Acer House 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. Acer House Care Home was last inspected in May 2016 when the service was rated Good overall at that time.

Acer House is registered to provide care for up to 60 older men or women, they do not carry out nursing care. Acer House is a three-storey building which has accommodation on the ground floor for people with general care needs (Milton) and on the first floor for people with dementia (Ashcombe). There is an internal courtyard garden which is secure.

There was a registered manager for the service. The new registered manager had been in post for nearly three months. 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 staff training programme in subjects relevant to people's needs was in the process of being updated. This was to complete and update staff training in health and safety and care related subjects.

The quality checking system for the care and overall service at the home had been brought up to date and consistently used effectively. This meant the care and service was properly checked and monitored to ensure it was safe and suitable.

People had positive views of the home and the care they received. Examples of comments included, “You can do everything you want to do here. You’re free to go out; you could go to the shop next door if you wanted to” and “The staff are really lovely, they come in and check on you and they hold your hand and listen to you.”

Risks to the safety and wellbeing of people were minimised because staff had completed safeguarding adults training. Staff continued to know how to identify the different types of abuse. Risk assessments were up to date and these identified the areas where the safety of people may have been at risk. Accidents and incidents were monitored and actions taken when needed to keep people safe. Trends were also picked up to reduce the risk of reoccurrences. There were safe practices and procedures for the administration and storage of people's medicines in the home.

People told us they liked the food and we saw they were offered choices at each mealtime to help them select the meals they liked.

People at the home and the staff had built up caring and positive relationships. This was also evident with relatives and friends who spoke positively of the caring attitude of the staff.

Staff continued to understand the needs of the people they supported and knew how to care for them in a way that met their needs. The staff we saw had a caring and attentive manner towards the people they supported who lived at the home. Whenever possible, people were involved in making decisions about their care and support needs. People were offered discrete and sensitive assistance if they needed support to eat their meals or with intimate care.

Acer House Care Home provides care and accommodation for up to 60 people, some of whom are living with dementia. During our inspection there were 53 people living in the home. The home comprises two floors; Ashcombe provides care to people living with dementia, and Milton which provides residential care. The home is situated in a residential area of Weston Super Mare.

We inspected Acer House Care Home in March 2015. At that Inspection we found the provider to be in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The regulations included; Regulation 9, person centred care, Regulation 11, need for consent and Regulation 17, good governance.

The provider wrote to us with an action plan of improvements that would be made. They told us they would make the necessary improvements by July 2015. During this inspection we saw the necessary improvements had been made.

This inspection took place on 19 and 24 May 2016 and was unannounced.

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.

People and their relatives said the home was a safe place. Systems were in place to protect people from harm and abuse and staff knew how to follow them. The service had systems to ensure medicines were administered and stored correctly and securely.

We received mixed comments from people and staff about the staffing levels. We found there were enough staff available to respond to people’s needs.

Risk assessments had been carried out and they contained guidance for staff on protecting people.

People’s rights were protected because the home followed the principles of The Mental Capacity Act 2005 where people lacked capacity to make decisions for themselves.

Staff felt well supported and well trained. Care plans provided information about how people wished to be supported and staff were aware of people’s individual care needs and preferences.

Staff had built trusting relationships with people. People were happy with the care they received. Staff interactions with people were positive and caring. People were complimentary of the food provided.

There were organised activities and people were able to choose to socialise or spend time alone.

People made choices about their day to day lives. They were part of their community and were encouraged to be as independent as they could be.

People, and those close to them, were involved in planning and reviewing their care and support. There was good communication with people's relatives. Relatives visited regularly and felt their views were listened to and acted on.

The registered manager and provider had systems in place to monitor the quality of the service. The service had an action plan in place that identified shortfalls in the service and the required improvements.

Our inspector set out to 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, a visiting healthcare professional and from looking at records.

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

People received their medicines as prescribed. Prescribed medicines (including Controlled Drugs) were stored and administered safely in line with current and relevant regulations and guidance.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. The manager understood when an application should be made, and how to submit one. This meant that people were safeguarded as required.

The manager set the staff rotas, they took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were always met.

Recruitment practice was safe and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

Care plans reflected people’s current individual needs, choices and preferences. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

People’s health was regularly monitored to identify any changes that may require additional support or intervention.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People we spoke with said “staff are wonderful” and “everything is very good”. People said that staff knew their needs “very well” and that they had a “life of luxury here”.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Staff had effective support, induction, supervision, appraisal and training.

The management team had an ongoing workforce development plan encouraging staff to develop and promote innovative practice.

We carried out this inspection to follow up concerns we had received. We found that all the concerns raised were unsubstantiated with the exception of medication issues. The registered manager had already identified problems with the recording of medicines and dealt with them appropriately.

People spoken with told us they were happy with the care they received. One relative told us they were happy with the way they were kept informed and involved in their parent’s care.

We observed staff had a very close and friendly rapport with people. We saw people were encouraged to make their own decisions about taking part in daily activities.

We found that people consented to their care and treatment, both in writing and verbally on a daily one to one basis.

We saw care planning was person centred and agreed with the individual when possible or a relative when appropriate. Regular reviews were carried out and also involved the individual, a relative or advocate.

We found the receipt, storage and administration of medication was managed safely within the Royal Pharmaceutical Society guidelines.

Staff confirmed they were given the opportunity to build on their skills and received appropriate support from the manager. The provider had an effective complaints system available.

Records seen confirmed that notifications following the death of a person who lived in the home were forwarded to the Care Quality Commission as required.

This inspection was carried out as part of our scheduled Inspection plan.

