Inspection on 01/08/05 for Acorn

This inspection was carried out on 1st August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Acorn 19/02/08

Acorn 20/02/07

Acorn 02/02/06

Acorn 31/01/05

Acorn 02/09/04

Acorn 01/03/04

Acorn 07/11/03

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Hillview Farm

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

CARE HOME ADULTS 18-65 ACORN 20 Hucklebury Close Purley-on-Thames Berkshire RG8 8EH Lead Inspector Steve Webb Unannounced 1 August 2005 @ 10:00 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 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 Stationary 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. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Acorn Address 20 Hucklebury Close Purley-on-Thames Berkshire RG8 8EH 0118 9427608 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Purley Park Trust Limited Kim Marie Facer Care Home 5 Category(ies) of Learning Disability registration, with number of places ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Two designated persons aged 65 years of age or over are accommodated by prior agreement. Date of last inspection 31/01/05 Brief Description of the Service: Acorn House is one of the three original ‘outlying houses’ within the Purley Park Trust, and is now one of eight separate small units within the estate. The unit now accommodates up to five adults of either gender, with a learning disability, in a pleasant building providing each service user with their own individualised bedroom. Communal accommodation consists of a shared lounge/kitchen/dining area, with comfortable furnishings, bathroom and toilet. The service users in this unit are relatively able and independent and work together with staff on various aspects of the day-to-day running of the unit. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, carried out between 10.00am and 2.00pm on 1/8/05. The manager was on leave, and the inspector was ably assisted by a support worker and the team leader. It was a very positive inspection. The unit was settled and relaxed with everyone going about their business. Staff support and encouragement was provided where required, but service users were encouraged to make their own decisions, and do things for themselves wherever they were able. The new service user appeared settled and happy, and seemed to have been made to feel welcome by everyone. She had already received visits from her family. What the service does well: What has improved since the last inspection? There is an improved medication management system in place and additional staff training is being made available on medication, including external pharmacist training. The views of service users have been sought through a quality assurance process, which will be reported upon in a subsequent inspection. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 6 There have been ongoing improvements to the physical environment, with the refurbishment of the kitchen now almost completed, and a new dining suite on order. Some of the required fire safety remedial works have been carried out, though the process is not yet completed. An attractive rose garden had been developed in memory of the service user who died in November last year. The organisation now has a dedicated staff member whose role is to coordinate and oversee the training needs across the service. This has meant that there is now a thorough overall induction and training package for all staff, and good progress is being made on NVQ. 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. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4 Prospective service users are fully assessed prior to moving in and have appropriate opportunities to visit the unit ahead of moving in. EVIDENCE: One new service user moved in two weeks before this inspection, following the death of a previous service user in November of the previous year. She was able to visit the unit twice before her move, and the care manager assessment was obtained. The head of care also carried out an assessment to the organisation’s format. Some of this information was initially unavailable because the keyworker had taken the main file home to work on the upcoming review, however, this was brought back to the unit during the inspection. All staff should be reminded that it is not good practice to remove original files and documents from the site. The new service user has settled in well so far and has been made welcome by other service users in this unit and others on the site. Her daily logs indicated useful detail and regular recording. Risk assessments were already in place in the collective risk assessment file, pertaining to the new service user. There was also a family contact sheet in place with records indicating that there had already been contact. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 9 As noted above the six-week review was coming up and the allocated keyworker was already working on the report. It was noted that the new service user needed to be added into the review schedule on the office wall. The cross-team meeting minutes referred staff to the available assessment documents for information on the new service user’s needs and interests. She has been given opportunities to take part in all available activities in order to help clarify her preferences and establish her activity plan. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 9 Service users assessed needs, interests and preferences are recorded within the care plan and essential lifestyle plan system, and they are supported to take appropriate risks within a risk assessment framework. EVIDENCE: Each service user has an individual care plan and an Essential Lifestyle Plan, which identifies individual needs, preferences, likes and dislikes, in such areas as food and activities. Each also has a compact (contract), in their file, appropriately countersigned. Risk assessments are carried out when necessary, and are held collectively for ready access by staff, as well as within individual files. Risk assessments are also present for service users from other units on site, where they are likely to be relevant to staff in the unit. As noted above, relevant risk assessments had already been produced for the new service user, which is good practice. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Service users take part in a range of on and off-site activities and leisure, and are part of both the local and on-site communities. All have regular contact with family or significant others. EVIDENCE: Service users access a wide range of activities, both on and off-site, some as part of a weekly activities plan, others of a spontaneous nature. On the day of inspection, one was out shopping in town alone, one went out to lunch with their 1:1 worker, one was going to an art session in the club-house that afternoon, and one was visited by a service user from another unit on the site. Each service user has an individual activities plan for regular scheduled activities. Available activities include karaoke, pub visits, bowling, shopping, swimming, computing, bible studies, horticultural therapy, attending church and church-run events such as coffee mornings, pamper sessions, and on-site art and craft sessions run by Reading College. Individual record sheets of all family contact indicate that all have regular contact with family or significant others. Service users freely visit each other in the other units on site. