Inspection on 02/02/06 for Acorn

This inspection was carried out on 2nd February 2006.

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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Acorn 19/02/08

Acorn 20/02/07

Acorn 01/08/05

Acorn 31/01/05

Acorn 02/09/04

Acorn 01/03/04

Acorn 07/11/03

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Hillview Farm

Dalewood Respite Care

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REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

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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 Huckleberry Close Purley on Thames Reading Berkshire RG8 8EH Lead Inspector Stephen Webb Unannounced Inspection 2nd February 2006 10:15 DS0000011169.V279784.R01.S.doc Version 5.1 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 DS0000011169.V279784.R01.S.doc Version 5.1 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. DS0000011169.V279784.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Acorn Address 20 Huckleberry Close Purley on Thames Reading Berkshire RG8 8EH 0118 9427608 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) Purley Park Trust Limited Mrs Kim Marie Facer Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places DS0000011169.V279784.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2005 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. DS0000011169.V279784.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out between 10.15am and 2.45pm on the 2nd of February 2006. The inspection included the examination of key records and policies, a review of progress on previous requirements, discussion with support workers, a tour of some areas of the premises and discussion with some of the service users. The inspector also had lunch with service users. This was a positive inspection. The manager was off duty but the support workers on duty worked diligently to meet the needs of the service users whilst also supporting the inspection. All of the previous requirements had been addressed. The unit had experienced a stable period with no changes of service user or staff. One service user had spent a period in hospital and was recovering well. Some of the service users were out on activities during part of the inspection but all were seen. Service user feedback about their care was positive and the observed relationships between them and the staff were positive and relaxed. In the longer term, there are proposals to replace the unit with a new one purpose-built to the new standards and including a lift. What the service does well: The unit is very obviously home to the service users, who are very relaxed within the unit and its campus, about which they can move freely. Service users have access to a good range of activities, both organised by the in-house day service, and by unit staff. They are enabled to spend time alone or together in whatever group they are comfortable. They are involved in day-to-day decision making and can influence their lives. Service users can be involved in various aspects of domestic tasks and cooking though they show limited enthusiasm for this. The unit has good links with healthcare professionals. Service users have access to an appropriate complaints procedure and can also raise any concern through other forums. DS0000011169.V279784.R01.S.doc Version 5.1 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. DS0000011169.V279784.R01.S.doc Version 5.1 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 DS0000011169.V279784.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: None of these standards were inspected on this occasion. Standards 2 and 4 were inspected at the previous inspection and were met. DS0000011169.V279784.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7 Service users receive support when necessary, to make decisions about their lives. EVIDENCE: Service users are able to make many day-to-day decisions for themselves, including when to get up and go to bed, the clothes they will wear, how they wish to spend their day, etc. The resident’s meeting minutes indicated that they were involved in choosing where they went on holiday and the preference of one service user for a specific individual holiday were to be met. Service users also take part in planning the menus for the house. Service users ability to manage their personal allowance is risk assessed. One service user gets her personal allowance weekly to spend as and when she wishes, another gets a small amount each week to hold for himself. Other service users’ weekly allowances are secured in a cash tin held by the staff. Written in/out/balance records are kept of all monies given to service users or spent with them or on their behalf, together with receipts. All accounts are returned to the central accounts department, weekly, for monitoring. DS0000011169.V279784.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 14, 16, 17 Service users are encouraged to engage in appropriate leisure activities, and their rights and responsibilities are respected. They are offered a healthy diet and have some say in the menus and enjoy the meals provided. EVIDENCE: Service users can access a range of planned day-to-day activities, operated by the in-house day care service. They also take part in impromptu trips with care staff individually and in small groups, to go shopping, to cafes, etc. Each service user has a written day care plan scheduling their regular activities. Two of the service users were out taking part in scheduled activities on the morning of the inspection. The rights of service users to choose their activities and whether they wish to take part in specific activities are respected. DS0000011169.V279784.R01.S.doc Version 5.1 Page 11 The daily routines of the house are fitted around the needs and wishes of the service users, and they are encouraged to take part in household routines, though they opt to have a limited role. The privacy of service user’s bedrooms is respected by staff and some service users have keys to their bedroom door. The staff and service users interact freely in a relaxed and positive way. There is good knowledge of individuals needs and preferences and a warmth in their relationships. Service users can opt to spend time in their bedroom away from the group if they wish, and some spend time listening to music. They can move freely about the campus, and some visit friends in other units. As noted, service users take part in planning the weekly menus. The main meal is served in the evenings apart from on Sundays. Menus show an appropriate mix and contain healthy options. The lunchtime meal observed was relaxed with various conversations between service users and staff. The lounge diner is a pleasant environment for meals. Records are kept of the meals provided, and for one service user, exactly what has been eaten, as part of health monitoring. One service user has their own individual menu as part of health management. DS0000011169.V279784.R01.S.doc Version 5.1 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 the following standard(s): 19 The service users’ physical and emotional health needs are met. EVIDENCE: Each service user has a healthcare section in their file, which contains details of any specific needs or issues and separate recording sheets for contact with a range of health professionals. One service user is given dietary supplements to help his recovery, following an operation. The records indicate regular and recent contact where appropriate, though the chiropody records should include specific dates of visits, rather than a general statement of frequency. There are also medication profiles and copies of any relevant reports from health professionals. There are also weight check records, which again indicate regular checks. The GP now visits service users in their unit and sees them in their bedroom, rather than holding a ‘surgery’ in one unit on the campus; and visited one of the service users during the inspection. Accident records are appropriately detailed and held both collectively and on individual files. DS0000011169.V279784.