Inspection on 20/01/10 for Acorn Grange

This inspection was carried out on 20th January 2010.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Acorn Grange 04/03/09

Acorn Grange 05/12/06

Acorn Grange 16/01/06

Acorn Grange 29/07/05

Acorn Grange 07/03/05

Acorn Grange 02/09/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Acorn Grange Vicarage Road West Cornforth Durham DL17 9JW     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Lowther     Date: 2 6 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Acorn Grange Vicarage Road West Cornforth Durham DL17 9JW 01740656976 01740656667 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Robert Pattinson t/a Manor Care Home Group care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is 48. The registered person may provide the following category of care: Care home only Code PC 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 - Code OP. No more than 19 places. Dementia - Code DE. No more than 29 places. Date of last inspection Brief description of the care home Acorn Grange is registered to provide residential accommodation for forty-eight older people including nineteen people with dementia who are over the age of sixty-five. Acorn Grange is not registered to provide nursing care. The home is situated in its own grounds. The grounds include parking spaces and colourful borders to the front and side of the building and large lawned areas to the back of the building. Inside the home provides single bedroom accommodation over three floors. A passenger lift Care Homes for Older People Page 4 of 26 Over 65 0 19 29 0 0 4 0 3 2 0 0 9 Brief description of the care home enables access to the upper floors. Two bedrooms have en-suite facilities. The home also has two conservatories, two dining rooms and several lounge areas. Acorn Grange is situated off a main street in West Cornforth, providing good access to local shops and social facilities. The weekly fees for living at this home are £382 - £402.50 The costs of newspapers, hairdressing, private chiropody and toiletries are not included in the fees. Additional costs include hairdressing, private chiropody, toiletries and personal items including clothing, newspapers and magazines and door guards. Actual fees paid depend on individual circimstances further details can be found in the homes Service User Guide. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced inspection of this home took place on the 20 and 26 January 2010. Two inspectors, Sue Lowther and Jean Pegg visited the home. Records were examined and a tour of the building took place. Time was spent talking to staff, the people who live in the home and their relatives. The manager supplied some written information to the CQC before the inspection. The inspection focussed on key standard outcomes for people who live in the home and to check whether requirements from the previous report had been met. We have reviewed our practice when making requirements, to improve national Care Homes for Older People Page 6 of 26 consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Care plans must be kept under review and where appropriate and, unless it is impracticable after consultation with the service user or a representative of his, revised to reflect the service users changing health and welfare needs. They must also clearly identify how their needs in respect of health and welfare are to be met. The systems in place for managing medication need to be improved. We observed one member of staff undertaking the medicine round. We saw that she left the trolley unattended and out of view. This gave the opportunity to other staff, people who use the service and visitors to access the drugs without her knowledge and placed people at risk. Complaints are not always responded to appropriately. People are at potential risk of abuse because of a lack of training for staff. Staff training in practical areas is poor and does not equip staff with the skills and knowledge that they need to do their jobs properly. Care Homes for Older People Page 8 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst people have up to date information about the home and are usually assessed prior to admission, the assessments are not always suitable in determining the level of care and resources a person needs. Evidence: The home has updated its Statement of Purpose and copies of information about the home were seen in the different areas that we visited. We saw copies of assessments completed by the staff in the home. These assessments help to identify the level and type of care needed to support the individual person concerned. However, we looked at one persons care file who had been readmitted to the home from hospital. There was no evidence of any reassessment prior to this taking place. Assessments must be kept under review and revised at any time when it is necessary to do so having regard to any change in circumstances. Care Homes for Older People Page 11 of 26 Evidence: The home does not provide intermediate care therefore assessment of Standard 6 is not required. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Lack of sufficient detail in care plans, along with some unsafe medication practices, potentially puts people at significant risk. Evidence: We looked at three care plans in detail. We then talked to the people concerned and those responsible for their care to see if the care plans were being followed. The care plans were inconsistent. In one set of care records seen it was difficult to establish whether the person had teeth, dentures or a combination of both as the entries in the assessments and the care plans were different. This persons care plans had not been updated since November 2009. However it was noted that they had been in hospital in December. We asked the person in charge about whether this person had been reassessed before they had returned to the home. She did not know and there was no documentation to support this. When we asked staff about the teeth they did not know, but two care staff said they thought the person had their