Inspection on 01/08/05 for Acorn House

This inspection was carried out on 1st August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Acorn House 13/10/08

Acorn House 12/09/06

Acorn House 15/11/05

Acorn House 19/01/05

Acorn House 17/06/04

Acorn House 17/02/04

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

CARE HOMES FOR OLDER PEOPLE Acorn House 18 Cearns Road Oxton Birkenhead Wirral CH43 1XE Lead Inspector Peter Cresswell Announced Monday, 1 August 2005 9.30 am st The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Acorn House Address 18 Cearns Road, Oxton, Birkenhead, Wirral, CH43 1XE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0151 653 0414 n/a Tree Vale Limited Mrs Mandy Courtenay (application under consideration) PC Care Home Only 33 33 Category(ies) of DE(E) Dementia - over 65 registration, with number of places Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 19 January 2005 Brief Description of the Service: Acorn House is a large, detached Victorian property, created from two houses and set in its own grounds in the Oxton area of Birkenhead. It is within walking distance of local shops, churches and bus services to Birkenhead town centre. There is an enclosed back garden and a large car park at the front of the building. Residents all have single bedrooms, many of which have en suite facilities. Accommodation is on four floors, all served by a passenger lift. The main lounge is downstairs, as is the dining room. There is a smaller lounge/diner on the first floor. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this announced inspection the inspector spoke to a number of residents, the manager and some staff. He toured the home and inspected all of the rooms in the home and the kitchen. He examined documents including care plans, staff recruitment and training. The inspector also checked a sample of the home’s medication procedures. A number of residents and their families sent in pre inspection survey forms. The inspection lasted for six hours What the service does well: What has improved since the last inspection? What they could do better: The home must tighten its recruitment procedures to make sure that all of the required checks are completed before staff start work. The manager said that this would be carried out immediately. All current staff have now been fully checked. Hot water provided to residents’ bedrooms needs to be regulated so that it is delivered at a safe temperature. Some minor improvements are needed to the home’s medication procedures for cases where the monitored dosage system is not yet in place. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4. The home carries out comprehensive pre-admission assessments, ensuring that residents are appropriately placed and therefore receive care that meets their needs. EVIDENCE: The manager has revised the home’s Statement of Purpose and it now covers the matters set out in the Care Homes Regulations 2001. She is currently revising the Service User’s Guide, though the existing version remains available in the meantime. The manager assesses prospective applicants prior to admission and following the last inspection the pre-admission assessment document has been revised and extended further. It now includes a section for ‘Mental Health and Behaviour Assessment’ and elements of behaviour identified here are incorporated into the care plan. The document is now comprehensive and addresses the impact of dementia on the resident’s behaviour, enabling the home to plan their care from the point of admission. Acorn House does not provide intermediate care so Standard 6 does not apply. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, 11. Care planning is good, helping staff to focus on the needs of service users. The basic systems for organising medication are sound but particular attention needs to be given to medication outside of the monitored dosage system to ensure the safety of residents. EVIDENCE: All residents have care plans which are reviewed every month by the manager and her senior care staff. Files included evidence that the reviews had taken place and changes to the care plan are set out on an attached sheet. Staff would find it easier to identify changes to the care plan if they were incorporated into the plan itself and this would be possible if the plans were maintained on a computer. As it is staff would have to consult the care plan itself and any amendment sheets made following a review. Most residents also have annual reviews which are attended by an officer from Social Services. Daily reports are made in loose-leaf folders and individual sheets are then transferred to the main file. If a brief, up to date summary of the care plan was attached to the daily report file staff would be able to relate their reports directly to the resident’s needs. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 10 Accidents are recorded on appropriate report sheets and copies of the sheets are put on the resident’s personal file ensuring that a full record of accidents is available for each individual. All residents have access to community and specialist health services. Most residents are registered with local GPs though if possible they remain with their own GP. A chiropodist visits the home regularly. A district nurse visits the home to provide nursing care most days. Medication is stored securely and is mainly administered via a Monitored Dosage system with tablets being provided in blister packs by the community pharmacist. The tablets in the blister packs were consistent with the records kept in the Medication Administration Record sheets. However, the records for medication of one resident who had recently been admitted from hospital were not consistent with the number of tablets in stock. The differences were very small but it was not possible to account for the discrepancy. The home needs to take great care to ensure that medication outside of the monitored dosage system is accurately recorded. Senior staff who are responsible for medication have all received approved training in the administration of medicines. Prescribed medication for one resident had been left unlocked in her room. If the resident has been assessed as being capable of looking after her own medication, despite having dementia, she should be encouraged to store the medication safely in a locked cupboard when she is not in the room. The inspector suggested that the home’s policies on death and dying are amended to reflect the fact that the manager would make suitable arrangements in the event of the death of a resident from a religious or ethnic minority, in order to respect their particular cultures. There are no such residents in the home at the moment. