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Acorn Hill Nursing Home Requires improvement

Reports


Inspection carried out on 10 April 2019

During a routine inspection

Rating at last inspection

At our last inspection of Acorn Hill (report published on 16 November 2018) we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service as Requires Improvement. At this inspection we found the breaches were met but further improvements were needed to ensure people received safe, effective care that met their needs.

About the service

Acorn Hill Nursing Home is registered to provide accommodation, nursing and personal care to up to 59 people, some of whom are living with dementia and/or have complex physical and mental health needs. At the time of our inspection there were 29 people using the service.

People’s experience of using this service

Since our last inspection the registered manager, provider and staff have made many improvements to the home. People, relatives and staff were positive about the home and told us about some of the improvements they had seen.

However further improvements were needed in the following areas: infection control; care records; staff following care plans and risk assessments; people and relatives’ involvement in care reviews; and the home’s audit system. The registered manager, provider and staff were working to address these issues.

People and relatives said the home was safe. A relative said, “[Person] is definitely safe. I can see how the staff look after [person] and I’ve seen them ensuring the safety of other residents here.” Staff were trained in safeguarding and knew how to protect people from abuse and harm and who to report any concerns to.

Staff were kind and caring when supporting people and offered them choices. People told us staff encouraged them to express their views and make decisions about their care and support. Care plans focused on people’s abilities and what they could do for themselves.

Staffing levels had improved. A relative said, “There is more staff than there used to be. I’m happy with it now and I have no complaints about the staff.” During our inspection visit there were enough staff on duty to meet people’s needs and spend quality time with people, assisting them with activities and socialising.

Staff were knowledgeable and experienced. A relative said, “I’m happy with staff skills. [Person] has as good a quality of life as they could get.” Improvements had been made to the storage, management and administration of medicines. People had the medicines they needed at the right time.

People and relatives said they liked the food served. A person said, “The food is good and we always have lots of drinks.” A relative told us, “[Person] loves the food. I’ve eaten it and it’s very nice. Very good portions, seconds offered.” Staff monitored people’s nutrition and hydration tools and ensured they had enough to eat and drink.

Staff ensured people’s healthcare needs were met. People saw GP’s and other healthcare professionals when they needed to. Staff monitored people’s well-being and took action if they were unwell. The home was working within the principles of the Mental Capacity Act 2005 and staff knew how to support people in making decisions and choices.

Improvements had been made to the premises to ensure they were fit for purpose. Better signage was in place to help people find their way around and staff had made the environment more stimulating using tactile objects, pictures, and murals.

People and relatives said they thought the home was well-led and the managers and staff kind and approachable. A relative said, “I chose this home because I like the lay out, the food, and the friendliness.” People, relatives and staff were invited to share their views about the home at meetings, through surveys, and on a one-to-one basis. They were listened to and changes and improvements made because of their input.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This was a planned inspection based on the previous rating.

Inspection carried out on 31 July 2018

During a routine inspection

We carried out an unannounced, comprehensive inspection on 31 July 2018. The previous comprehensive inspection of the service in June 2016 rated the service as Good. This was followed up by a focussed inspection carried out in March 2017 in response to concerns about people's safety. The service remained rated as Good. At this inspection we found improvements were needed to ensure people received safe, effective care that met their needs.

Acorn Hill Nursing Home 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.

The service accommodates up to 59 older people in one adapted building. Some of the people using the service had complex physical and mental health needs and many people were living with dementia. At the time of our inspection there were 40 people using the service.

The service had 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.

People were not always protected from the risk of infection. Procedures and systems were not effective in preventing the risk of infection.

The premises were not consistently well maintained or assessed to prevent potential risk of harm for people.

Risks to people were not always assessed in a timely manner. Records lacked clarity in providing guidance for staff on the measures they needed to take to keep people safe.

The management and monitoring of people's wounds was not safe or effective in protecting people from the risk of infection or prevent further deterioration of wounds as far as possible.

Improvements were needed to ensure people's medicines were stored and administered as prescribed.

The registered manager undertook a range of audits and checks to monitor the quality of the service; producing action plans to identify and address where improvements were required. We found these had not been effective in identifying the areas of concerns we found.

