Tree Vale Acorn 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.

Tree Vale Acorn House is registered to provide accommodation for up to 33 people who require accommodation and support with their personal care. The home is located in residential area. At the time of our inspection there were 28 people who lived at the home.

At the last inspection the service was rated overall requires improvement. At this inspection we found the service had continued to improve and a rating of ‘good’ has been achieved. This reflects the hard work of the manager, deputy manager, provider and staff since our last inspection.

We spoke with three people who lived in the home. They all gave spoke highly of the home and the staff who supported them. It was clear from what people said that the manager and staff team were well thought of. They told us the manager and staff were kind, caring and that the support provided was good.

People’s care records contained clear and easy to understand information about people’s needs and risks and how to support them effectively. People’s life histories were included and gave staff information about their families, life prior to coming to live at the home and the things that were important to them in their day to day lives. This gave staff an understanding of the people they supported so that positive relationships could be developed.

Staff spoken with had a good knowledge of people’s needs and spoke with genuine affection about the people they supported. The atmosphere at the home was warm, homely and relaxed. People and staff chatted socially to each other, these conversations were natural and it was obvious that people had warm relationships with staff members.

Staff recruitment was safe. The service was staffed sufficiently at all times and staff had received the training and support they needed to provide safe and appropriate care.

People’s physical emotional well-being was at the forefront of the service. Where people’s mental health had declined we saw that prompt action was taken to get people the help they needed. Where people needed help to make informed decisions about their care, the Mental Capacity Act 2005 had been followed to ensure that people had the support of external advocacy service or family members. Records showed that any decisions made on people’s behalf had been done so in their best interests.

People’s physical health was monitored and responded to quickly if they became unwell. Changes in people’s mobility needs were promptly addressed with referrals to the falls prevention team or occupational therapy for a re-assessment of their needs.

Accidents and incidents and people’s health needs were managed appropriately with support from a range of health and social care professionals. Medication was managed satisfactorily and staff had clear guidance on how and when to administer ‘as and when’ required medications such as Paracetamol in order to maintain people’s comfort.

People received enough to eat and drink and had a choice. People told us the food was of a good quality and we saw that portion sizes were ample. Where people did not like what was on offer, an alternative meal was provided without hesitation.

A range of person centred activities were provided ranging from a music sessions, nail care, balloon games, bingo and quizzes. This promoted people’s social and emotional well-being. People’s well-being and level of participation in the activities provided was monitored and responded to where appropriate.

There were a range of effective mechanisms in place to monitor the quality and safety of the service and the views of people were regularly sought by the manager. This was good practice.

During our visit, we had no concerns about people’s care or t

This inspection was unannounced and took place on the 30 March 2017.

Tree Vale Acorn House is a four storey care home situated in a residential area of Prenton, Wirral. The home provides accommodation and personal care for up to 33 older adults. The home primarily caters for adults who live with dementia. Accommodation consists of 33 single bedrooms. On the ground floor, there is a communal lounge and dining room for people to use. There is also an additional small lounge on the first floor.

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.’

At our last visit in November 2016, we identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated inadequate and placed in special measures. During this visit we followed up the breaches we identified at our previous visit and found that significant improvements had been made. These improvements meant that all of the breaches we identified in November 2016 had been addressed. At this inspection, the service was compliant with all of the health and social care regulations.

As the domains of safe, responsive and well-led were rated inadequate at our last inspection, we were unable to rate them any higher than requires improvement at this inspection. This was because the provider needs to show that they can sustain these improvements over time. We will therefore check this at our next inspection. The domains of effective and caring which were rated ‘requires improvement’ at the last inspection were found to be good at this inspection.

We looked at the care files belonging to four people. We saw that the assessment of people’s risks had improved. People’s risk management plans contained sufficient information for staff to follow to mitigate risks in the delivery of care and people’s care plans were person centred. This meant that people’s individual needs, preferences and wishes in relation to their care were clearly stated and planned for. It was obvious from looking at people’s care plans that staff knew people well and understood the people they were caring for.

We saw that where specific risks in relation to people’s care were identified, these were acted upon a timely manner to ensure people received the support they needed. For example, where people had frequent or multiple falls over a short period of time, they had been referred to the falls prevention team appropriately and assistive technology ordered to help keep them safe. People’s accident and incidents were now properly monitored to ensure information about people’s risks was used to plan safe and appropriate care..

People whose ability to make decisions was in question, had their capacity assessed. It was clear from looking at this documentation that people were involved in their own assessment. We saw that any decisions made in relation to people’s care had followed a best interest process where the person’s capacity was found to be impaired. During our visit, we saw that staff ensured people’s consent was obtained before any support was provided and that people had a choice with regards to how they lived their lives at the home.

We checked medication management. We found that medicines were now stored at appropriate temperatures. There were also systems in place to enable the manager to check and account for medication that had been administered.

People’s weights were taken and monitored regularly to ensure they maintained a health weight. Improvements had been made to people’s dining room experience. Napkins and condiments were available for people to use during mealtimes and people’s meals we

This was an unannounced inspection carried out on 9, 10 and 11 November 2016. Tree Vale Acorn House is a four storey care home situated in a residential area of Prenton, Wirral. The home provides accommodation and personal care for up to 33 older adults. The home primarily caters for adults who live with dementia. Accommodation consists of 33 single bedrooms. A passenger lift enables access to all floors for people with mobility problems. On the ground floor, there is a communal lounge and dining room for people to use. There is also an additional small lounge on the first floor.

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.’

During this visit, we identified concerns with the safety and quality of the service. We found breaches in relation to Regulations 9, 10, 11, 12, 14, 16 and 17 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 this report.