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15. The home arranges a range of activities which enhance residents’ quality of life. Meals provided meet the dietary needs of the residents, who said that they enjoy the food and can have choices if they wish. EVIDENCE: Acorn House now has activities organisers who work for a total of 24 hours a week. A schedule of activities is available and includes cake decorating, music and dancing, model making, ‘hair and beauty’ and trips out. The residents made the signs for their own rooms as part of the activities programmes. The home has a vehicle which can be used to take residents out, though the manager said that some of them are reluctant to go out. Trips tend to be local, to ensure that the residents do not have to spend too much time travelling and recent trips have included Parkgate and the Williamson Art Gallery. On the day of the inspection the activities included dancing and exercises. The home has a pleasant garden which is used for activities such as barbecues in the summer months. Visitors are welcome at any time and most of the residents have contact with family and friends. One relative who visits regularly wrote to the inspector before the inspection to say how pleased he was with the care given to his mother at Acorn House. The menu for the home provides a balanced diet and the chef discusses the residents’ likes and dislikes with them. If an individual resident wants a Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 12 particular meal the chef is happy to provide it. Lunch is usually a lighter meal, though often cooked, and the main meal is served at teatime. The emphasis is on home cooking from fresh ingredients and the chef makes his own soup and puddings. Fresh fruit was served as the afternoon snack. All of the residents who spoke to the inspector said that they enjoyed the food at Acorn House. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18. Procedures for complaints and adult abuse allegations are in place, providing protection for residents. EVIDENCE: Acorn House has an appropriate complaints procedure but has not received any complaints for over a year. The manager said that any issues are usually resolved informally, before they reach the stage of being a formal complaint. The home has appropriate adult abuse procedures and adult abuse is discussed in the induction process. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 23, 24, 25, 26. The home is well maintained, providing a comfortable environment for the residents. EVIDENCE: The home was clean, well maintained and well decorated on the day of the inspection. There was a malodour in three bedrooms and the manager said that the particular needs of the residents in question were being reassessed, including the use of outside expert professionals, to ensure that the smell would be eliminated. If necessary, homely impermeable floor covering would be fitted. All residents have individual bedrooms, and 18 of them have en suite facilities. The bedrooms were homely and most of them had been personalised by the residents and their families. One resident’s bed was fitted with a ‘bed leaver’ bar. If such a device is to be used the manager must complete a risk assessment as to its use and consult the advice issued by the Medical Devices Support Agency. Several ceiling tiles have been badly stained by leaks and need to be replaced, the self-closers on two bedroom doors were not working, and in one case appeared to have been removed – these must be repaired to ensure the doors’ effectiveness as fire doors. The Registered Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 15 Person employs a maintenance man who carries out routine repairs and maintenance in the home. The home has two supported baths and hot water delivered to bathrooms is controlled by thermostats. However, water to wash handbasins in bedrooms and en suites is not controlled and in several rooms on the first floor was too hot and presented a risk of scalding. The most effective way of ensuring that hot water is at a safe temperature is to fit thermostats, and the manager said that the Registered Person is planning to fit them to all taps used by residents. In the meantime, the manager should complete risk assessments concerning the risk faced by residents who may have excessively hot water delivered to their rooms. This also highlights the importance of having the home’s water system tested for Legionella. There is a smaller lounge on the second floor which includes a small dining area and is used as a quieter room by some of the less confused residents, though it was not being used on the day of the inspection. All radiators are fitted with safety covers. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30. Sufficient staff are employed to meet the needs of the residents though additional staff training in dementia is required to ensure that the interests of residents are best served. The home’s recruitment procedures at the time of the inspection were inadequate and could potentially leave residents at risk. EVIDENCE: Acorn House employs three senior care staff and eleven care staff for daytime duties and two seniors and six care assistants at night. There are normally one senior and three or four care assistants on duty in the daytime, in addition to the manager. The home also employs activities organisers (24 hours a week) domestic staff, two kitchen staff, a laundry assistant and a handyman/decorator. Administrative support is provided by an administrator who works at the owners’ office. Agency staff are used to provide additional cover when needed. Four staff have NVQ2 and a further 16 are currently studying for it, ten of them on a fast track course provided by Learn Direct. Other recent training has included Manual Handling and First Aid. The manager said that she is planning to arrange for the Alzheimer’s Society to provide training in person-centred dementia care for all care staff. Applicants for jobs are interviewed and references are taken up. However, a number of staff had been employed before either a CRB check or a POVA First check had been completed. The manager assured the inspector that this practice would cease immediately. Staff must not be employed unless a satisfactory CRB check has been obtained other than in exceptional circumstances, when they may be employed under supervision if a clear POVA Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 17 First check has been obtained. Staff must not be employed under any circumstances whatsoever without a clear POVA check. All of the staff in post did have satisfactory CRB checks and clear POVA checks at the time of the inspection. It would help the manager to keep abreast of policy developments if she had access to the internet. When agency staff are employed the agency provides evidence of a satisfactory CRB and POVA check. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 38. The home is efficiently managed and has financial procedures that protect the interests of the residents. EVIDENCE: The manager has been in post since May 2004. She is just about to complete her NVQ4 and her application to register is being dealt with by the Commission for Social Care Inspection. She is an experienced manager and was previously registered under the Care Standards Act 2000 in a previous post. At her fit person interview and at the previous inspection the Commission suggested that she would benefit from specialist training in person-centred dementia care. To that end she has arranged to go to a conference organised by Bradford University in November and was due to meet the Alzheimer’s Society the following day to discuss such training. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 19 Staff are now receiving regular supervision and notes of supervision sessions were seen on staff files. The manager said that she is planning for senior staff to start carrying out some supervision and would be arranging training to help them to do this. On the day of the inspection there was a relaxed atmosphere in the home and relationships between staff and residents appeared to be good. The Registered Person visits the home regularly and submits written reports to the Commission for Social Care Inspection. The visits form part of the home’s quality assurance framework, which includes resident/relatives surveys and an Annual Operating Plan. The home has the Investors In People award, which is due for review this year. Residents’ money is dealt with either by relatives or their legal representatives and records are kept by the Registered Person’s administrator. The kitchen was clean and well organised but the Environmental Health Officer asked following a visit last month that the performance of the small domestic fridge in the kitchen itself be monitored. Records now indicate that it does not maintain an appropriate temperature and it therefore needs to be replaced. Fire safety records were properly kept and safety certificates were in place, but the fire door self-closers referred to earlier need to be repaired. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 x 3 3 3 2 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 Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 x x 2 Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 4 Regulation 12 Requirement The Registered Person must ensure that training in dementia care required at the last inspection and discussed at this inspection are implemented (originally required by 28 February. The Registered Person must ensure that proper arrangements are in place for the recording and storage of medication, especially that which is not included in the monitored dosage system. The Registered Person must ensure that premises are kept in a good state of repair by replacing the identified stained ceiling tiles. The Registered Person must ensure the safety of residents by ensuring that: *hot water is delivered to bedrooms at a safe temperature; *water storage facilities are tested for Legionella. The Registered Person must ensure that all persons employed at the home are fit to do so by ensuring that: *staff do not start work at the home without a current CRB Timescale for action 1 November 2005 2. 9 13(2) 1 September 2005 3. 19 23(2) 1 September 2005 1 September 2005 4. 26 13(4) 5. 29 19 With immediate effect Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 22 6. 38 13(4) check unless the home would otherwise fail to meet minimum staffing requirements; *no person works in the home without a clear POVA check under any circumstances. The Registered Person must ensure the safety of residents by: *repairing the self closers to the identified fire doors; *repairing or replacing the small fridge in the kitchen. 1 September 2005 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. 2. Refer to Standard 24 26 Good Practice Recommendations The manager should complete a risk assessment in respect of the bedleaver bar in a residents bedroom. The manager should act on the outcome of the assessment of residents in the identified rooms to ensure that malodours are eliminated. Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Liverpool Area Office 3rd Floor, 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Acorn House F52 F02 S18852 Acorn House V229052 010805 Stage 4.doc Version 1.40 Page 24 - 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. 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