There were insufficient arrangements in place to ensure sufficient numbers of staff were always deployed in response to unplanned staff absence, although sufficient numbers of staff were available on most occasions.

Staff told us they had completed a range of training to give them the skills and knowledge to provide effective care and this was evaluated during regular supervision. Training records were not fully completed or kept up to date to support the effective monitoring of staff training.

People's care and support needs were not always effectively monitored and reviewed to ensure care was provided in the way they needed. People were supported to eat and drink. However records did not reflect people were always protected from the risk of poor nutrition.

The premises did not fully support people to engage with their environment or support them to orientate around the building. Improvements were needed to ensure people were provided with meaningful activities that engaged and stimulated them and provided them with a sense of purpose.

Care plans were personalised and supported staff to provide personalised care. There were limited opportunities for people and their relatives to be involved in their care planning or to share their views about the service.

The provider had systems to manage any complaints they received. Although people and relatives knew how to raise concerns, they were not confident that improvements would be made or sustained as a result.

People felt safe when they were receiving care from staff. Staff understood their roles and responsibilities to safeguard people from the risk of harm.

Staff

Inspection carried out on 6 March 2017

During an inspection to make sure that the improvements required had been made

We carried out this focused inspection unannounced on 6 March 2017.

We carried out an unannounced comprehensive inspection of this service on 22 June 2017. After that inspection we received concerns in relation to people’s safety and the responsiveness of the care and support provided. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

Acorn Hill Nursing Home provides nursing and personal care for up to 49 people. A number of people accommodated at the service have complex physical and mental health needs. Some people are living with dementia and others are receiving end of life care. The service is located in Leicester and accommodation is provided over three floors with a lift for access. At the time of our inspection there were 33 people using the service.

The service has a registered manager. This 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 using the service and staff knew what to do if they had any concerns about their well-being. There were enough staff on duty to meet people’s needs. Staff were quick to respond if people needed support and answered call bells promptly. Staff were knowledgeable about how to provide safe and responsive care to people.

Staff took action to reduce risks to people and keep them safe. They ensured people were assisted to move around the premises safely and supported them with their meals. Improvements were needed to some people’s risk assessments to ensure they were accurate, up to date, and had the information in them that staff needed to maintain people’s safety.

People told us they liked and trusted the staff. The service employed both care staff and qualified nurses so people’s care and nursing needs could both be met on site. Staff were safety recruited and their competency checked to ensure they were suitable to work at the service.

People told us they received their medicines when they needed them. Medicines were mostly managed safely and administered by skilled, trained and qualified nursing staff. Improvements were needed to some medicines records.

People told us they were satisfied with the care the staff provided. There had been improvements to some care records making them more personalised. People and relatives had the opportunity to take part in care planning and reviews and have in say in how their care was provided.

Group and one-to-one activities were provided at the service and people said they enjoyed these. During our inspection people took part in a fruit tasting session, went for walks with staff, and took part in a religious service. People being nursed in bed had hand massages and a discussion about the day’s news.

People told us they if they weren’t happy with any aspect of the service they would tell staff. Records showed that when complaints were received the registered manager dealt with them in an open and positive way.

Inspection carried out on 22 June 2016

During a routine inspection

This was an unannounced inspection that took place on 22 June 2016.

Acorn Hill Nursing Home provides nursing and personal care for up to 49 people. A number of people accommodated at the service had complex physical and mental health needs. Some people were living with dementia and others were receiving end of life care. The service is located in Leicester and accommodation is provided over three floors with a lift for access. At the time of our inspection there were 32 people using the service.

When we inspected the service did not have a registered manager. This 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. The previous manager de-registered in January 2016. A manager was in post and was in the process of applying to the Care Quality Commission for registration.

The service was last inspected on 30 July 2015 when the provider was found to be meeting their requirements.

The service had a welcoming atmosphere and improvements to the environment meant that the premises were homely and inviting. A new manager was in post and people said she was friendly and approachable. Staff were available at the times people needed them and greeted people with a smile and an offer of assistance. During our inspection we saw that people had opportunities to purse their hobbies and interests. This included both group and individual activities. These activities gave people something to focus on and provided them with stimulation.

People using the service were safe and staff had a good understanding of how to manage risks associated with people’s care. Staff also knew how to support people if they became anxious, with a positive effect.