We looked at the care files belonging to five people and found their needs and risks were not properly assessed, planned for or managed. There was insufficient information in people’s files on how to keep people safe and meet their needs in a way they preferred. Risk assessments were inadequate and did not provide staff with sufficient guidance on how to manage people’s risks in order to keep them safe. People’s health needs were not adequately described and records showed that they had not always been followed up with healthcare professionals. Dementia care planning was poor and staff had limited guidance on how to provide safe, appropriate person centred care.

We found people’s capacity was assessed using the two stage test recommended by the Mental Capacity Act 2005 but people’s assessments were generic and lacked evidence of their involvement in the assessment process. It was unclear how these assessments had been undertaken as there were no best interest decision records on file and no evidence that any least restrictive options had been explored. Some people had deprivation of liberty safeguarding (DoLS) in place but there was limited evidence as to how an assessment of their capacity in relation to this had been made.

Medicines were not always managed safely. Medicines received by the home were not always properly accounted for or stored at appropriate temperatures. This meant the management of medications was unsafe.

Systems in place to ensure people receive adequate nutrition and hydration were not robust. Risk assessments and care planning for people’s dietary needs was poor and people’s weights were not always monitored appropriately for any unintentional weight loss to be picked up and addressed. Professional advice was not properly documented and healthcare appointments were not routinely followed up to ensure the person received the nutritional support they needed.

People’s accidents and incidents were not monitored adequately to ensure action was taken to protect them from avoidable harm. A number of people had experienced multiple falls without a referral to the falls prevention team being made or assistive technology being put into place to help staff manage people’s safety. This meant that the manager had failed to take any appropriate action to keep people safe. Poor moving and handling techniques were observed in use by staff at the home. This placed people at risk of injury. We spoke with the manager and senior carer about this and asked them to address it immediately.

Staff were observed to be kind, caring and compassionate in their interactions with people. There were lots of positiv

People who lived at Acorn House had dementia but did not require nursing care. People were usually able to remain at the home for end of life care with support from GPs, district nurses and other health professionals. People we spoke with told us:

“I wouldn’t want her to be anywhere else but here.”

“She’s very happy and well looked after here.”

We saw that people were supported to remain as mobile as possible and assistive technology had been introduced to help reduce the risk of falls.

We looked all around the home and it was clean, tidy and in a good state of repair and decoration.

Personnel records showed that the home’s recruitment procedures were followed and the required records were in place before people started working at the home. All staff who worked in the home, including domestic assistants and kitchen staff, received the same core training. Duty rotas showed that there was a sufficient number of qualified and experienced staff employed at the home to ensure that people were kept safe and their care needs were met.

The home had a complaints procedure and a copy of this was given to people new to the home and their families. The manager kept records of any complaints received and of how the complaint had been investigated, addressed, and responded to.

We spoke with two people living at the home and three relatives. All of the people we spoke with were very happy with the home and had never had to raise any concerns. One relative said “I can’t praise them enough” and another said “it’s a homely place.” They all told us the staff were always respectful and very helpful.

All of the people we spoke with told us the food was good and that they were given choices in what they wanted to eat. One person told us “I get plenty to eat” and another said “the food is usually good but you can always have an alternative meal if you don’t like what is on the menu.”

We saw that staff were well supported to carry out their role and received regular training. We had a minor concern at a previous inspection with regards to documentation. We found at this inspection that improvements had been made.

We carried out this visit as a result of specific concerns expressed to the Commission. On this occasion we did not ask people living at the home for their views.

A relative we spoke with said 'I had a good feeling about Acorn House right from the start'. Her relative now requires nursing care and this is a difficult time, however she said that 'Mandy (the home manager) has supported us all really well'

We spoke with a person who was sitting in his bedroom on the top floor of the home. He said that he lived on his own for a long time and likes his own space. He is able to use the key code to open the corridor door so he can go downstairs whenever he wants to.

We saw that most people went into the dining room to have their morning coffee. The manager told us that this was introduced as a result of looking at accident records, which showed that people could go for long periods without moving out of their chair and this increased their risk of falls. The staff encourage people to remain as mobile as possible and there is minimal use of wheelchairs.

During our visit we saw small children visiting one of the people who lives at Acorn House and they were made very welcome.

We saw written comments received from relatives of people who lived at the home. These included:

Many, many thanks for all the help and support shown to K whilst in your care. It gave comfort to the family to know he was in safe hands.

We would like you to know just how much you have come to mean to us over the last three and a half years. We are so glad that Mum was with you till the end. We will never forget you and what you have done.

Finding Acorn for our dear [relative] was our very good fortune, for which we are more than grateful. Keep up and maintain your high standards.

We spoke with a relative who was visiting his mother. He told us that his mother has lived at Acorn House for two and a half years and they are very, very happy with her care. He lives a distance away and visits every few weeks but his sister lives nearby and visits several times a week and has no concerns.

One of the people who lives at the home told us 'This is a good place to come'.

We observed two carers assisting a resident to get up from her chair. They were using a handling belt and explained to her what they were doing and gave plenty of reassurance.

One of the people we spoke with said 'We get plenty to eat'.

We observed people being assisted into the dining room for their lunch. Members of staff asked them ‘'would you like to come for lunch?'. We asked one person what she was having for lunch and she said 'I don't care, it's all nice'. One person was walking around whilst eating a sandwich. She has been identified as needing finger food and does not like to sit still to eat her meals. Another person is reluctant to eat and has problems with wearing dentures. Members of staff were trying to tempt her with a soft pudding, and then a short while later with a milk shake, but she politely refused all. Lunch was a social occasion and there were lots of smiles and conversations going on.

When we visited Acorn House we observed that people who were living at the home appeared relaxed and comfortable and staff addressed them in a way that was pleasant and respectful.

One of the people who lives at the home told us: 'This is the cleanest place in England'