Inspection on 12/09/06 for Acorn House

This inspection was carried out on 12th September 2006.

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 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

Acorn House 13/10/08

Acorn House 15/11/05

Acorn House 01/08/05

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 Unannounced Inspection 12th September 2006 8:50 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 House DS0000018852.V288886.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 House DS0000018852.V288886.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acorn House Address 18 Cearns Road Oxton Birkenhead Wirral CH43 1XE 0151 653 0414 0151 652 7121 acorn@fsbdial.co.uk 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) Tree Vale Limited Mandy Courtenay Care Home 33 Category(ies) of Dementia - over 65 years of age (33) registration, with number of places Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2005 Brief Description of the Service: Acorn House is a large, detached Victorian property set in its own grounds in the Oxton area of Birkenhead. It is within walking distance of local shops, churches and other community facilities in Oxton Village as well as bus services to Birkenhead town centre and other parts of Wirral. The back garden is enclosed and has a protected patio. There is a large car park at the front of the building. The accommodation is on four floors, all served by a passenger lift. All of the residents have single bedrooms, many of them with en suite facilities. The main lounge is downstairs, as is the dining room. There is a smaller lounge/diner on the first floor, which is used for some organised activities and by some residents who prefer a quieter room. Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit and the inspector spoke to a number of residents, relatives, staff and the Registered Manager. He examined documents including care plans, medication, staffing files and fire safety records. He also toured the building, including all of the lounges, most residents’ rooms and the kitchen. The site visit lasted six hours. The manager returned a Pre Inspection Questionnaire before the inspection and some residents completed survey forms, with support from staff or relatives. What the service does well: What has improved since the last inspection? What they could do better: Some of the carpets in the home, including the one in the main lounge, need to be repaired. Where a restriction is put on a resident, after full consultation with everyone concerned, both the restriction and the details of the consultation should be fully recorded. The Registered Manager is continuing to put care plans on the computer, which will make them easier to amend and more readily accessible. Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 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 DS0000018852.V288886.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 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 the following standard(s): 2, 3, 4, 5. Quality in this outcome area is good. The Registered Manager carries out comprehensive pre-admission assessments, ensuring that residents are appropriately placed and receive care that meets their needs. Residents have contracts which set out their entitlements and what the home provides. EVIDENCE: Residents sign contracts before moving into the home and copies were seen on the case files examined during the site visit. The Registered Manager visits prospective residents to assess their suitability for the home before admission and copies of these detailed assessments are kept on file. There were also copies of assessments carried out by social services staff and primary care trusts. Prospective residents and their families are encouraged to visit the home before deciding to move in but this is not always possible for people with dementia. Fees range from £418 -£456 a week. Acorn House does not provide intermediate care so standard 6 does not apply. Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9, 10. Quality in this outcome area is good. Care planning at Acorn House is good, helping staff to focus on the needs of service users. Medication is well organised, protecting the health and safety of the residents. EVIDENCE: There are detailed care plans for each resident, which are reviewed every month by senior staff. Annual reviews are also held and relatives and other professionals are invited to them. The Registered Manager is in the process of putting all of the care plans on to the computer so that they can be readily amended after reviews. This will also make them accessible to staff via one of the computers. Daily reports are made in loose-leaf folders and individual sheets are then transferred to the main file. Summaries of care plans are filed alongside the daily report sheets so staff completing the daily reports have instant access to details of the resident in question. Accidents are recorded on appropriate report sheets and copies are put both on the resident’s personal file and a central file of loose-leaf reports. This system ensures that a full record of accidents is available for each individual and that the requirements of the Data protection Act are met. Residents have access to community and specialist health services. Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 Page 10 Medication is stored securely and the home uses a Monitored Dosage system with tablets dispensed in blister packs by the community pharmacist. The records for three residents were examined and were accurate and properly recorded on Medication Administration Record sheets. Residents are only given homely remedies if there is written agreement from a GP. If a resident has medication which is to be given ‘as required’ (PRN) the home has an individual ‘PRN protocol’ setting out the circumstances in which the medication is to be used. No residents control their own medication. Controlled drugs (CD) are appropriately stored in a CD cupboard and their administration is recorded and countersigned in a bound CD register. Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. The home provides activities to enhance its residents’ quality of life and is planning to extend this further. Meals are imaginative and well cooked, meeting the dietary needs and tastes of the residents, who said that they enjoy the food at Acorn House. EVIDENCE: Acorn House has a part time Activities Organiser and her hours of work have very recently been extended to 30 hours a week. Activities include cake decorating, arts and crafts and reminiscence. During the site visit some residents were listening to music in the small lounge with a member of staff. Some residents told the inspector about the visit of the ‘old time slide show’ which they had enjoyed. The Registered Manager said that here had not been many outside visits during the summer due to the hot weather. The additional hours for the organiser will allow the programme of activities to be developed further. Friends and relatives are encouraged to visit the home at any time and the inspector spoke to two relatives during the site visit. Both spoke very highly of the care given to their relatives by the staff and management of the home. The Registered Manager has made contact with an advocacy service to provide advocacy services to those residents who may need them. Relatives and residents spoke especially highly of the food at Acorn House. The menu is varied, appetising and imaginative. The chef places great Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 Page 12 emphasis on home cooking, making his own fresh soups and puddings for instance. The main meal is served in the evening but lunch is also substantial. On the day of the inspection lunch was home made broccoli and Stilton soup with a variety of fresh filled rolls, all attractively presented. The chef occasionally provides less traditional meals, such as curries, though he will always provide something different for any one who does not want the main meal. In fact most of the residents enjoyed the mild lamb curry, which he recently served, contrary to the widespread supposition that older people will not eat such food and only want ‘brown mince’ (for instance). The chef has a detailed list of the preferences and special needs of each resident. This includes details such as the fact that one resident does not like carrots - the chef has observed that if carrots are put on her plate she may feel discouraged from eating at all. During the very hot part of summer the chef and the Registered Manager ensured that there were plenty of juices and fluids available and also prepared menus, which were suitable for the energy-sapping hot weather. They found, for instance, that ‘finger foods’ suited many of the residents in such weather, as they are easy to eat. The chef interacts very well with the residents, getting to know them, their likes and dislikes. This approach, together with attention to detail, good ingredients and good cooking has created a highly successful catering service. Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 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 the following standard(s): 16, 17, 18. Quality in this outcome area is good. Procedures for complaints and adult abuse allegations are in place, providing protection for residents. EVIDENCE: Acorn House has an appropriate complaints procedure but the Registered Manager said that she had not received any complaints for over a year. She felt that any issues are usually resolved informally before they reach the stage of being a formal complaint. In fact, one matter raised by a relative in correspondence was clearly a complaint and should have been recorded as such. The manager had investigated the situation, concluded that the complaint was not substantiated and the relative who raised the issue appears to have accepted those findings. The home has appropriate adult abuse and whistle blowing procedures and adult abuse is covered in the induction process. Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is good. The home is clean and well furnished, providing a comfortable environment for its residents. EVIDENCE: The home was clean, well maintained and appropriately decorated on the day of the inspection. All residents have individual bedrooms, 18 of them with en suite facilities. The bedrooms inspected were homely and most of them had been personalised by the residents and their families. The self-closers on bedroom doors had been repaired. The Registered Person employs a maintenance worker who carries out routine repairs and maintenance in the home. The main lounge is divided into two areas, one of which faces onto the attractive patio and back garden. The carpet in the lounge has seen better days and is stained. It is recommended that this be replaced. The carpet in one identified bedroom was badly marked and worn and must be replaced. One other bedroom carpet was crumpled and needed to be stretched to avoid a trip hazard developing. One polystyrene ceiling tile in an en suite was badly Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 Page 15 marked following a leak and should be replaced. The Registered Manager said that this was in hand. There were malodours in three bedrooms, resulting from the particular needs of the residents. The Registered Manager said that the continence nurse had been consulted and had advised the home on how to minimise