The inspection visit at Acorn was undertaken on 04 January 2017 and was unannounced.

Acorn provides nursing care and treatment of disease, disorder or injury. They support a maximum of 40 older people who may live with a physical disability. At the time of our inspection there were 40 people living at the home. Acorn is situated in a residential area of Blackpool close to public transport. Single room accommodation is provided for people and there is a passenger lift for access to the upper floors. There are ample toilet and bathing facilities and a variety of communal areas and gardens for people’s use.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (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.

At the last inspection on 24 March 2015, the service was rated as good in all five key areas and overall. The service met the requirements of the regulations.

During this inspection, we found the provider had systems to manage accidents and incidents to reduce the potential risk to people’s safety. Care files contained risk assessments to guide staff to reduce the risks of harm or injury to people who lived at Acorn. Staff demonstrated a good understanding of how to protect people from potential abuse and had training to underpin this. Everyone we spoke with told us they felt safe living and working at the home.

People who lived at Acorn told us staffing levels were adequate to their needs. We saw evidence to confirm the management team checked staff backgrounds prior to their recruitment to ensure their suitability. Staff said they were effectively trained to undertake their duties and records we looked at confirmed a varied training programme was in place. One staff member said, “There’s lots of training. There is no issue with attending courses.”

The registered manager had systems to oversee the safe management of medication to protect people from potential harm. For example, staff had relevant training and all related processes were audited to monitor their effectiveness. Staff signed charts after the administration of medicines to confirm individuals had taken them.

Those who lived at the home said they had a choice of what to eat and where to have their meals. One person told us, “I like my meals in my room. The staff are very obliging with that.” We saw staff supported them to meet their nutritional needs with a respectful approach. The registered manager completed risk assessments to protect people from the risks of malnutrition.

Records we looked at held evidence to confirm people or their representatives had signed consent to care and treatment. We found those who lived at the home were not deprived of their liberty. Staff received training to underpin their knowledge of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards.

We observed staff were kind and engaged with people and their relatives in a meaningful way. Staff encouraged them to be fully involved in their care planning and we found this was personalised to their individual requirements. The main aim of agreed outcomes centred upon maintaining the person’s independence, whilst respecting their culture, diversity and human rights.

Staff, people and their relatives told us the home was well organised and had good leadership. The registered manager had suitable arrangements to check and monitor the home’s quality assurance. Satisfaction surveys were provided for staff, visitors and people who lived at the home. We saw action was taken when issues were identified to maintain everyone’s safety and welfare.

We visited the home as part of a follow up inspection. We spoke with the manager, nurses, care staff, residents and relatives.

At our previous visit in October 2013 we found minor shortfalls in some areas of care the residents received. This was because there were times when there was no oversight of the residents in the lounge areas. We also observed that some moving and handling practices were unsafe. This meant that at times, the residents were at risk of not receiving appropriate support.

The manager had addressed the issues by introducing documentation to ensure ‘end of shift welfare checks’ had been completed. This was a checklist of duties for staff to complete daily. One staff member said, “We now have a list that ensures all footplates on wheelchairs are checked daily. It works well.”

During our inspection we used a method called Short Observational Framework for Inspection (SOFI). This involved observing staff interactions with the people in their care. SOFI helps us assess and understand whether people who use services are receiving good quality care that meets their individual needs. We observed staff being responsive and attentive. This confirmed people who required support with their personal care were being treated with respect and dignity.

The manager told us the staff were now attending training courses in moving and handling. Staff we spoke with confirmed this.

We spoke with a range of people about the home. They included the registered manager, staff members, residents and visitors to the home. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at Acorn Nursing home.

We spoke with people who lived at the home. They told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs. One person said, “The care is wonderful, the staff are superb and I am very happy here.”

We spent time in areas of the home, including the lounge and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff interactions with those in their care. In general we found that staff treated people with respect and provided support or attention when requested. However there were occasions when there was no oversight of the residents in the lounge areas. We also observed that some moving and handling practices were unsafe. This meant that at times, the residents were at risk of not receiving appropriate support.

There were a range of audits and systems in place to monitor the quality of service people received. Residents and relatives told us that they were well supported by the manager and staff team. A relative said, "You can always speak to the manager, her door is always open."

Some of the people living at the home said they were encouraged to express themselves about their care and treatment. They said they thought they received the right care and support from the staff at the home, and that they felt safe and that the people working there knew how to care for them.

The inspection visit at Acorn Nursing Home was undertaken on 24 March 2015 and was unannounced.

Acorn Nursing Home provides care and support for a maximum of 40 older people and people who may have a physical disability. At the time of our inspection the home was full. Acorn Nursing Home is situated in a residential area of Blackpool. There are ensuite facilities and lift access to all floors. A number of lounges are available so people can choose where to relax.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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.

At the last inspection on 10 October 2013, we asked the provider to take action to make improvements to how people’s care and welfare was maintained. At the follow-up inspection on 23 January 2014 we observed improvements had been completed and the service was meeting the requirements of the regulations.

During this inspection, people who lived at the home and their representatives told us they felt safe. We observed staff were respectful and caring towards individuals and had a good understanding of how to protect them against abuse. Risk assessments were in place to protect people from the potential risks of receiving care and support.

Staff worked with individuals to ensure they received appropriate support and followed their agreed care plans. Care records were up-to-date and personalised. Staffing levels, skill mixes and medication processes were managed safely to ensure people were safeguarded against inappropriate care.

People told us they were involved in their care and were supported to make decisions and maintain their independence. We observed staff demonstrated an effective understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Systems were in place to protect people’s human rights and we observed staff followed their recorded preferences and diverse needs.

We observed staff maintained people’s privacy and dignity throughout our inspection. For example, staff knocked on bedroom doors and posters were placed about the home describing good practice about the principals of dignity. Staff effectively monitored people’s health and worked with other providers to ensure their continuity of care.

We found there was a welcoming and friendly atmosphere in the home. Staff and people who lived at the home told us the registered manager was visible and promoted an open working culture. People were supported to express their views about the quality of the service they received. The management team carried out frequent audits to protect the welfare and health and safety of staff, visitors and people who lived at Acorn Nursing Home.