Inspection on 11/07/08 for Acorn Court Care Home

This inspection was carried out on 11th July 2008.

CSCI found this care home to be providing an Good service.

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

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Acorn Court Care Home The Kilns Redhill Surrey RH1 2NX Lead Inspector Marion Weller Key Unannounced Inspection 10:00 11th July 2008 X10015.doc Version 1.40 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 Acorn Court Care Home DS0000071406.V367007.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 Older People. 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. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acorn Court Care Home Address The Kilns Redhill Surrey RH1 2NX 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) 0845 017 9021 01737 644058 bill.howell@carebase.org.uk Carebase (Redhill) Ltd Mr William David Howell Care Home 86 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) The maximum number of service users to be accommodated is 86. Of the 86 beds registered, 8 may be used in a separate unit to accommodate people who have an acquired brain injury. There is no category of registration for this group of people. N/A - New Service 2. 3. Date of last inspection Brief Description of the Service: Acorn Court is a large detached care home with resident accommodation arranged over three floors. The property is located on a new housing development on the outskirts of the town of Redhill in Surrey. The home provides accommodation, nursing and personal care for up to 86 residents. The home is owned and operated by Carebase (Redhill) Ltd. The Carebase organisation is a provider of nursing and care homes in the Southeast/London area of the UK. The ground floor of the home accommodates, in a separate specialist unit, up to 8 people who have an acquired brain injury. These people can be in the age range of 18 to 65 and of either gender. The ground floor also provides accommodation for 17 older people. The first floor accommodates 30 older people and those who have dementia who also require nursing care. The top floor of the care home accommodates 31 people who have dementia. Each floor consists of single occupancy bedrooms with en-suite facilities. The en-suite bathrooms consist of a toilet, low-level sink and level access shower. These are fully adapted to suit those with mobility problems. The 8-bed acquired brain injury unit on the ground floor is designed to the same specifications as other bedrooms in the home, but the rooms, and in particular the en-suite facilities are much bigger. Overhead hoist tracking is also in place. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 5 The home has been purpose built to a high specification and is fully wheelchair accessible throughout with upper floors being serviced by two passenger lifts and two staircases. External areas consist of a car park to the front of the building and secure, enclosed gardens to the side and rear of the property. The gardens are easily accessible to residents and have pathways throughout. The home employs registered nurses and care staff working a roster, which provides 24-hour cover. Ancillary staff for reception/administration, catering, maintenance and housekeeping duties are also employed. The home has a dedicated activities staff. A hairdresser and chiropodist visit the home on a regular basis. The fees at this service range from £750 to £950 per week for older peoples services. The fees for the specialist acquired brain injury beds are individually agreed according to assessed personal need. Residents pay separately for hairdressing, chiropody, opticians, personal toiletries and newspapers/ magazines at cost. Please contact the home’s General Manager for more information. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was the first key inspection of Acorn Court Care Home. The site visit was conducted by Marion Weller, regulation inspector between 10:00 am and 3:00 pm. During that time the inspector spoke with several residents, the general manager, and the care services manager and other members of the staff team. Some judgements about the quality of life within the home were taken from observations and conversation. Some records and documents were looked at. The annual quality assurance assessment (AQAA) sent to us by the service before the site visit took place was also used to inform our judgements. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. In addition, a tour of the building was undertaken. As part of the inspection process, surveys were sent out before the visit to some people already living at the home and other health and care professionals involved with the home. This is done to find out how satisfied people are with the standard of care the home provides. No responses were received prior to the site visit and none have been received to inform this inspection report. Acorn Court Care Home is a new service, which fulfils the criteria for registration. This first site visit to the home was undertaken to judge the quality of the service now it is in operation. The first resident was admitted during April 2008 and the home is not yet working at full capacity. The home is in the process of consolidation and further development. The general manager is responsible for the day-to-day operation of the home and leads a dedicated team of department heads. The general manager made application to be the registered manager of Acorn Court Care Home. He completed the fit person process and was registered by the CSCI in January 2008. Mr Bill Howell is an experienced manager but has no nursing related qualifications. A clinical lead has therefore been appointed at the home to undertake admission assessments, develop care and treatment plans and to carry out clinical supervision for the registered nurses. The acquired head injury unit has a dedicated head of unit, who is an experienced senior nurse with specific knowledge and skill in caring for people with acquired head injury. The manager and staff gave their full co-operation throughout the