This inspection took place on 25 and 26 September 2018 and was unannounced.

Acorn House Care Centre 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.

Acorn House Care Centre is a residential home and is located in Blackburn, Lancashire within easy reach of the town centre. The service is registered to provide nursing or personal care for up to 32 people. Nursing care was not provided at this service. On the day of our inspection there were 30 people using the service.

The service did not have a registered manager in place. A registered manager is a person who has registered with the CQC 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. A new manager had been identified and commenced their employment on the second day of our inspection. They would be applying to the Commission to register in due course.

We undertook a comprehensive inspection of Acorn House Care Centre on 31 January 2017. The overall rating from this inspection was Good, with requires improvement in responsive. This was due to concerns around the lack of activities and stimulation for people who used the service.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question, is the service responsive, to at least good. We checked the action plan had been met during this inspection and found no improvements had been made and the overall rating had deteriorated to requires improvement.

During this inspection we found breaches of the regulations in relation to meeting peoples nutritional and hydration needs, good governance, staffing and person centred care. We have also made recommendations in relation to deprivation of liberty safeguards (DoLS) applications, consent, dignity and respect, nurse call system, recruitment, medicines and care planning.

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

We received information prior to our inspection that staffing levels were low within the service. Most of the staff we spoke with told us there was not enough staff on duty. People who used the service told us they regularly had to wait long periods of time for support. We found there was a lack of sufficient numbers of suitably qualified, competent, skilled and experienced persons employed to meet the needs of people using the service.

Recruitment systems and processes were not always robust. The required amount of adequate references were not always gained when recruiting staff. We have made a recommendation in relation to this.

Medicines were not always managed safely. The interim manager had highlighted a number of areas of concern and were making progress to address these. However, we found issues in relation to ‘as required’ medicines, storage of thickeners and the safety of medicines being returned to pharmacy. We have made a recommendation the service considers current best practice guidance.

Records had been kept in relation to accidents that had taken place at the service, including falls. We found that all accidents, including falls, were recorded and then analysed at the end of each month.

In the main, we observed the service to be clean and tidy. All the staff we spoke with told us they had undertaken training on infection control and knew their responsibilities. Infection control policies and procedures were in place.

Throughout the first day of our inspection we saw people were only offered a drink at certain times of the day, despite some people having had urinary tract infections. Records showed people had been

This was an unannounced inspection which took place on 30 and 31 January 2017. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. The service was last inspected on 4 November 2014 when we found it to be meeting all the regulations we reviewed.

Acorn House is located in Blackburn, Lancashire within easy reach of the town centre. The service is registered to provide nursing or personal care for up to 32 people. On the first day of our inspection there were 29 people living in the service with one person admitted on the second day of our inspection.

The service had a registered manager in place at the time of our 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.

During this inspection we found a breach 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 the report.

There was a lack of activities and stimulation for people who used the service. The activities co-ordinator was working as a care staff on both days of our inspection. Records we looked at showed that concerns had been raised by relatives of people who used the service in the past about the lack of opportunity to undertake activities.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

The management of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare. The service was clean and tidy and there were no malodours.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed. The service had achieved a five star, very good rating from the national food hygiene rating scheme.

All staff members had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of their responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Care plans contained people’s personal preferences so they could be treated as individuals.

People were given the information on how to complain with the details of other organisations if they wished to go outside of the service. The complaints

We carried out this inspection on 4 November 2014 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The service is registered to provide nursing or personal care for 32 people. On the day of the inspection 28 people resided at the home.

We last inspected this service on 20 November 2013 when we found it was meeting the regulations we reviewed.

This was an unannounced inspection. During the inspection we spoke with six people who used the service, four relatives, three care staff, a domestic, the chef, the deputy manager and the registered manager.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

People who used the service told us, “There is no bullying. If I had any problems I would speak to the manager. She is very approachable”, “I feel very safe and happy here” and “I feel very safe. I cannot see but the staff are prompt, kind and caring”. Relatives told us, “The care is safe and we can chat to staff about mum”, “I have no issues with the home. Mums care is very good and the staff keep me informed about her welfare” and “My dad is well looked after and feels safe”. The people we spoke with felt safe at this care home.

The Mental Capacity Act 2005 (MCA 2005) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need, where there is no less restrictive way of achieving this. Staff understood their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). We found action had been taken where necessary to ensure people’s capacity to make their own decisions had been assessed. Where any restrictions were in place we found these were legally authorised under the Mental Health Act 1983 or with people’s consent. The registered manager had made applications for people using the current framework including one person’s needs to be accompanied in the community.

We saw that people who used the service or a family member had signed their consent for staff to administer medication. People received the support they required to take their medicines as prescribed. Staff responsible for administering medicines were regularly assessed to ensure their practice was safe.

Staff received a range of training and told us they were supported so they could deliver effective care. People who used the service said, “All the staff are good” and “The staff look after me”.