During the inspection we spoke to ten people who lived in the home and two people who visited a relative who lived there. People told us that they were very happy at Acer House. One person told us, they had lived in the home since it had opened and felt very comfortable with the way the home was run. Another person told us, “I really like it here they seem to know what they are doing”. One person commented on the staff who worked in the home, “The girls are very good, you cannot fault them”. One person who was visiting a relative said, “It’s really easy for visiting as we can stay for the day and join in at mealtimes”.

During our visit we observed staff interactions with people. We saw that interactions between staff and people who received care were kindly and relaxed. People could take part in activities or chose to stay in their room. Everybody spoken with said they could do what they wanted throughout the day.

At lunch time we observed staff offered people a choice and provided alternatives if they were not happy with the options available. One person told us, “Mealtime is the highlight of my day”.

We carried out this inspection on the 12 and 18 March 2015 and was unannounced. At our last inspection in April 2014 no concerns were identified.

Acer House Care Home provides accommodation for up to 60 older people who require personal and/or nursing care. At the time of our visit there were 52 people living at the home. Acer house is set over two floors. The ground floor is called ‘Milton’ and the first floor is called 'Memory care. The first floor provides care to people who have dementia. It had visual objects outside people’s rooms. This related to their life history. There was access at both ends of the corridor to hats and coats. Both floors have access to two passenger’s lifts, a care’s station and communal areas including a lounge, dining room and kitchens and quiet sitting rooms. There is a central laundry area and main kitchen on the 2nd floor where the food gets prepared and cooked.

The home at the time of the inspection did have a registered manager however shortly after the inspection they deregistered. There is currently no 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 responsibilities for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The senior manager was present during the inspection.

Risks relating to swallowing difficulties were not always accurately identified in peoples care plans and risk assessments. Where one person required a thick and easy prescription to be added to their fluids we found this was not added to the person’s drinks every time.

This was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People told us they felt safe and they confirmed staff knew them well. Most staff had received training in safeguarding adults and were able to confirm what abuse was and what they should do if they suspected abuse.

There were emergency evacuation plans in place. These had up to date information relating to the person and what help they required in the case of an emergency evacuation. The fire alarm sounded on the second day of the inspection. We found the home’s procedure was not followed and people were left unsupported by the appropriate staff. Training was identified and arranged immediately.

We heard call bells being answered quickly and people we spoke with confirmed there were enough staff to help them when they needed it.

Medicines were administered and stored safely and those staff who were responsible for medicines had received training. Staff had a good knowledge of administering medicines

People who did not have the capacity to make specific decisions did not have the principles of The Mental Capacity Act 2005 code of practice followed. This was because best interest decisions and who had been involved in these were not evidenced as required by The Mental Capacity Act.

This was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 11(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are an amendment to the Mental Capacity Act 2005, which allow the use of restraint or restrictions but only if they are in the person’s best interest. All staff we spoke with confirmed no one was subject to any restraint. We reviewed the Deprivation of Liberty (DoLS) applications made by the home. Paperwork we saw confirmed the home was making applications as required by the Law.

There was a comprehensive induction for staff. Staff we spoke with were happy with the training they received. We found not all staff had received supervision in the last 12 months but staff meetings held every two weeks allowed staff access to raise any concerns they had. Staff had access to regular appraisals.

All people we spoke with confirmed how they enjoyed the meals. People had access to different meal options and an alcoholic drink if they wished.

We saw there was a good range of activities within the home. Examples included local garden visits, schools and shops. People we spoke with confirmed how they enjoyed the choice of activities. We observed people taking part in these activities and saw the choice available.

Staff interacted with people in a polite and caring manner. We saw staff responded quickly and appropriately where there was an incident between two people they quickly calmed the situation down.

Care plans included information relating to the person’s life history. This included what they liked to do including social activities and their past occupation.

The service displayed in the reception area who was on duty that day. There were pictures of the staff on duty also available behind the carers station.

Not all care plans confirmed when people’s representative or relative should be contacted and in what circumstances. One care plan identified when the person’s spouse should be contacted for example when the person deteriorated but it failed to identify if their spouse required an update in between or what the previous deterioration was.

The evaluation section of the persons care plan failed to trigger and update the main section of to the person’s needs and the delivery of care. This is important so that information and changes are not lost over time.

There was a complaints procedure in place and we saw complaints were responded to as required by the home’s policy. There was also a suggestions box in the reception area that people could use to make comments about the care they received and make suggestions about improvements.

We found care plans were not used to ensure people received care that was centred on them as an individual. This was because risk assessments and care plans were not being reassessed and amended when there was a change to people’s care needs and treatment. This could mean people are put at risk of receiving care and treatment that is not appropriate.

The home did not have a robust system in place to monitor the quality of the service. This included having an audit that identified missing incidents and accidents, incomplete records, and care plans that contained out of date information.

This was in breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 17(2)(b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

People at risk of not consuming enough food and fluids did not have their charts accurately filled in. This was because charts had missing information relating to totals, dates, and amounts along with being completed in a timely manner

This was in breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to Regulation 17(2)(c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Not all staff felt able to approach the manager and deputy. Staff had access to the home’s whistleblowing procedure but not all staff felt confident they would be supported if they ever needed to use this.

Not all staff were aware of their responsibilities and accountabilities. This was in relation to communication. We found one member of staff thought it was the responsibility for the unit manager to update a family member. The unit manager confirmed this was not the case.

The home had a system in place to review the maintenance of the home. This included equipment, water temperatures and tests, passenger’s lifts and the internal call bell system. We saw these were completed and up to date.

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