inspection. What the service does well: Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 7 Acorn Court Care Home is welcoming and has a relaxed and inclusive atmosphere. Residents enjoy living in a new, high specification, purpose built environment that is practical, attractive and very comfortable. There are ample communal areas for people to enjoy and friends and relatives are welcome to visit and could do so at any reasonable time. The home encourages the involvement of resident’s friends and families and regularly invites feedback as to the further development of the services being offered there. Residents’ benefit from a full assessment of their needs and they or their representatives are encouraged to look around the home before they move in. Residents are treated with respect and there are arrangements in place to protect and maintain their privacy and dignity. Services that provide social and nursing care must be sensitive to people of different cultures, age, gender, faith, disability and sexuality. Throughout the service, there was evidence of a good awareness and understanding of equality and diversity issues, which translated into positive outcomes for residents. There was an activities programme organised to which residents of all levels of capacity had equal access. What has improved since the last inspection? What they could do better: Residents and their representatives would benefit from the home’s information documents being reviewed to ensure people considering moving in and those already in residence have the most up to date and accurate information to guide them. Resident’s are protected by the home’s policies and procedures regarding medication administration. They can be confident that where minor shortfalls in good practice exist the home will review its arrangements to secure their safety and protection. Residents will benefit from a review of the home’s complaints procedure to ensure it provides them with all the information they need. The registered persons must ensure that all aspects of the home’s recruitment procedures are sufficiently robust to ensure the safety and protection of people living in the home and to enable them to evidence the home’s good practice. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 8 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. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 123456 Service users experience good quality outcomes in this area People who use this service can easily access information about the home to make an informed decision about whether the service is right for them. They would benefit further if information provided were reviewed to ensure it is up to date and accurate. Residents can be confident that they are appropriately placed due to good preadmission assessments. They benefit from being able to visit the home prior to admission and are given a contract that clearly tells them about the service they will receive. EVIDENCE: Information documents about the services offered at Acorn Court are made readily available to people. They are used to inform residents or their representatives prior to choosing a home and as a source of reference for all parties after moving into the home. The home has a Service User Guide, Statement of Purpose and a brochure. The Carebase provider organisation also has an informative web site for those with access to a personal computer. Although all documents and sources of information are comprehensive, Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 11 informative and detailed they would benefit from review to ensure their individual content is up to date and provides accurate information to people. For instance, the home’s conditions of registration state that the maximum number of service users to be accommodated is 86. The home’s web site states that the home is registered for 87 elderly residents. This is incorrect. Both the provider’s web site and the home’s service user guide explain the CSCI inspection methodology incorrectly. The inspection methodology has changed under the ‘Inspecting for Better Lives’ modernising agenda. If it is included in information documents then it should be accurately explained to ensure people know what they can expect. For example, The CSCI no longer undertakes one announced and one unannounced inspection of registered services every year as stated in the home’s documentation. Equally, the CSCI contact details are incorrect and may cause confusion and frustration for people wishing to contact the Regulator. The general manager stated his intention to resolve the shortfalls discussed in this standard. The care services manager who is the home’s clinical lead or a trained senior member of staff visits prospective residents prior to admission to make a decision as to whether the home can meet the person’s needs. Information is obtained from other parties, including relevant health care professionals to assist in assessments. Samples of pre admission assessments were inspected and were found to be detailed and comprehensive. Prospective residents and their families are invited and encouraged to come to the home for a visit, have coffee or stay for lunch and inspect the service prior to making their final decision to move in. Residents are provided with a statement of terms and conditions or contract when moving into the home. Evidence was seen of the home’s contracts. Content clearly shows the rights of the resident and Acorn Courts responsibilities under the agreement. Acorn court is not registered for intermediate care. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Service users experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s health and social care needs are clearly set out in individual plan of care ensuring their needs will be met. They are protected by the home’s policies and procedures regarding medication administration. They can be confident that where minor shortfalls in good practice exist the home will review its arrangements to secure their safety and protection. The privacy and dignity of service users is considered important and their independence is promoted. EVIDENCE: Each resident has a plan of care based on the homes pre admission assessment. The home uses a standex format for care planning and daily records maintenance. Care plans had been developed with the resident or their representatives help and had been signed by them to evidence their involvement and agreement to the plan. Residents’ daily monitoring records were being maintained. They clearly reflect that staff are following the Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 13 demands of a resident’s plan of care and give sufficient detail on which to base the monthly review. Care plans were being reviewed with changes recorded and actioned. The care services manager records resident’s reviews in writing. Decisions made and actions to be taken as a result of the review are clearly recorded and provide effective audit trails to evidence the home’s good practice. Resident’s relatives and their representatives are invited to attend reviews. Attendees are sent a written copy of the outcome of the review. Risk assessments were completed and covered amongst other things, the prevention of falls, nutrition and maintenance of skin integrity. Staff had a good understanding of residents needs. Records indicated the home had a good working relationship with specialist and local health care professionals, supporting residents in their health care needs. The home has a dedicated GP who visits weekly on a routine basis and at request. Residents may also retain their own GP if they are willing to attend them when they move in. Specialist hoists and other aids were seen in use. The care services manager stated that all staff has received training in their safe use to protect service users welfare. All staff has either received training in Moving and Handling or this is being planned. The care services manager stated that support and ancillary staff also receives moving and handling training in inanimate loads. Trained nursing staff administers medication in the home. An appropriate policy and written procedures are in place for the storage and administration of medication. Medication was obtained from a local pharmacy and dispensed in a monitored dosage system. The care services manager stated that the supplying pharmacy are contracted to visit the home regularly to audit their systems and give good practice advice. It had further been arranged that the supplying pharmacy provide staff medication training. This was due to start in the next 2 weeks. An up to date list was maintained of all nursing staff authorised to administer medication in the home, together with their specimen signatures. Medication records inspected were largely sound with no unexplained gaps and evidenced a photo of each resident to aid identification. Several handwritten transcriptions on MAR’s however were not signed by the author or by a second person, checking for accuracy of transcription as good practice demands. When completed properly, this procedure ensures residents are not given the wrong medication. Some residents were prescribed variable dose and ‘when required’ medication by their GP. Some medication administrators were recording the amount of tablets administered on each occasion and others were not. This omission could result in residents being given more than the recommended amount of medicine in any 24-hour period and therefore places them at risk. It is also Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 14 good practice to record the reasons why ‘When Required’ drugs are administered or not for that matter, to inform the individuals monthly review. The back of MAR sheets was not being completed. The care services manager felt this was because the pharmacy had not yet provided the training on the best use of MAR’s and the situation would improve when this had been achieved. The home could evidence a risk assessment process for establishing a residents capacity to self medicate if they wished to. The assessment could be further improved by assessing if the individual knew what would happen if they did not take their medicine as prescribed. Facilities are available for the proper storage and administration of controlled drugs. The home had no controlled drugs on the premises at the time of the inspection. The care services manager stated that there are procedures in place for trained staff to hand over keys/ stock balances between shifts. Minor medication shortfalls detailed above were discussed with the manager and senior nursing staff. The inspector is confident the home will quickly review its arrangements to secure residents safety and protection. Residents felt that staff were kind and considerate and treated them with courtesy and respect. A relative visiting the acquired head injury unit said, “marvellous care here, …… some problems to iron out initially, as one would expect, but the manager and staff have been understanding and very helpful” Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Service users experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyles match their needs and preferences, and they are able to maintain contact with family and friends and enjoy activities of their choosing. EVIDENCE: There are no set routines that you wouldn’t expect to see in any other well run home. It was clear from observation and discussion that the lifestyle in the home largely matched residents expectations and preferences. Individual care plans record each residents social and leisure interests. Cultural and religious needs are also recorded. Residents are encouraged to discuss their beliefs and an individual plan is created to recognise and support their religious and spiritual diversity, where this is necessary. The home also organises regular religious services and local clergy visit the home every month to speak with residents. A full time activity organiser has been recruited and an activities programme is organised to which residents of all levels of capacity had equal access. The manager is aware how important it is to offer meaningful and stimulating activities to residents and stated