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,20,21 Service user’ preferences and needs regarding how they are supported by staff, are obtained and recorded within essential lifestyle plans. None of the service users is able to manage their own medication, but an appropriate system is in place for staff to manage this on their behalf, although staff should be reminded of the need to record the quantities of all medication coming into the unit. The wishes of one service user, regarding funeral arrangements, have been obtained, and those of some others are to be obtained. In some cases it is not felt appropriate to pursue this information at the moment. EVIDENCE: The service users in the unit require relatively low levels of personal care support, but this is offered with regard to any identified preferences, which are recorded within essential lifestyle plans. Where risk assessment indicates a service user is able to undertake something without direct staff support, this is enabled. None of the service users is felt able to manage their own medication, and this is managed by the staff via a dosette system. Three staff are currently trained to administer medication, one of whom is the manager. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 13 Improvements have been made to the medication system, such that each dose administered is now countersigned by both the staff member who is administering, and a second witness. Staff receive in-house medication training via a video and are monitored on their first few occasions. All staff are also scheduled to receive external medication training from a pharmacist. The medication file contains clear guidance and includes individual medication profiles, photos of the service user (apart from the newest one, which should be included), and a signature sheet to record each staff member’s initials. The quantities of most medication coming into the unit were recorded on the Medication Administration Record (MAR), sheets, with the exception of some medication prescribed after the sheet’s production, and added later. The quantities of all medication coming into the unit, must be recorded as part of the medication audit trail. Record sheets for appointments with GP, chiropodist, dentist, optician, psychiatrist etc, indicate contact at appropriate intervals. The preferences around funeral arrangements for one service user have been obtained and recorded. In the case of the others this was said to be in hand or was felt to be inappropriate for specific reasons. The reason for not seeking this information should be included in their care plan documents. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The views of service users are sought through various forums, including a quality assurance survey. Complaints would be recorded in the unit’s complaints log. EVIDENCE: An appropriate complaints procedure is in place, which is available in text and symbol formats, and has been explained to service users. A unit complaints log has been established though there are no recorded complaints as yet. Service users attend residents meetings regularly and can also access the head of care and chief executive who are both based on site. Service users have also been asked for their views on the service as part of the organisation’s quality assurance system, though the report is still awaited. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 Service users live in a homely and comfortable environment, which protects their wellbeing for the most part, though the use of door wedges on the lounge and kitchen doors, could compromise their safety, and should cease. EVIDENCE: The kitchen had been refitted since the last inspection with new units, cooker, flooring, tiling and decoration, and just required some finishing. A new dining suite was on order. The décor in communal areas is homely. Some of the fire safety works arising from the fire officer’s last visit had been addressed but a self-closer was needed on the laundry door. The ongoing use of wedges to hold open the lounge and kitchen doors was of concern. It is suggested that a risk assessment be completed on the fitting of an appropriate hold-back device to these two doors, enabling them to be held open during the day to facilitate ease of movement about the unit, whilst allowing them to close freely on the sounding of the fire alarm. The devices must be tested in situ to ensure they will function effectively. A rose garden, with a bench seat provided, had been developed in memory of the service user who died in November. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 The needs of service users are met by a well trained and stable staff team. EVIDENCE: The unit is fully staffed, and single staffing (as agreed), continues to be the norm, although a second staff member is sometimes available. A training calendar was on the office wall indicated the planned programme for the year, including training on the role of the care worker, abuse in the care home, fire safety, principles of care, first aid, epilepsy and crisis intervention. The organisation now has one post dedicated to coordinating the training across all of the units, which ensures a consistent approach and a good overview of cyclical needs. Spreadsheets of training needed or completed, for units or individuals can be produced as required. A thorough range of core training is now provided to all staff. The manager is undertaking NVQ level 4, the team leader is on NVQ level 3, and one carer is doing level 2, with another due to start level, who registered on this on the day of inspection. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The health, safety and welfare of service users is promoted by the unit, though this will be further improved once the previously identified remedial works are carried out and the fire risk assessment is completed. EVIDENCE: The required safety certification and service records were available for the unit. All staff have current first aid and food hygiene certificates in place. Staff receive other relevant training related to safety issues. Three of the staff have received medication training to date, though it is planned for all to receive external pharmacy training. Fire alarm testing takes place weekly and is logged as are the monthly fire drills. There is a need to continue to try to explain the importance of leaving the unit on the sounding of the fire alarm, to service users, who are frequently reluctant to evacuate. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 18 The unit requires an overall fire risk assessment, though this was in process. Individual fire risk assessments are already in place for service users, which will also form part of the overall unit fire risk assessment. This document should be copied to the inspector on completion. As already noted under standard 24 above, a fire door self-closer also needs to be fitted to the laundry door and a risk assessment is suggested on the fitting of an appropriate hold-back to the lounge and kitchen doors, to avoid the use of wedges on these doors, which could compromise safety. ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x x Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 ACORN Score 3 x 2 3 Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 20 YES 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. 1. 2. Standard 20 24 Regulation 13 23 Requirement The quantities of all medication coming into the unit should be recorded on the MAR sheets. A self-closer should be fitted to the laundry door. This requirement remains from the previous inspection. A risk assessment should be carried out on the use of suitable hold-back devices on the lounge and kitchen doors. The devices should be tested in situ, for effective operation. An overall fire risk assessment for the unit should be compiled and copied to the inspector. Timescale for action 3/9/05 3/9/05 3. 24 23 3/9/05 4. 42 23 3/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard None. Good Practice Recommendations ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 2nd Floor 1015 Arlington Business Park Theale Reading RG7 4SA National Enquiry Line: 0845 015 0120 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 ACORN H52-H01 S11169 Acorn V235285 010805 Stage 4.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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