Inspection on 25/04/07 for Acacia House

This inspection was carried out on 25th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Acacia House 12/07/05

Acacia House 26/01/05

Acacia House 18/01/05

Acacia House 13/07/04

Similar services:

Chesham House

Argyll House

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Acacia House 37a School Road Newborough Peterborough PE6 7RG Lead Inspector Dragan Cvejic Key Unannounced Inspection 25th April 2007 10:00 Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acacia House Address 37a School Road Newborough Peterborough PE6 7RG 01733 810000 F/P 01733 810011 acacia@communitycaresolutions.com www.communitycaresolutions.com Community Care Solutions Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Anita Barber Care Home 5 Category(ies) of Learning disability (5), Mental disorder, registration, with number excluding learning disability or dementia (5) of places Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only service users who have a mental disorder, which is associated to their learning disability to be admitted to the home 12th July 2005 Date of last inspection Brief Description of the Service: Acacia House is a care home for up to five adults who have a learning disability. The home is a modern bungalow, which has been substantially extended and adapted to meet the National Minimum Standards for Care Homes for Adults. Accommodation comprises five bedrooms all with en-suite facilities (two of which also have showers). In addition service users have access to a large lounge, dining room, kitchen and laundry room and the home has sufficient office space. To the rear is an area of raised decking with ramped access to a garden area, and a long driveway at the front provides off road parking for staff and visitors. Practical and emotional support is provided by staff 24 hours a day including waking night staff. The fee charged to service users is £1250. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection with a site visit that was carried out on the 25th April and lasted for 3 hours. All five service users were in the home and two of them, that were verbal, spoke to the inspector. Two staff members accommodated the inspection, as the manager had her day off. Two case tracked users commented on the home, were observed, and documentation relating to them was checked to inform the inspection. A pre-inspection questionnaire was sent to the CSCI office prior to the site visit and was used to prepare and conduct the on-site part of the inspection. What the service does well: The home had a very good description of the service. This was also included in care plans, demonstrating how the service, provisions and environment were appropriate for each individual. Very good care plans were used to devise comprehensive and detailed risk assessments that clearly stated any limits imposed on users. An example was a risk associated with one user using knives, but it was suggested that she was supervised, rather than forbidding her to use the kitchen. Staff were very knowledgeable of users conditions, needs, likes and dislikes and their personalities. Users could express themselves fully and staff were there to support them in the way agreed with service users. A female user determined the shift pattern so a female staff member was always on duty. This user was also protected by a female staff member accompanying her on her outings, ensuring that her vulnerability did not prevent her from enjoying events outside the home. Two users were very proud of attending college. Staff were appropriately trained and used their knowledge to meet the needs of each individual. . The relationship between staff and service users was admirable. Users trusted staff, staff treated users with full respect. Laminate and wooden floors contributed to the nice clean and bright environment. A service user who showed her room stated: “I love my room. I have all I need and want in it.” There were no loose items in communal areas; pictures were fixed on the walls providing a homely environment without risk of damage or to the users. Activities offered and organised for service users well exceeded minimum standards. They were chosen according to users abilities and organised for each individual. The quality assurance review carried out by the organisation confirmed the satisfaction of service users and their families with the service. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information about the home was made very accessible to potential and existing users. The home carried out an effective and comprehensive assessment prior to offering a place to potential users to ensure that they could make a clear and informed choice and, once admitted, that their needs were met. EVIDENCE: As there were no changes to elements described in the home’s statement of purpose, this document had not changed since the last review. Documents describing the home were produced in a short version, too, as well as in Makaton signs. The service user’s guide was in each file checked. The home did not have recent admissions, but all three checked files contained evidence of the admission assessment for service users. These assessment documents demonstrated that the assessment was carried out thoroughly, fully and covered all areas of users lives. The assessments were used to create the care plans. Service users confirmed that their needs were fully met. A user spoken to stated: “I like living here, I like the food and staff help me a lot.” Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 9 Staff spoken to emphasised good teamwork that ensured users needs were met: “We know users well and we support each other in helping users. It is much better now that we have a stable staff team.” Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users were encouraged to make their own decisions and to take risks, but were protected by well-organised staff support that was co-ordinated with support from external professionals. The home exceeded this group of standards. EVIDENCE: The operational manager was regularly checking service users’ files and care plans. The monthly reports indicated that 8 care plans were checked during these visits. During the site visit, as a part of the inspection, a further 3 care plans were checked. Plans were detailed and showed why staff intervened to help service users. One plan stated: …”has a tendency to abscond and staff need to monitor if she wanted to go out.” Another service users plan stated: “likes to cook, but needs supervision.” The user commented: “I like to bake cakes. The staff help me”. Her risk assessment addressed a hazard with her using knives, but did not restrict her Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 11 cooking and provided instructions to staff on how to support, help and protect her while she was cooking. A case tracked service user stated that she was “not much interested in care plan”, but her care plan was written in the first person and her hand writing was recognisable, showing that users were involved and respected when their care plans were drawn up. Care plans were detailed and the content was clear and informative, exceeding minimum standards. A service user stated that she learnt Makaton in order to communicate with three service users who used this form to communicate. Staff were also trained to use Makaton. She stated: “We can decide for ourselves. I choose and do my own activities.” She emphasised the involvement of her social worker and how her support was co-ordinated with that of staff in the home. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users were able to control their lives and were supported to exercise choice, independence, their rights, and to explore reasonable risks. EVIDENCE: A service user stated that she learnt Makaton to be able to communicate with users who did not have the ability to communicate verbally. All service users were involved in some house chores and were responsible for cleaning their rooms. Some of them were cooking and were doing their own laundry with support from staff. The case tracked user proudly stated: “I go to college 3 days a week. I spend weekends with my family. I will be a bridesmaid in September.” She also commented that she had found a new friend, pointing to a newer staff member and demonstrating that staff were seen as supporters and friends. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 13 The activity programme showed that service users spent time on activities both in and outside of the home and that they led fulfilling lives. A range of leisure activities included swimming, bowling, visits to the cinema and going out for walks with staff. The manager stated that service users were going on holiday and that the organisation paid £250 towards it in the pre-inspection questionnaire. The layout of the home and daily routine allowed and directed service users to spend time together in communal areas and to develop relationships how they wanted. A service user explained that she was sometimes disturbed by another user being loud, but she showed an understanding and tolerant approach. Two users were walking from the house to the garden and back, showing that they could use the premises as they liked. A staff member helped one of them when he became a little unstable on his feet. Mealtimes were flexible and accommodated within the planned daily programme, so the timing was adjusted for each day individually and still remained flexible, if users wanted to eat at different times. The menus supplied prior to the visit showed a balanced and nutritious diet. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home respected service users wishes, privacy and dignity when their healthcare was dealt with. Service users were protected with clear and safe healthcare and medication procedures and practices. EVIDENCE: The majority of service users had a structured weekly programme that was set during care planning meetings with them. A service user filled her care plan herself, signed and dated it. The way in which she was supported was clearly discussed with her during the care planning process. Daily records were compared for 3 case tracked users with their care plans and recorded staff input matched actions from care plans and their risk assessments. The case tracked user knew her key worker, trusted the manager and was happy that her social worker supported her, too. A mixture of male and female staff to reflect service users’ gender enabled respect for users choice when they wanted male or female staff to help them. She stated: “We have always a female staff member on duty, as I prefer females to help me with personal things.” Her risk assessment indicated the Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 15 need to be with female staff due to some previous false allegations and some concerns from staff about her vulnerability and safety. The picture format of care plans also made it easier for service users to understand the planned actions about their healthcare. The files contained details such as: “…wears orthopaedic shoes with callipers. Staff to be familiar with these.” The instructions to staff on how to deal with seizures and record them were very clear. Medication procedure and records for all three case tracked service users were checked and found to be accurate and appropriate. Service users’ wishes in case of death were recorded. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home valued highly the safety of service users and a number of procedures and policies were in place to ensure users’ protection, as well as risk assessments when freedom was limited in any way. EVIDENCE: The manager reported in the pre-inspection questionnaire that there were 3 complaints since the last inspection. She pointed out that they were resolved within 28 days, the set time scale. The records showed that these three were concerns rather than complaints and that they were resolved to the user’s satisfaction. The operational manager’s visits in the last four months recorded: “No complaints”. The CSCI had not received any complaints. The procedure was in the service user’s guide in picture format and was also displayed in the office. A service user spoken to stated that there were no complaints and continued: “I have told staff that the other service user wakes me some nights”. The staff explained that this statement was partly true, as a user stayed up until very late and that another user occasionally screams either early in the morning when all users were up or sometimes at night, but staff offer reassurance and the whole house goes back to sleep. The home ensured the protection of service users through a rigorous recruitment procedure, staff training on POVA and set strict policies about protection from abuse. Staff were trained in restraint procedures, but did not use any restraints in the home. All limits were recorded in risk assessments, Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 17 such as one for a user with tendency to abscond, who was given a room key, but not the main key for the house. Staff however, stated that she could go out when she asks them. When the service user was asked about this procedure, she confirmed that the staff would accompany her when she wanted to go out. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The house was bright and very clean and easy to maintain, allowing service users to use the entire house as their own and to be proud of this opportunity. EVIDENCE: The tour of the premises and observation of service users moving around in the house showed that the home was suitable for their needs. A service user showed her bedroom, proudly stating: “This is my bedroom. I clean it and I look after it. I have all I need here. “ Another user commented: “I love my bedroom.” Laminate flooring and wooden floors in communal areas gave the house a homely, warm feeling and were easy to keep clean. Pictures were secured on the walls, minimising potential damage. There were no unsecured items in the communal areas. Individual bedrooms, two of which were seen, were individualised and appropriate for users’ abilities. Radiators were covered to prevent risk of scalding. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 19 Both communal areas and users bedrooms were clean and tidy. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staff team was skilled, experienced and able to meet the service users, needs. Service users were protected by good inductions of new staff and training appropriate to staff roles and service users’ needs. The home exceeded these standards related to staffing. EVIDENCE: The staff rota was sent to the CSCI prior to the site visit and showed good planning and appropriate cover. The home particularly benefited from a communication co-ordinator who determined the development of Makaton and pictures used to communicate. A “sign of the week” was displayed on the notice board. Interactions of staff and service users was observed and showed a friendly, but educational approach. The staff team consisted of both male and female staff and was proportional with service users’ gender. Staff were well trained and had qualifications that equipped them with the knowledge of how to best meet the users’ needs. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 21 “We do a great job here as a team and it is a shame that the organisation does not fully recognise the achievements of this home”, commented a staff member, confirming the observations and findings of this inspection. The level of NVQ trained staff did not fall under 50 and the staff were very motivated to work on their personal development. This approach in turn encouraged service users to work on their development, as seen through a case tracked user who learnt Makaton and attended college. Staff did not have access to staff files as the manager had a day off on the day of the site visit. This indicated, and staff confirmed, that the home would further benefit from the introduction of another senior position. Staff training included mandatory subjects, but went on covering topics related to users’ conditions: NAPPI (training on restraints), autism, dementia, epilepsy, care principles, Person Centred Planning and communication. Staff spoken to confirmed that they received regular supervision and felt well supported in the home. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38,39,40,42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home promoted and encouraged safe working practices and listened to staff and service users to identify all potential hazards and minimise them. Service users were protected, but still allowed to exercise autonomy, individuality and creativity. Management of the home exceeded minimum standards. EVIDENCE: The management hours were split into 24 hours for management and 16 for care. This division allowed the manager to stay in direct contact with service users and still to retain the atmosphere in the home that ensured the satisfaction of service users and staff. Although the manager was not present during the site visit, her style was seen in the home and in the filled preAcacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 23 inspection questionnaire. She had all the qualities, skills and knowledge to manage the home. The staff were proud of their teamwork and team atmosphere and stated: “We do an excellent job here, but the organisation does not always recognise that. We would greatly benefit from another senior position in the home.” Service users confirmed staff’s statement. The quality assurance review contained responses from 5 service users, 4 families, 3 from staff and none were returned from questioned social workers. The home used the ISO 9001 quality assurance system. Safe working practices were in place. Staff received regular updates of mandatory training. Procedures regarding safety were followed and used to measure the effectiveness of staff work. The operational manager’s visits reported to the CSCI showed that the deep cleaning procedure, fire evacuation procedure were checked, and water was regularly checked against Legionella; COSHH sheets were updated in February. Risk assessments were updated and reviewed and regularly checked by the operational manager who pointed out any potential shortfalls. The management of the home responded to all internal recommendations and to those of the inspecting authorities. The home’s policies and procedures were reviewed and kept up to date, as seen in examples of: admission policy, staffing related policies, recruitment, bullying, complaints, policies on food hygiene and handling service users’ money and valuables. Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 4 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 4 33 4 34 X 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 4 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 3 4 4 4 X 3 X Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Acacia House DS0000044097.V338608.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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