that they hope to provide entertainers and Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 16 outings as the service grows and develops. Residents are currently encouraged to participate in small group and individual activities. A list of activies arranged for the forth-coming week is made available on the notice board of each residential unit. The manager suggested that as occupancy increases, a residents meeting would be arranged every two months. It is anticipated that residents and their relatives may use the forum to consult with the management about the operation of the home, which ensures people living there are helped to exercise choice and control over their lives. Resident’s meals are served in spacious, well-equipped and attractive dining rooms on each residential unit. A weekly menu is on display for information. Tables are nicely laid up and there are a well-balanced, nutritious variety of meals on offer, including a choice of two main meals each day. The home has its own team of catering staff. The home’s Chef advised that specialist diets could be catered for and a vegetarian option is made available to those who prefer it. Fresh produce is used wherever possible in menu plans. Residents enjoy a cooked breakfast each Wednesday morning. Residents, who are unwell or wish to take their meals alone, are offered trays in their rooms. Mealtimes are relaxed; staff are patient and helpful and allow residents the time they need to finish their meal comfortably. Hot and cold drinks are available through out the day. Each residential unit has a kitchenette fitted with a fridge, microwave, toaster, kettle, sink, range of cupboards and a hand wash sink. Family and friends feel welcome and know they can visit at any reasonable time. There is a sign displayed throughout the home inviting friends and family to join residents every Wednesday afternoon for tea and cakes. The design of Acorn Court provides seating areas within the communal areas where residents can entertain their visitors, in addition to the privacy of their own room. Relatives are encouraged to take as much part in the daily life of the home as the resident chooses and are invited to care reviews. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Service users experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service can be confident that their concerns and complaints would be taken seriously and acted upon. There are also systems and procedures in place to protect people living in the home from the risks of abuse. Residents and their representatives would benefit further from a review of the home’s complaints procedure to ensure that the content provides them with all the information they need. EVIDENCE: The home has a complaints procedure, which is available within the statement of purpose and service user guide. It is also displayed in the home for easy reference. Copies can be made available to residents and relatives in large print, Braille or in a different language. The manager maintains a complaints register and this was inspected. No formal complaints had been received since the home became operational three months ago. It was clear from discussion with the manager that all minor concerns or complaints would be taken seriously and investigated fully using their published complaints procedure. The managers AQAA records that he operates an open door policy and observes the resident’s charter of rights. Arrangements for advocacy services can be accessed if anyone involved with Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 18 the home needs support to make their views known or to help them address issues of concern. The home’s service user guide evidences that it was reviewed on the 2nd June 2008. It would benefit from a further review to ensure that it contains the correct contact details for the CSCI. Additionally, residents and their representatives should also be given contact details of the local social services department and health care authorities. The Commission has not received any complaints about this home since it was registered in February 2008. There are procedures in place for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The manager stated that the home’s adult protection policy is in line with Surrey’s multi agency document to ensure there is no delay or confusion about what actions are to be taken to protect individuals and when. The staff induction package and NVQ training have elements of adult safeguarding training and there has been POVA training for some staff. Some staff are yet to be trained. The manager has formulated a staff training programme and stated the intention to make this a priority. Staff spoken with had a sound understanding of adult abuse and safeguarding/protection procedures. The Manager stated any allegation of abuse would be referred to the concerned agencies without delay. There have not been any safeguarding alerts in relation to this home. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Service users experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using this service benefit from a safe, clean, well furnished and commendably well equipped home with attractive décor and a secure garden to enjoy. EVIDENCE: Acorn Court Care Home is a new service and was registered with the CSCI in February 2008. The premises were assessed prior to registration as being fit for the proposed purpose of providing accommodation, nursing and personal care for up to 86 residents. The care home has accommodation arranged over three floors, is purpose built to a high specification and is fully wheelchair accessible throughout. The upper floors are being serviced by two passenger lifts and two staircases. External areas consist of a car park to the front of the building and secure, enclosed gardens to the side and rear of the property. The gardens are easily accessible Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 20 to residents and have pathways and seating areas throughout. Raised flowerbeds are to be purchased to enable residents to participate in gardening activities. Each residential