People received their medicines safely and at the required times. Medicines were kept securely and administered by trained staff. A few improvements were needed to medicines records to ensure they were complete and properly audited with issues addressed promptly where necessary.

Staff had undertaken most training the provider considered essential to meet people’s care and support needs. We observed staff put their training into practice to support people in a professional and caring way. There were enough staff on duty to keep people safe and meet their needs. Training in crisis intervention had recently been introduced to the service to ensure staff could effectively meet the needs of people who may become agitated. If people needed restrictions on their lifestyles these were applied lawfully.

People’s nutrition and hydration needs were mostly met and people had a choice of meals and drinks. If people needed assistance with their meals staff provided this. Improvements were needed to the way one person’s nutritional needs were monitored. People’s health care needs were identified and met by staff at the service or local healthcare professionals.

People made many positive comments about the staff and were at ease with them. Staff communicated with people in a warm and friendly manner. People were offered choice about all aspects of their lives and we saw this in practice, for example during lunchtime and when people were offered personal support. Visitors were welcome at the service at any time.

Staff had a good understanding of people’s social and healthcare needs and knew about people’s lives, for example their past occupations, family circumstances, and likes and dislikes. People’s preferences, for example getting up and going to bed times and personal care choices were included. Some care records were in need of improvement and the manager said she was in the process of reviewing and updating these.

People told us the manager was friendly and approachable. They said they would tell her if they had any concerns or complaints about

Inspection carried out on 30 July 2015

During an inspection to make sure that the improvements required had been made

This inspection took place on 30 July 2015 and was unannounced.

We previously carried out an unannounced inspection of this service on 15, 22 and 31 December 2014. Nine breaches of legal requirements were found and the service was judged to be ‘Inadequate’ overall. This was because people were not being protected from the risks associated with the unsafe use and management of medicines. People’s nutritional and hydration needs were not being met. People’s privacy, dignity and independence were not being ensured. The provider had not acted in accordance with legal requirements where people did not have the capacity to consent to their care. Recruitment checks were not operated effectively. Care was not being planned and delivered to meet people’s individual needs. There were no effective systems in place to regularly monitor the quality of the services. Accurate records were not being kept. There were insufficient numbers of suitably qualified, skilled and experienced persons employed at the service.

After this inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this inspection on the 30 July 2015 to check that they had followed their plan and to confirm they had now met legal requirements.

Acorn Hill Nursing Home provides nursing and personal care for up to 49 people. At the time of our inspection there were 29 people using the service. A number of people accommodated at the service had complex physical and mental health needs. Some people were living with dementia and others were receiving end of life care. The service is located in Leicester and accommodation is provided over three floors with a lift for access.

Acorn Hill Nursing Home is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of our inspection a registered manager was not employed at the service. However an acting manager had been appointed and the provider was in the process of actively recruiting for a manger who would apply to be registered with CQC.

People using the service told us they felt safe in the service and relatives felt their family members were safe. Staffing levels were good and this had had a positive impact on the care and support provided. Staff were safely recruited to help ensure they were suitable to work in a care setting. They were trained in safeguarding and knew what to do if they had concerns about the well-being of any of the people using the service.

All areas of the premises inspected were clean and fresh. People were satisfied with how staff supported them with their personal care. Risks to people’s health and well-being had been identified, assessed and managed in an appropriate way. Medicines were safely managed. Some improvements were needed to medicines records.

This provider had implemented a new system for recording and actioning MCA (Mental Capacity Act) DoLS (Deprivation of Liberty Safeguards) applications and outcomes. Appropriate paperwork was in place, including care plans, to demonstrate that any restrictions on people’s liberty were being lawfully applied.

People were supported to have sufficient to eat, drink and maintain a balanced diet. Meals were served individually and staff provided assistance to people who required it. There was a choice of dishes at every meal and people told us the food was of a good quality and well-presented. People’s nutritional support plans had not always been followed.

People using the service and relatives said the staff were well-trained and provided effective care and support. We observed staff were confident and skilful in their interactions with people and always talked with people as they supported them and put them at ease.

