This unannounced inspection took place on 14 and 20 November 2017. Acorn House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Acorn House accommodates up to 64 people in one adapted building. During our inspection, 60 people were using the service, including some people who were living with dementia.

At our last inspection in October 2015, the service was rated 'Good' overall. At this inspection we found that the service remained 'Good’ overall and had improved to ‘Outstanding’ in Responsive.

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.

People were supported by staff who understood and acted appropriately in relation to their responsibility to keep people safe. Risks to people’s health and safety had been identified and mitigated to reduce the risk of harm as much as possible. People were supported by a sufficient amount of staff, received their medicines safely and lived in a clean and hygienic service.

People were supported by staff who had received appropriate training and support. People were supported to eat and drink enough and staff monitored and responded to changes in their health conditions. People lived in a building which had been specifically designed to meet their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with kindness and respect and we saw that staff took time to sit with people and let them know they mattered. The staff we spoke with were knowledgeable about the people they supported and ensured that people were involved in making decisions about their own care as much as possible. People could be assured that their privacy and dignity were respected by staff.

People received care which was focused on them as individuals and staff went the extra mile to enhance people’s lives. Efforts had been made to overcome any barriers people may face to achieving their aspirations, partake in activities and maintain or develop relationships. People were provided with opportunities to make a complaint about the service and these were responded to efficiently. People’s preferences as to how they wished to be cared for at the time of their death were recorded and followed and relatives were complimentary of how their loved one had been supported at the end of their life.

There was an open and transparent culture at the service and the management and staff team were committed to a shared philosophy to deliver excellent care. People’s views regarding their satisfaction with the service and any areas for improvement were regularly sought and acted upon. Robust systems were in place to monitor the quality of the service and the management continually sought to make improvements to the service people received.

The inspection team who carried out this inspection consisted of two inspectors. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

We spoke with ten people who were using the service and asked if they felt safe living at the service. People told us that they did feel safe, one person said, “Yes I do feel safe, I have a key to my room.” Another person said, “Yes I have not had any problems. Staff check up on me to make sure I am alright.”

We saw that the provider had an appropriate policy in place in relation to the safeguarding of vulnerable adults. Staff were aware of this policy and of their responsibility to protect people from the risk of abuse. The contact details of the local safeguarding team were available for staff and people using the service.

We observed the staff who were responsible for administering medication on the day of our inspection. We saw that medication was administered appropriately and in a timely manner. However people were not protected against the risks associated with medication, because the records did not always reflect the medication that had been given. People had not always received their medication as prescribed.

There were enough staff available to meet people's needs on the day of our visit. The provider explained that the staffing levels were due to increase shortly after our visit. We looked at future rotas which confirmed this increase in staffing levels.

Is the service effective?

People’s needs were not always properly assessed and care was not always planned and delivered in line with their individual care plan. We looked at the care plans of six people who were using the service. A care plan describes a person’s needs and gives guidance to staff in how to meet those needs. We saw that the care plans were not always person-centred and did not always provide adequate guidance to staff.

Staff had received an appropriate induction and a comprehensive range of training. Whilst supervision processes had not been fully embedded, staff had received supervision and felt supported by the provider.

Is the service caring?

We asked people if they felt staff treated them with dignity and respect. One person said, “'The staff are very good. They are kind and can't do enough for us.”' Another person told us, “Staff know us and have a laugh with us. They are very kind.”

Is the service responsive?

We observed the support that people received during our inspection. There was a continual staff presence in the communal areas of the home. When people made requests for support in the communal areas these were responded to in a timely manner. However there was sometimes a delay in response when people pressed the call bell in their bedroom.

Is the service well-led?

People using the service told us that they would speak to the provider or staff if they had any concerns. However the provider had not formally asked people for their feedback about the quality of the service being provided. The provider did not have an effective system in place to monitor the quality of the service.

This inspection took place on 20 and 21 October 2015 and was unannounced. Acorn House provides accommodation for up to 64 people with or without dementia and people with physical health needs. At the time of our inspection 48 people were using the service. The service is provided across three floors, comprising of support for people living with dementia and residential care.

Although there was a registered manager they were no longer employed by the provider but they remained on our register at the time of the inspection. A new manager was in post and had applied to become registered. 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.

At our last inspection in April 2015 we found that the provider was not meeting the legal requirements in respect of the numbers of staff that were deployed across the home. During this inspection we found that the provider had made the required improvements and people were cared for by sufficient numbers of staff. The provider ensured appropriate checks were carried out on staff before they started work.

People felt safe living at the home and staff took appropriate steps to protect people from the risk of abuse. Relevant information about incidents which occurred in the home was shared with the local authority. Risks to people’s safety, such as the risk of falling, were assessed and managed. People received their medicines as prescribed and they were safely stored.

Staff received a range of training relevant to their role and additional training was scheduled to take place soon after our inspection. Staff told us they were well supported. People were provided with the opportunity to give consent to their care. The Mental Capacity Act (2005) (MCA) was used correctly to protect people who were not able to make their own decisions about the care they received.

People were provided with sufficient quantities of food and drink, however staff were not always attentive to the needs of people who required help to eat. Healthcare professionals such as the GP and district nurse were involved in people’s care when needed.

There were positive and individualised relationships between staff and people. The manager had invested time in ensuring that people were involved in the planning and reviewing of their care. People made day to day decisions about how they wished to spend their time and they were treated with dignity and respect by staff and had access to private spaces.

People received care that was responsive to their changing needs and staff had access to detailed information in their care plans, which was kept up to date. A wide range of activities were provided which were based on what people had said they wanted to do. There was a clear complaints procedures and any complaints received had been responded to appropriately.

There was a positive and transparent culture in the home. People felt able to speak up and staff were confident in the leadership provided by the manager. There were different ways people could provide feedback about the service such as regular meetings and satisfaction surveys. There were robust quality monitoring systems in place and culture of continuous improvement was evident.