Staff were recruited using current guidelines to help minimise the risk of abuse to people who used the service.

People who we spoke with told us, “Every day staff come round and offer me a choice of food. If you don’t like what’s on the menu they will give you something else” and “The food is good and we get lots of fresh fruit and vegetables. I drink lots of water which is always available”. We were present for a short time whilst people took their meal. All the people we spoke with at this time said the food was good.

People’s needs were assessed and regularly reviewed so that staff could deliver personalised care and support. Staff ensured they worked closely with the wider multi-professional care team to ensure people’s needs were met.

Systems were in place to record and review complaints. People were encouraged to express their views about the service they received. Records we looked at indicated people had been satisfied with the way any complaints they had made had been dealt with. The registered manager said she was available to talk to regularly for people to have the opportunity to voice their concerns.

People who used the service were supported to take part in individual and group activities both in the home and in the community. These activities were designed to stimulate people and allow people to have access to the community.

Staff told us they enjoyed working at Acorn House Care Centre and felt well supported by the registered manager and other staff in the home. People who used the service, staff and family members told us registered manager was approachable and open to ideas to improve the service.

The registered manager had systems in place to regularly monitor and assess the quality of care provided at this care home. Arrangements were in place to seek and act upon the views and opinions of people who used the service. We looked at the results of a survey sent by the service to families and people who used the service. The results were positive and included comments like, “A friendly, homely care home”, “Clean and comfortable” and “I feel the staff are very good and care for my relative well”.

During our visit we spoke with three people who used the service, one visitor and three staff.

People told us they were happy with the care and support they received. We observed staff treating people in a friendly and respectful way. Comments from people living in the home included, “It’s a nice place and staff are always good to me”, “They look after me and keep me well, I am very happy here”.

During our visit we found all areas of the home to be bright, safe and comfortable. We found improvements were on-going and there were systems in place to maintain standards of the environment, equipment and standards of cleanliness. People told us they were happy with their rooms and most had brought in personal items to make them more homely. One person said, "My room is lovely; it's clean and bright and I have all the things that I need".

Records confirmed a safe and effective recruitment process had been followed which should help to make sure that only suitable staff were employed. Staff had undertaken training that gave them the skills and knowledge to meet peoples' needs

People told us they had no complaints about the service but felt confident they could raise any concerns with the staff or managers. People were encouraged to discuss any concerns during day to day discussions with staff and management, during meetings and reviews and also as part of the annual survey.

We wanted to review the service for people who had conditions that meant they could not reliably give their verbal opinions on the service they received. Therefore we used a Short Observational Framework (SOFI) for two of the people living at Acorn House Residential Care Centre. This framework helped us to evidence the quality of the care provided. We saw staff who used practices that reflected the needs of people who used the service. We observed staff who showed respect to the people when delivering their individual care and they ensured that care was delivered privately. This ensured that the care and personal support was consistent and met the changing needs of the people who used the service.

We spoke with three people who used the service. They told us they were happy with their care and accommodation and said they were treated very well by the staff at the home. They commented, "The staff are good to me” and “I’m very happy here”.

People using the service told us they were satisfied with the care and services they received at Acorn House. They could make choices and decisions about matters that affected them.

They said staff treated them well, that they were enabled to maintain their independence and they were treated with respect.

“I have no complaints”.

“The staff treat me well”.

“The staff are helpful”.

They also told us that they were keeping in touch with family and friends.

People said they were getting support with healthcare needs and they had ongoing attention from health care professionals.

Everyone we spoke with made positive comments about the catering arrangements, they said, “The staff are good, the food is good here”.

We received positive comments about the accommodation and facilities provided at Acorn House.

People said that the home was being kept clean and one person said, “The home is always clean and tidy”.

We spoke with some of the relatives who were visiting the home on the day of our visit. They told us;

“It’s fantastic here, I’m really happy with the way they care for my dad”.

“My father is treated very well”.

“My mum seems happy here”.

People using the service told us they were satisfied with the care and services they received at Acorn House. They could make choices and decisions about matters that affected them.

They said staff treated them well, that they were enabled to maintain their independence and they were treated with respect.

“I have no complaints”.

“The staff treat me well”.

“The staff are helpful”.

They also told us that they were keeping in touch with family and friends.

People said they were getting support with healthcare needs and they had ongoing attention from health care professionals.

Everyone we spoke with made positive comments about the catering arrangements, they said, “The staff are good, the food is good here”.

We received positive comments about the accommodation and facilities provided at Acorn House.

People said that the home was being kept clean and one person said, “The home is always clean and tidy”.

We spoke with some of the relatives who were visiting the home on the day of our visit. They told us;

“It’s fantastic here, I’m really happy with the way they care for my dad”.

“My father is treated very well”.

“My mum seems happy here”.