this problem. It may be that the fitting of a homely impervious floor covering should be considered in these rooms, in consultation with the residents and any involved relatives. The home has two supported baths and hot water delivered to bathrooms is controlled by thermostats. The home’s Environmental Health Officer had visited the home and advised that in her opinion there was no need to specifically test for Legionella. She had offered advice on how to take precautions against the disease and these have been put in place. A smaller lounge on the second floor includes a small dining area and is used as a quieter room by some of the less confused residents as well as for some activities. During the inspection a member of staff was sitting with some of the residents listening to a new (to the home, that is) Vera Lynn CD and they were joining in with some musical instruments. All radiators are fitted with safety covers. Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. Acorn House employs sufficient staff to meet the needs of the residents. Specialist training in dementia care helps to ensure that staff have the appropriate knowledge to meet the particular needs of confused residents. The home’s recruitment procedures protect residents from being put at risk by the employment of unsuitable staff. EVIDENCE: Acorn House employs three senior care staff and thirteen care staff for daytime duties and two seniors and six care assistants at night. There is normally one senior and three or four care assistants on duty in the daytime, in addition to the manager. The home also employs an activities organiser, domestic staff, two kitchen staff, a laundry assistant and a handyman/decorator. An administrator who works at the owners’ office provides administrative support. Agency staff are used to cover some shifts when necessary. Staff meetings are held periodically and are minuted. All of the senior carers and ten other care staff have NVQ2. One of the senior carers has NVQ3 and the other two are continuing to study for the qualification. Acorn House therefore clearly exceeds the national standard of at least 50 of care staff with NVQ2. Five other staff also have NVQ2s. All care staff have received training on dementia care provided by the Alzheimer’s Society. The Registered Manager is in discussion with the Society about follow up training in this field. Other recent training has included food hygiene, personal safety, adult abuse and moving and handling. New staff recruited since the last inspection had current CRB (Criminal Records Bureau) certificates, obtained by the Registered Person, and POVA (Protection Of Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 Page 17 Vulnerable Adults) clearance. All had been POVA checked before they started work. The Registered Manager is compiling a training matrix which includes an assessment of the ‘business impact’ of the training. Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38. Quality in this outcome area is good. The home is efficiently managed, with financial procedures that protect the interests of the residents. EVIDENCE: The manager is experienced in management and has an NVQ4. She is due to attend a further conference on dementia care in the autumn. The conference will have input from Bradford University’s specialists in dementia. Staff are now receiving regular supervision. Senior carers supervise care staff and the Registered Manager supervises them in turn. Supervision is recorded. On the day of the inspection there was a relaxed atmosphere in the home, with respectful relationships between staff and residents. The Registered Person visits the home regularly and completes written reports which are filed in the home. The visits are part of the home’s quality assurance framework, which includes resident/relatives surveys. The residents’ survey forms use pictures to help residents to understand them, and most are completed with the help of family members. The home has the Investors In People award, which is being Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 Page 19 reviewed 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 manager requests money from the administrator if money is needed and invoices are sent to the resident’s family. The home itself pays for items such as newspapers, toiletries and ‘treats’ on trips out. The kitchen was clean and well organised. The Environmental Health Officer has recommended that the home uses the Food Standards Agency’s Safer Food, Better Business pack and the chef is currently working his way through the pack and will be preparing an action plan for safety checks and good safety practices. Fire safety records were properly kept and safety certificates were in place. The Fire Prevention Officer had visited the home recently and had no outstanding issues apart from suggesting that a warning sign be displayed to alert fire officers to the presence of oxygen cylinders in one room. The Registered Manager said that this was in any case being discontinued as the resident no longer uses it. Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Acorn House DS0000018852.V288886.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. 2. Refer to Standard OP13 OP19 Good Practice Recommendations Any restrictions put on visiting should be fully recorded. The carpets in the main lounge and an identified resident’s bedroom need to be replaced. The carpet in the other identified bedrooms should be stretched to get rid of the potentially hazardous wrinkles. The Registered Person should investigate the possibility of installing homely, impermeable floor coverings to those bedrooms where there is a persistent malodour. 3. 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