floor consists of single occupancy bedrooms with en-suite facilities, dining rooms with kitchenettes, a large lounge, a quiet lounge, sluice, nurse’s station, medication room and two assisted bathrooms. All bedrooms are in excess of the minimum standard, ranging from 12.1 m sq to 16.6 m sq in size excluding the en-suite bathrooms and are finished to a high standard. All windows have restrictors and security locks fitted to protect residents from harm. Radiators have covers fitted and individual thermostats, so that residents may control the temperature in their room. Soft furnishings and floor coverings in the rooms are compliant with current fire safety regulations. Residents bedrooms already occupied were personalised and had plenty of space to display personal possessions, store clothing, sit and relax and all had a comfortable bed that met the specific needs of the occupant. All bedrooms have a minimum of three double electrical sockets, alarm call system, a telephone point and TV aerial point. The en-suite bathrooms consist of a toilet, low-level sink and level access shower. These are fully adapted to suit those residents with mobility problems. The bathrooms have non-slip floor covering. All hot water outlets have thermostatic temperature control valves fitted to eliminate the risk of scalding. Each dining room is multi functional and has a ceiling mounted projector and large, pull down screen for showing films. Each residential floor has a sluice facility, COSHH storage and medication storage compliant with current legislation. There are 2 communal bathrooms on each floor that are very large and have an electric hi/low bath with shower. Non-slip floor covering is fitted. There is a separate toilet on each unit with adaptations for those with mobility difficulties, again having non-slip floor cover and thermostat control on hot water outlets. Walkways in the home are spacious and allow plenty of natural light. Seating is provided along these walkways and various activities and/or points of interest have been put in place aiding orientation and engagement for people who use the service. The 8-bed acquired brain injury unit on the ground floor is designed to the same specification as the other bedrooms but the rooms and in particular the en-suite facilities are much bigger. Overhead sky tracking is also in place. There is a designated laundry that is suitably equipped with systems in place to reduce the risks of cross infection. The sluicing facilities are also clean and well ordered. Disinfectant gel dispensers are fitted in high-risk areas. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 21 The kitchen is large, airy and is fitted out to a high specification with a range of stainless steel units and commercial appliances. There is a food storage cupboard, located next to the kitchen that is fitted with easy clean shelving and a separate toilet for use by kitchen staff only. All areas of the service are fitted with smoke detectors, emergency lighting and fire alarm call points linked to a main system as well as having fire fighting equipment as appropriate. All doors are compliant with current fire safety requirements and soft furnishings are retardant to the appropriate standard. A full fire risk assessment has been undertaken and the provider has acted upon any recommendations made. The home is commendably clean and free from any offensive odours. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Service users experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff is being provided in sufficient numbers to meet the needs of residents and they can be confident they are in safe hands. The home’s recruitment procedures do not yet fully protect service users. EVIDENCE: The care home is new and although operational it is not yet fully staffed or occupied. Adequate levels of staff were available to care for the residents admitted to date. Staff was observed to be appropriately supervised. Vacant duties on staffing rosters are covered with substantive staff taking on additional hours or by the use of the home’s bank staff. The home does not use agency staff, which allows for greater continuity of care for the resident group. The general manager stated that the home has the capacity to increase staff numbers as occupancy, activity and dependency levels increase and the service grows and develops. The manager stated that staff training would take a high priority in the home. Apart from qualified registered nurses, care staff, who are unqualified are being encouraged to attain National Vocational Qualifications (NVQ) in care. The manager provided information that the home already exceeds the standard of 50 of NVQ qualified care staff. All staff spoken with were enthusiastic in regard to developing their skills. The home could evidence training records for staff that provide a clear overview of training completed to Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 23 date and when training updates are due. The home has a comprehensive induction programme for new staff. All mandatory training for staff is being planned. The files of the most recently recruited staff showed that appropriate checks are made prior to them commencing duties. The home’s recruitment process would be even more robust however if a full employment history was in evidence on all staff files, together with a satisfactory written explanation from the applicant of any gaps in their previous employment. To meet the demands of amended legislation, the application form for staff needs to be updated to include a clear statement by the person as to their suitability for the post in relation to their mental and physical health. The manager stated his intention to address the shortfalls discussed. Throughout the site visit there was evidence of good relationships between staff and residents. Staff mentioned how much they liked working with the residents in the home and this was reflected in the way care and support was given. Staff obviously knows the residents well and how best to put them at ease. There is an active key-worker system in place. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Service users experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a service that is being run and developed in their best interests by a manager and staff who are motivated and keen to provide a good quality service. Where minor shortfalls exist there is a firm commitment to improve and clear potential of sustainability. EVIDENCE: The general manager, Mr Bill Howell is responsible for the day-to-day operation of the home leading a dedicated team of dept heads. He was assessed as fit by the CSCI to be the registered manager of Acorn Court Care Home and attended for his fit person interview on the 15th January 2008, during which he demonstrated a good understanding of the role and responsibility of a registered manager and issues of equality and diversity, giving examples of good practice in this area. Mr Howell has worked in the care Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 25 sector in senior management positions since 1994. He is an experienced manager of large care services both in the UK and the US. During his time in the US he undertook the Nursing Home Administrator Licensure Course (similar to the registered manager award in the UK). Mr Howell has a Bachelor of Science Degree in Health Policy and Administration gained at The Pennsylvania State University in 1993. He does not have a nursing qualification, however two registered nurses with management experience and relevant nursing skills have been recruited to undertake the care management aspects of the home in relation to the older people’s service and the 8-bed acquired brain injury unit. In addition, the clinical lead carries out clinical supervision for the registered nurses. Mr Howell has registered to commence the Registered Managers Award (RMA) through a local awarding body. In discussion, he stated that he still has some work to do to complete the RMA qualification, but believes he will complete by the end of this year. Mr Howell stated that he intends to develop and operate an effective quality assurance and quality monitoring system, which take into account the wishes of the residents and other stakeholders involved with the home. This ensures the home is being run in the best interest of the people living there. Relatives are currently offered the opportunity to attend resident reviews where they can make comment about the service. The general manager is also intending to arrange regular residents and relatives meetings. Visits to the home by a representative of the provider organisation under regulation 26 are carried out and recorded. The home is fully committed to ensuring staff receive appropriate training and support for their role. Training records were sound and staff understood what is required of them. Ensuring staff are appropriately trained maximises safety to both residents and staff. All records seen are kept in a manner that preserve confidentiality. General record keeping is good and well ordered. The administrator, who reports directly to the general manager, handles residents accounting and financial procedures on site in conjunction with support from the Carebase Ltd Central Office. Resident’s relatives and representatives are encouraged to be fully involved with resident’s finances and assist them with this aspect of their care. An up to date insurance certificate and the home’s registration certificate is prominently displayed in the home. There are records of fire systems checks and fire drills/training and staff spoken with have a sound understanding of emergency procedures. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 26 The manager said all records of maintenance and safety checks are up to date. These were not inspected on this occasion. These were however inspected by the CSCI registration inspector in January 2008 and found to be both robust and sound. Feedback at the end of the inspection raised some issues of health and safety with both the general manager and the clinical manger in relation to minor shortfalls in medication procedure. Some improvements that should be made to the home’s information documents will ensure people using the service have all the information they need. It was also discussed that all aspects of the home’s recruitment procedures must be sufficiently robust to ensure the safety and protection of people living in the home and to enable the home to evidence good practice in this area. The general manager stated his firm intention to resolve all shortfalls evidenced. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 28 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. 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. 1. Refer to Standard OP1 OP16 Good Practice Recommendations Residents and their representatives would benefit from the home’s information documents being reviewed to ensure people considering moving in and those in residence have the most up to date and accurate information to guide them. It is strongly recommended that the registered person fulfil the stated intention of reviewing the medication administration practices in the home in line with good practice advice to secure residents safety and protection. It is strongly recommended that the registered person fulfil the stated intention of ensuring the home’s recruitment procedures are amended to ensure they are sufficiently robust to protect residents from any potential for harm. • A full employment history should be in evidence on all staff files, together with a satisfactory written DS0000071406.V367007.R01.S.doc Version 5.2 Page 29 2. OP9 3. OP29 Acorn Court Care Home • explanation of any gaps in previous employment. To meet the demands of amended legislation, the application form for staff needs to be updated to include a statement as to the applicant’s suitability in relation to their physical and mental health. Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Acorn Court Care Home DS0000071406.V367007.R01.S.doc Version 5.2 Page 31 - 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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