Nurses and care workers said they were satisfied with the amount and quality of the training they received. People were well-supported with their healthcare needs and records showed they were seen routinely and when required by a range of health and social care professionals.

People told us the staff were caring and encouraged them to be independent. People were offered choices and were involved in their own care. Relatives said staff kept them up to date with any changes to their family members’ care needs.

The provider had implemented a new keyworker system to help ensure people received personalised care delivered in the way they wanted it. Staff were knowledgeable about the people they supported and knew their likes, dislikes, hobbies, and interests. Care plans had been re-written to focus on people as individuals and described their choices about how they wanted their care to be provided.

Staff had introduced a new programme of daily one to one and group activities. These included music, coffee mornings, gardening, and arts and crafts. Records showed these were well-attended and people told us they enjoyed having more to do.

All the people using the service, relatives, and staff we spoke with during our inspection said the service had improved. The provider’s quality assurance system had identified where some developments were needed to the service and these had been actioned. Further improvements were needed to record-keeping.

Inspection carried out on 15, 22, and 31 December 2014

During a routine inspection

This inspection took place on 15, 22 and 31 December 2014 and was unannounced. The additional visits on 22 and 31 December 2014 were carried out due to concerns raised in relation to people’s safety and well-being identified during our inspection on 15 December 2014 and information of concern we received from the commissioners of the service, who fund people’s care.

Acorn Hill Nursing Home provides nursing and personal care for up to 49 people. There were 39 people receiving nursing care and one person receiving personal care at the time of our visit on 15 December 2014. A number of people had complex physical and mental health needs. Some people were living with dementia and others were receiving end of life care. The service is located in Leicester and accommodation is provided over three floors.

There was a registered manager in post 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. However, the registered manager had resigned from their post at the time of our inspection and the service was being managed by the provider’s clinical lead. A new manager was due to start on the day of our inspection on 15 December 2014, however, they did not arrive for work and the provider was unable to contact them.

At our last inspection on 13 May 2014 we identified a breach of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2010. We found that people’s care and welfare needs were not always being met. We asked the provider to take action to make improvements.

At this inspection we found that improvements had not been made and significant concerns about how people’s care was being planned and delivered were identified. Due to the significant concerns we identified about how people’s personal and health care needs were being met at Acorn Hill, we made five safeguarding alerts to the Local Authority in order for investigations to be undertaken. In addition, prior to and during the course of our inspection, a number of other safeguarding concerns had been raised from a range of sources about the care afforded to people at the home.

There were not suitable management arrangements in place when we inspected this service and this was having a significant impact on people using the service. There were not effective systems in place to monitor the quality of the service being delivered. The provider was failing to assess risks to people’s safety and well-being and people were receiving unsafe and inappropriate care as a result.

At our first visit we found significant concerns in relation to staffing levels at the service and how people’s individual needs were being met. All of the people we talked with were positive about the staff who cared for them but many of them told us there were not enough staff to meet their needs. We observed people having to wait for assistance and people being left to eat without support. We found that there was an insufficient number of staff working at the service.

Staff working at the service told us that staff morale was low. They described working in a negative environment and told us that they did not feel supported in their job roles. Several staff members told us that they wished to leave their employment at the service. Staff told us that they lacked any time to spend with people and that they struggled to meet people’s care needs. We observed this to be the case.

We found that, although Deprivation of Liberty Safeguards (DoLS) had been applied for appropriately at the service, some of these DoLS had expired and no action had been taken to address this. There was a lack of staff training in relation to the Mental Capacity Act 2005 despite this being relevant to the people who used the service, many of whom lacked the capacity to make decisions about their care and treatment.

We found that people were not protected from the risk and spread of infection. We saw that the home environment was dirty and on occasion people’s bed linen was dirty. This was undignified for the people concerned and put them at risk of acquiring a health care associated infection.

We found records were not completed accurately and that clinical charts contained gaps and omissions. Staff told us that this was due to them not having the time to complete them. Whilst this meant that we were not able to fully establish the actual care that these people were receiving, we identified significant concerns in relation to the care and support other people received.

People’s care and treatment records were inaccurate, out of date and we found that they were not being stored securely. We found shortfalls with the arrangements in place for the management of medicines.