own teeth. When we went to see this person we found that they had dentures but did not wear them any more. Staff were not aware of this information and it was not contained within the plans. Also the available care plans, which were very brief and not signed, did not Care Homes for Older People Page 13 of 26 Evidence: reflect the current needs of the person. For example information contained within the plans indicated that the person could use a spoon to feed independently and that they had some degree of mobility. On the first day of the inspection, we saw staff feeding the person and they were in a reclining chair and staff confirmed that this person was immobile. There was no evidence in the plans to confirm that people had been consulted about how they would like to be cared for. People spoken with were not aware of this documentation. People spoken with and those who returned surveys, confirmed that they are happy with the care that they receive. Comments include, Very pleased with the care. Staff take an interest in you. Since coming here I am much happier and much more settled and relaxed then when I was at home. Staff are always willing to listen and help you. Staff are very caring. Although the home have policies and procedures in place for the ordering, storage and administration of medication, these require review to make sure they contain all of the guidance staff require. We looked at the medication administration records. Many did not contain a photograph. The room in which the drugs were stored felt warm. The temperature of the room should be monitored regularly and action should be taken if the measured temperature falls outside the manufacturers recommendation. We observed one member of staff administering medication. We saw that she left the trolley unattended and out of view. This gave the opportunity to other staff, people who use the service and visitors to access the drugs without her knowledge and placed people at risk. People spoken with confirmed that staff generally treat them with dignity and respect. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities are varied and provide recreation for some of the people living in the home. Family and friends can visit the home at any time and are made to feel welcome. The meals are of a good standard. Menus are varied and people are given a choice. Evidence: Most of the people said that activities are suitable. The activities organiser spends time with people on an individual basis to find out what activities they would like to do. One to one activities take place during the morning and group activities in the afternoon. Regular activities include card and board games, bingo, board games and arts and crafts. People spoken with were generally positive about the activities. Comments include Provide very interesting activities. Enjoy the entertainment provided. I am pleased that I can either do activity within the home or go to the day centre that I used to attend. Relatives said that they could visit at any time and that they are always made welcome. People said that they have a choice about how they like to spend their day. They can also choose what time to get up and go to bed and when they would like to have a shower or bath. Care Homes for Older People Page 15 of 26 Evidence: We observed the lunch on the second day of the inspection. Staff who were helping people were doing this in a discreet and dignified manner. Evidence was seen in care plans to confirm that nutritional needs are assessed and other professionals consulted if required. However staff were not keeping records of daily intake, even when a risk was identified. Most of the people said that the food was good, although one person did say that there could be more choice. Although the home do not provide a formal menu, people confirmed that if they do not want what is offered, they are given an alternative. We observed this to be the case on the second day of the inspection. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns and complaints are dealt with appropriately. However the lack of appropriate staff training potentially places people at risk of abuse. Evidence: Information about complaints, how and who to make them to, is made available to the people who live in the home and their families through information displayed in the entrance to the home and in the Service Users Guide. Whilst formal complaints are recorded and appropriately addressed, there was no evidence to demonstrate that issues are addressed when these are raised informally by people who live in the home. One person told us that she regularly raises issues, and that these are always seen to. There was no written evidence to confirm this. There have been two formal complaints recorded since the last inspection. These were investigated by the home. The home had an adult protection procedure. This gives staff the support they need to make a referral should this be required. The staff spoken to during the inspection were asked about abuse and what they would do if they saw or heard anything inappropriate. Staff said they would tell the person in charge, but did not know about the locally agreed procedure and who they could contact if they felt unable to approach the person in charge. Staff training is in house and is in the form of a DVD and questionnaire. Lack of training in this area potentially places people at risk of harm. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained. It is decorated and furnished to an adequate standard. However it has not yet been adapted and is therefore not suitable to meet the needs of people with dementia. Evidence: During a tour of the building the inspector saw that many of the rooms are decorated to the persons own taste and there was evidence to confirm that people can take in some personal items when they go to live there. This includes pieces of furniture as well as photographs and ornaments. An adequate standard of decor and furniture is provided throughout the home. However Acorn Grange provides a service for people with dementia. The environment has not yet been adapted to meet the special needs of this client group. There was a range of equipment seen around the home to support people with bathing and mobility. We found the building to be clean, tidy and free from offensive odours. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are appropriately recruited and in sufficient numbers to meet the needs of the people who live in the home. However the lack of practical staff training potentially places people at unnecessary risk. Evidence: From the rota supplied at the inspection there was sufficient care staff on duty to meet the assessed care needs of the people who were using the service. People said that staff were usually around and answered the call bells quickly. One person said, The staff come quickly when I need them. The home had staff files in place, which provided evidence that the appointment of a new staff member is in the main made through proper recruitment processes. This includes the vetting of staff through the use of references, POVA first checks and Criminal Record Bureau (CRB) checks. Many of the staff having an NVQ at level 2 or above. Although there was evidence to confirm that staff training does take place, this is in the form of DVDs and questionnaires. Staff said that they do not generally have face to face or practical training. As such people do not always feel that they have the appropriate skills and knowledge to look after people properly. Care Homes for Older People Page 19 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home is generally well managed, the lack of practical training in safe working practices, potentially places people at risk. Evidence: The registered manager has been in post for two years. She has a NVQ Level 4 in care and is currently enrolled for the Registered Managers Award. However she told us that she has had no formal training or guidance with regard to care planning. This inspection has identified that care planning is poor. There was evidence in staff files to show that supervision was taking place and that the staff were being appraised. Staff confirmed that supervision takes place on a regular basis and that they are well supported. People living at the home and visitors who were spoken to during the inspection confirmed that the manager is approachable and that they would go to her if they had any concerns. Staff also confirmed this to be the case. Care Homes for Older People Page 20 of 26 Evidence: Regular meetings are held and there are a number of systems in place to consult with people living at the home. Relatives and the people who live in the home can approach the staff at any time. The manager carries out regular audits covering all environmental and care aspects which may result in improvements being made. Personal finances are kept in the home for people who request this. Signatures are obtained and receipts are kept to ensure peoples financial interests are safeguarded. The manager confirmed that all equipment in the home is regularly checked. The maintenance certificates that were seen at this inspection were found to be in order. Health and Safety checks are carried out regularly to safeguard people living and working at the home. However there is a lack of practical staff training in the areas of safe working practices with regard to moving and handling, fire safety and first aid. This could place people at significant risk. Care Homes for Older People Page 21 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Assessments must be kept under review and revised at any time when it is necessary to do so having regard to any change in circumstances. This will ensure that peoples assessed needs can be met by the resources available within the home. 05/04/2010 2 7 15 Ensure that service user plans clearly identify how their needs in respect of health and welfare are to be met. This will make sure that all of the needs of people are appropriately met. 14/05/2010 3 7 15 Ensure that care plans are 14/05/2010 kept under review and where appropriate and, unless it is impracticable after consultation with the service user or a representative of Page 23 of 26 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action his, revised to reflect the service users changing health and welfare needs. This will make sure that peoples changing needs are met 4 15 17 Records of food provided for service users must be maintained and include sufficient detail to demonstrate whether the diet is satisfactory. To demonstrate that people receive an adequate diet. 5 18 13 All staff must receive training in Adult Protection so that they are aware of the agencies to contact should they suspect abuse has taken place. This will safeguard people from abuse. 6 30 18 Persons employed by the registered person to work at the care home must receive training appropriate to the work they perform. This will ensure that staff have the required skills and knowledge, are kept up to date and service users are not put at risk through ignorance or poor practice. 14/05/2010 30/06/2010 05/04/2010 Care Homes for Older People Page 24 of 26 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 38 18 Staff must receive practical training in moving and handling and first aid. This is to make sure that staff are appropriately trained to the work they perform and that people are safe. 30/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The temperature of the medication storage room should be regularly monitored and action should be taken if the measured temperature falls outside of the manufacturers instructions. Staff should have regular competency checks with regard to the administration of medications to make sure their practice is safe, and that people are not placed at risk. A record should be kept when people raise concerns, even when they are addressed immediately. This will demonstrate that the home takes all concerns and complaints seriously. 2 9 3 16 4 19 The environment should be developed further to make sure that it is suitable for people with dementia. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!