People who lived at Acacia and their relatives told us that they were happy living at the home. They told us that staff always sought their agreement before providing care and support.

Individualised care plans detailed the support and care each person required. People confirmed they received the support and care they needed and liked. The home ensured relevant health care professionals were contacted when needed.

The environment of the home was maintained to an adequate and safe standard.

The recruitment process ensured that staff who were employed had been checked to ensure the safety of people using the service..

The quality of the service provided was monitored by an effective quality assurance processes.

There was an affective complaints procedure.

We observed staff being respectful, asking people if they needed support and assisting when needed.

During the visit we spoke with five people who use the service and two relatives. Three of the five people we spoke with said they received good care and that staff knew how to meet their needs, the other two did not comment on this. People told us staff listened to their requests and provided care in the way they wanted it. People told us they received support to take their medicine at the right time.

Most people told us they were able to have drinks when they wanted and said the food was generally good, although sometimes not enough. People said there was a choice of meals and they were able to request something different if they wanted to. One person told us staff ensured their drink was placed in the right place to enable them to reach it and said they received the support they needed.

Four people said there was generally enough staff available, although they felt that there was sometimes a problem at weekends. One person said they felt there was sufficient staff, who came quickly when they used their call bell. One person said staff answered the call bell quickly, but said they would like to get out of bed earlier. Another person we spoke with did not comment on staff availability, but said they received all the care they needed and were satisfied with the home.

Relatives told us that they were happy with the staff and the care that their family member received. They said they were always informed if there were any concerns and they were able to approach any member of staff if they were worried. Examples of comments included; “Staff are always friendly and most of them are professional”.