This inspection visit took place on 07 March 2018 and was unannounced. Acorn Lodge provides care for up to ten people with enduring mental health needs. Support is available through local community mental health services. It offers long term accommodation in a domestic dwelling within a residential area of Blackpool. Communal areas include a dining room and lounges. Access to the home requires people to be mobile without the need for mobility aids as there is no lift. At the time of the inspection visit there were ten people who lived there.

There was 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.

At the last inspection in November 2015, the service was rated ‘Good’. At this inspection we found evidence continued to support the rating of ‘Good’. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At the last inspection we recommended people were kept safe by ensuring master keys to enter the home and bedrooms were available to staff in cases of emergencies to keep people safe. Also staff had sufficient information in care documentation for people who had behaviour that challenged. At this inspection we found they had addressed the issues.

People commented staff had a kind and caring attitude. One person told us, “In all the homes I’ve been in, the staff here are by far the best, they really care.” People said they were fully involved in their care planning and able to explore their mental, physical and social needs with experienced staff.

We spoke with people who lived at Acorn Lodge and a visiting health professional and comments were positive in relation to care and support provided by the staff team. One person who lived at the home said, “The staff are great they are so kind, helpful and caring.”

We found staff were aware of treating people as individuals with importance placed on promoting independence, dignity and respect. People who lived at the home confirmed staff treated them as individuals and delivered person centred care.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. The layout of Acorn Lodge and facilities provided were appropriate for the care and support provided.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

People told us they had regular health care visits. Staff we spoke with said any changes in health were managed in a timely manner and care records updated. Care plans we looked at confirmed this.

People who lived at Acorn Lodge were offered a choice of nutritious meals and snacks, they told us they enjoyed their food. Care records we saw included a dietary requirements document, this provided information about special diets, medical conditions such as diabetes and food preferences. One person said about the quality of meals, “Yes since I have come here the food has been plenty and good.”

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.

This inspection took place on 18 August 2015 and was an unannounced inspection.

Acorn Lodge Residential Care Home provides personal care for up to ten people with enduring mental health needs. It offers long term accommodation within a residential area of Blackpool. There are eight single rooms and one double room. Communal areas include a dining room and lounge. The service requires people to be mobile on admission. There is no lift and limited access for anyone with mobility difficulties. Whilst staff would try to meet any changing mobility needs, they feel it would be difficult to accommodate anyone with long term limited mobility.

The service was last inspected in January 2014. The service was meeting the requirements of the regulations that were inspected at that time.

There was 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.

People told us they felt safe living at Acorn Lodge and almost all the people we spoke with were happy there. One person said, “We are well looked after and I am comfortable and safe here.” A relative said, “I have no concerns about [family member]. We know they are safe here.”

Almost all people said they could talk to the staff team, express any ideas or concerns and they would help. One person was not satisfied with the care they received and said that staff didn’t listen to them. We discussed this with the registered manager who told us that the staff team were aware of the comments and were working with the person to meet their care needs and preferences. Other people we spoke with were praising of the care they received. One person told us “The staff here, particularly the manager, listen. If we don’t like something they will do something about it if they can.” A relative commenting in a recent survey told the home, “My concerns, which are few, are always dealt with.”

Five of the six people spoken with about the meals provided said that the choices were good and the meals were plentiful. One person said they did not get enough to eat and the evening meal was too early. The registered manager said that they would discuss meals with people individually and at the next residents meeting.

Records were available confirming appliances and equipment in use by the home had been serviced and maintained as required. However we found that there was no master key for people’s bedrooms or the front door. This meant that in an emergency situation, staff would need to check which member of staff was carrying the keys before being able to enter bedrooms or exit the home.

Although there was a programme of refurbishment. There was an unpleasant odour in the downstairs toilet. The registered manager told us they were awaiting new flooring to resolve this problem and this would be dealt with quickly.

We talked with staff about how they supported people whose behaviour challenged services. We saw that there was information about one person who could have behaviour that challenged. However where there were restrictions in place to manage this behaviour, there was insufficient guidance in place.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff we spoke with knew the steps they would take if they became aware of abuse.

We looked at how the home was being staffed. People we spoke with were satisfied with staffing levels and said staff were available when they needed them. One person told us, “There are always staff about if you need anything.”

When we undertook this inspection visit, the service had not appointed new staff members for some time. They had appropriate procedures in place and were just starting the process of appointing a new member of staff.

Medicines were managed appropriately. They were given as prescribed and stored and disposed of correctly. People told us they felt staff supported them with medicines well.

People told us of regular health care visits. They said any changes in health were managed in a timely manner.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) which meant they were working within the law to support people who may lack capacity to make their own decisions.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. A relative said of the staff team, “They are an excellent care team – extremely competent”.

Staff took into account people’s individual needs and were person centred in their approach. They were proactive in making sure that people were able to keep relationships that mattered to them.

There were procedures in place to monitor the quality of the service. Any issues found on audits were quickly acted upon and any lessons learnt to improve the service going forward.

We spoke individually with the manager and two staff at Acorn Lodge. We also discussed standards of care with two people living at the home. We observed staff interactions with people in their care. We reviewed care records, staffing files and the home’s infection control procedures. We also checked policies and procedures, as well as various audit processes.

We observed staff interacting with people in a dignified and supportive manner. Care provided matched service user’s related care plans. Care records were person-centred and reviewed regularly. We were told that consent was consistently sought. Although records did not always confirm this, a new system was being introduced. One person told us, “I don’t feel restricted in any way”.

Acorn Lodge had effective procedures in place to maintain infection prevention and control. We additionally observed that staff were appropriately trained and supervised to undertake their duties. Suitable systems were in place to monitor the quality of the service provided.