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 22, 23 Though there is an appropriate complaints procedure in place it was not possible to examine its operation, as there were no recorded complaints. The feedback from service users indicated they had no complaints on the day of inspection, and were happy with the care of the staff. The unit effectively protects service users from abuse, but some staff required refresher training on the protection of vulnerable adults. EVIDENCE: The unit has an appropriate complaints procedure in place. The complaints log had no recorded instances of complaint, so it was not possible to examine the procedure in operation. Various thank you letters were on file demonstrating the level of satisfaction felt by the families of some service users. Conversation with some of the service users during the inspection indicated no issues about which they might wish to complain. There is a version of the procedure in symbol form, posted in the unit and on each service user’s file. Service users can also raise any concerns within the regular resident’s meetings. The minutes indicate them being asked individually if they had any concerns or problems. They also have access to the head of care and Chief Executive who both work on-site and make themselves freely available to service users; and to the Regulation 26 monitoring visitor, although these visits have not been taking place monthly as required. (Requirement made under Standard 39). DS0000011169.V279784.R01.S.doc Version 5.1 Page 14 The unit has an appropriate procedure for the protection of vulnerable adults, and any concerns have been addressed appropriately. The local multi-agency POVA procedure is also present. Service user’s finances are protected from abuse by appropriate systems, and service users are risk assessed, to establish whether they are able to manage their own personal allowance. Some staff require a refresher training on the protection of vulnerable adults, which should be provided annually to all staff. DS0000011169.V279784.R01.S.doc Version 5.1 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 the following standard(s): 24, 30 The service users live in a homely, comfortable and safe environment, which is well maintained. The unit is clean and hygienic. EVIDENCE: The environment was satisfactorily decorated for the most part, with a few areas where the walls had become marked. The lounge furniture is due for replacement within the next few months. The communal areas are homely, and contain a range of pictures, ornaments, plants etc. Service users and staff commented on the limitations caused by the fire doors remaining closed at all times, and there was discussion of the possibility of some form of approved hold-back device. If an appropriate risk assessment has been carried out, an approved hold-back device could be fitted to the lounge door, in consultation with the fire authority. DS0000011169.V279784.R01.S.doc Version 5.1 Page 16 Service user’s bedrooms were pleasantly decorated and furnished, and very much individualised to reflect their interests. Feedback from two individuals was that they were very happy with their bedroom. The works to the kitchen were complete and were a good improvement to the facilities, including the new flooring. The unit was clean and free of any unpleasant odours. Appropriate laundry facilities are provided. DS0000011169.V279784.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 It was not possible to assess the protection offered to service users by the organisation’s recent recruitment practice, as there had been no recent recruits to the unit. Improvements have previously been made, however, in response to past requirements, and there are no known current issues. EVIDENCE: There had been no new staff recruited to the unit since the previous inspection. The organisation have continually reviewed and improved their recruitment procedures in light of legislative changes and CSCI requirements. All staff receive an organisational and unit-based induction and foundation training programme, then commence on NVQ level 2. A range of specific training courses are also provided, both from in-house and external trainers, and the organisation has a range of supplementary training videos. Crisis intervention training (NCPI), has been booked for all staff and is due to commence in February. All of the unit staff apart from the manager, who has previously attended, will attend this course. DS0000011169.V279784.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 The views of service users have been sought as part of a developing quality assurance system but the resulting report has yet to be produced. Regulation 26 monitoring visits are also not taking place with the required monthly frequency, reducing service user access to another party with whom they could share their views and any concerns. EVIDENCE: At the time of inspection no quality assurance report was available, though it is understood that QA questionnaires have been made available to service users, families and medical practitioners, and are awaiting analysis. A summary report of the QA feedback should be produced and made available to interested parties. An annual cycle of QA surveys and reporting, should be established to inform the annual review and annual development planning for each unit, when combined with feedback from complaints, inspection reports and Regulation 26 reports. DS0000011169.V279784.R01.S.doc Version 5.1 Page 19 A development plan for the period August 05 to October 06 was posted on the office wall, in the form of a spreadsheet, with various tasks such as service user reviews scheduled. However, the format contained limited information. The development plan should cover staffing issues, training priorities, premises issues and other areas, and it may be that the spreadsheet format could be supplemented with a written document detailing the aims and developmental aspects of the plan. Examination of Regulation 26 monitoring visits indicated that these were not taking place monthly as required. Two new governors are due to be appointed in April and it is intended that they will carry out these visits. DS0000011169.V279784.R01.S.doc Version 5.1 Page 20 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 X 2 X 3 X 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X X X X 2 X X X X DS0000011169.V279784.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO 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 YA23 YA39 Regulation 18(1)(c)(i) Requirement Timescale for action 06/05/06 3 YA39 4 YA39 The manager must ensure that all staff receive annual POVA training. 24(2) The registered provider must 06/05/06 produce a report of the findings of the service user survey, and make it available to interested parties 24(1) 24(2) The registered provider must 06/08/06 24(3) establish an annual quality assurance and review system in accordance with Standard 39, and make the resulting reports available to interested parties. 26(2)(3)(4)(5) The registered provider must 06/05/06 ensure that the unit is visited in accordance with Regulation 26 and reports are produced. 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 DS0000011169.V279784.R01.S.doc Version 5.1 Page 22 1 YA19 It is suggested that individual dated records of chiropodist visits are maintained in line with other health records. DS0000011169.V279784.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks 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 DS0000011169.V279784.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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