Staff treated people with kindness and we observed positive interactions between and staff and people using the service. However, due to staffing levels at the home people’s dignity was, at times, compromised. There was a lack of activities on offer and a lack of evidence about systems in place to obtain people’s views about how they spent their time. People were observed to be engaged in little or no activity during our inspection.

We found that staff were not adequately trained in key areas in order to deliver safe and effective care and that training about how to support people who may experience behaviour that was challenging had not been undertaken. We identified that there had been a number of injuries sustained by staff whilst working with people at the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to a number of breaches 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 also found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and have taken action to protect people using the service. We will report on this action once completed.

Inspection carried out on 13 May 2014

During a routine inspection

We spoke with four of the people living in the home, six visiting relatives and three staff. Some of the people we saw in the home had memory problems or difficulty with communicating their needs.

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

Is the service safe?

At our inspection of 30 December 2013 we found that some people using the service were not stimulated by a staff group that largely reacted to contain situations rather than proactively engaged with people.

At this inspection we found the staff were more pro-active. That meant that when a challenging situation arose, with a person that lived in the home the member of staff dealt appropriately with the situation and helped the person regain their composure. Care plans were written in an individual way that ensured people received personalised care and support. There were arrangements in place to deal with foreseeable emergencies such as individual evacuation plans in case of a serious event such as a fire.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no recent applications had needed to be submitted. Relevant staff were aware when an application should be submitted.

Medicines were stored and administered securely. However we saw that the storage of care plans and other confidential materiel could be made secure and so increase confidentiality.

Staff told us they were provided with personal protective equipment (PPE). We also saw plentiful supplies of PPE placed around the home. We also noted that the cleaning schedules did not cover all the areas we would expect in the home, and a number of bins waste bins did not have disposable liners, which would have reduced the occurrence of cross contamination and cross infection in the home.

Is the service effective?

People�s health and care needs were assessed, and they and their representatives were involved in the agreement of their plans of care. One visiting relative said, �My sister had a form to complete about things that are important to our mother.� We later confirmed that care plans reflected that individual person's details. That meant care plans reflected people�s individual preferences.

Is the service caring?

The service worked well with other agencies and services to make sure people received care appropriate to their needs. We saw where people were supported by visiting doctors, specialists and district nurses on a regular basis.

Is the service responsive?

The staff took action to ensure a wall light was moved after we highlighted the issue during our visit. A visiting relative stated, �Although we�ve not had a problem, I wouldn�t hesitate to go to the manager if there was a problem. I�m quite confident that they would do something about it.�

Is the service well-led?

Quality assurance systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. A visiting relative said, �We appreciated that the manager was open about the problems and the plans to put things right.�

Inspection carried out on 30 December 2013

During an inspection to make sure that the improvements required had been made

We returned to the home to follow up non-compliance from the last visit in November 2013. During our visit we used a Short Observational Framework for Inspection tool (SOFI) to help us see what people�s experiences were. The SOFI tool allowed us to spend time watching what went on in a service and helped us to record how people spend their time and whether they had positive experiences. This included looking at the support that was given to them by the staff. We saw at our last inspection that noise levels and disruption were high. At this inspection the change was significant and the home was much quieter and people appeared calmer.

We were once again accompanied by an expert by experience who also observed and spoke with people using the service and their visiting families. People who spoke with the expert by experience said, �I think it�s improved a bit and changed with different staff.� A visiting family member said, �For us, the staff have always been caring and my Dad feels safe, therefore both he and us are happy that he�s in here.�

We noted that the acting manager had undertaken a number of quality assurance exercises that had resulted in improvements and changes to the care and support people received, and staffing numbers and deployment.

There had also been improvements to the furniture in the home, with a programme of redecoration planned to commence in January 2014.

Inspection carried out on 14 November 2013

During an inspection in response to concerns

Some people who lived at Acorn Hill Nursing Home have cognitive disability or communication difficulties, we were unable to ask all of the people directly about their experiences. We were supported on this review by an expert-by-experience who has personal experience of using services. He spent time with people in the lounge and dining areas of the home and spoke with a number of people living in the home. One person said to him �I just don�t feel safe. I fear for my life. I don�t know when I may be attacked by one of the other residents.� The expert also spoke to a family member that was happy with the care and said �My own mind is at rest, knowing my wife was well-fed and safe.�

Our inspection of 29 August 2013 found that we found continuing poor practice with the arrangements to supply medicines safely to people which might have resulted in people�s needs not being fully met.

The provider wrote to us and told us that they would be compliant and have the issues resolved by 25 September 2013. When we visited we saw that medicines administration for people had improved in some areas. However we saw where a person had not received their full cours of treatment and another person their medicine on the correct day. This could have had an effect on their health and wellbeing.

We also saw at that visit, that the monitoring of staff and quality assurance systems were poorly organised, another area which is still apparent.

Inspection carried out on 29 August 2013

During an inspection to make sure that the improvements required had been made

We returned to Acorn Hill as we had outstanding compliance actions from the visit in June 2013. We were unable to ask people directly about their experiences, but spent time and observed people�s routines from a distance.

We observed staff administering medication which they did efficiently and accurately. People were spoken with in an appropriate way and we checked to see they were offered the correct medicines. We checked other parts of the medication system and noted improvements in the appropriate temperature of the room where medication is stored and daily nursing audits.

However we also noted that there are still some improvements required to the medication policy and procedure, temperature monitoring of refrigerated products, PRN or as required medicines and disposal of medicines that are no longer required.

We also looked at the changes to peoples care records and how they were completed by staff. We noted that all these documents had been gathered into two main files. This allowed staff to ensure the daily recording was in one file, which has led to a greater degree of accuracy of detail.

We also looked at how the Manager quality assured the medication processes that had been altered. We found there were areas where quality audits had been undertaken but had not resulted in a thorough check of the system. These checks were not well thought through or undertaken efficiently to reveal discrepancies that we found on our visit.

Inspection carried out on 14 June 2013

During a routine inspection

Because some people who lived at Acorn Hill have cognitive disability or communication difficulties, we were unable to ask people directly about their experiences. We spent time and observed people�s daily routines and interactions with others from a distance.

We observed staff talking with people this was done with their privacy and dignity in mind and showed the staffs� awareness of peoples individual support needs. We also observed how people are assisted to eat their meals; again this was done with the person�s dignity in mind. We looked at how care and support plans are compiled and reviewed and how, when necessary receive additional dietary input. We also looked at how the staff were supported with training, and individual and group meetings.

We looked at medication and recognised not all the people in the home were assured of being given all their medication all the time. We also looked at how staff completed care and other supporting records and documents. These were not completed in a consistent way which left staff without clear direction and instruction.

Inspection carried out on 9 January 2013

During a routine inspection

We observed staff talking with and assisting people throughout the day, this was done with the peoples� privacy and dignity in mind and showed the staffs� awareness of peoples individual support needs.

We spoke with a number of people living in the service and a number of visiting relatives. One of the relatives of a person using the service stated �the staff are kind and friendly� and �the food looks lovely�. Another added �we went through the care plan, we can see it anytime�.

On our tour around the home we noted a number of sitting and dining rooms. There has been a number of floor coverings replaced and some areas decorated recently. There is regular maintenance of the equipment in the home where a number of external contractors are used to ensure this is safe for use by the staff. Toilets and bathrooms have privacy locks in place, bedrooms have yet to be brought up to individual peoples needs.

The recruitment process has recently been updated and should now ensure people are safe. Staff receive regular training to ensure people are cared for safely.

We spoke with staff and they were able to tell us how people living in the home should be safeguarded and were aware how to follow this up with outside agencies were this necessary.

Inspection carried out on 18 July 2011

During an inspection in response to concerns

People who use the service at Acorn Hill Nursing Home said they were satisfied with the care and treatment provided by the staff. They said they were consulted and involved in the care planning and review meetings. They felt they were well looked after and staff responded promptly to their requests for assistance. They felt they received co-ordinated care and treatment from other health professionals on a regular basis or when required.

The visiting relatives said they were satisfied with admission process when their family member moved to the home and the care provided. They said they are kept informed of any significant event or incident with regards to their family member using the service.

People who use the service and visiting relatives said they were confident to report any concerns or complaints about any aspect of their service. They were aware of the complaints procedure and who to contact should they need support to express concerns.

Reports under our old system of regulation (including those from before CQC was created)