Inspection on 13/10/08 for Acorn House

This inspection was carried out on 13th October 2008.

CSCI found this care home to be providing an Excellent 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

Acorn House 12/09/06

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Acorn House 18 Cearns Road Oxton Birkenhead Wirral CH43 1XE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter Cresswell     Date: 1 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Acorn House 18 Cearns Road Oxton Birkenhead Wirral CH43 1XE 01516530414 01516527121 acorn@fsbdial.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mandy Courtenay Type of registration: Number of places registered: Tree Vale Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following category of service only: 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: Dementia - Code DE The maximum number of service users who can be accommodated is: 33 Date of last inspection Brief description of the care home 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 which is partly in the new conservatory. There is a smaller lounge/diner on the first Care Homes for Older People Page 4 of 25 Over 65 0 33 Brief description of the care home floor, which is used for some organised activities and by some people who prefer a quieter room. Fees range from £464 to £500 a week. Care Homes for Older People Page 5 of 25 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: three star excellent 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 3 star. This means that the people who use the service experience excellent quality outcomes. The manager sent us an Annual Quality Assurance Assessment (AQAA) before we visited the home. This provides us with information about the home and sets out the managers and owners view of how they meet the required standards. We sent out survey forms to staff and residents before we went to the home. We received eight survey forms from staff and one from a resident (completed on her behalf by a relative). We visited the home without telling anyone that we were coming. During that visit we looked at all parts of the home and talked to the manager, several members of staff, a number of residents and two relatives who were visiting at the time. We also looked at documents including care plans, safety records, menus and staffing files. Care Homes for Older People Page 6 of 25 Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 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 9 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager carries out or obtains detailed assessments before anyone moves in, making sure that the home can meet the persons needs. Evidence: People are assessed by the manager before they move in to the home unless they are admitted in an emergency, in which case an assessment is obtained from relevant professionals involved in placing the person. We looked at the files for the people who had moved in most recently. They all had assessments provided by social services. All of the files we looked at contained copies of a contract. We talked to some relatives of residents and one resident who had moved in during the last year and they all said that the home had been helpful and provided all of the information they needed before they decided to move in. It is unusual for prospective residents to visit before moving in, due to their mental state. They manager has produced a detailed Acorn House Enquiries Pack as well as the service user guide. The home does not provide Care Homes for Older People Page 10 of 25 Evidence: intermediate care so standard 6 does not apply. Care Homes for Older People Page 11 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning helps to focus care on the needs of the residents. Medication is well organised, protecting the health and safety of the residents. Evidence: We looked at the case files for five people who live in the home. They all contained detailed care plans which set out how the home and its staff would meet the persons needs. They all included a section about proposed funeral arrangements. Care plans are being rewritten in the first person so that they focus more clearly on the needs of the individual. For example, one says If given time I can help staff support me around my personal care........I might take some time so please be patient. Each file has a Care Plan Quick Summary which provides an instantly usable summary of the essential elements of the plan. A copy of this is kept with the daily reports so that the member of staff can easily refer to the care plan when they are completing the daily reports. This helps to provide an accurate picture of the care that has been provided. Care plans are reviewed every month by the manager or a senior carer and each year there is a fuller review to which relatives, key workers and outside professionals are Care Homes for Older People Page 12 of 25 Evidence: invited. Details are kept of medical appointments and correspondence. In the AQAA the manager said that one resident who was non-compliant with dental care inside the home was escorted to the dentist for appointments at the surgery. This helped as the resident recognised the fact that s/he was at the dentists and co-operated with the treatment. Risk assessments are completed for particular risks such as falling, and there was a moving and handling plan on file for each resident. Although accident forms are kept centrally, copies are also kept on the individuals file so that there is a ready record of, for instance, whether the person is having a lot of falls. There is also a central audit of accidents which helps the manager to identify any particular patterns and therefore take action to prevent further accidents. In two of the files we looked at there were detailed reports from an NHS dietitian which addressed concerns about the persons diet. Issues raised in these reports had been built in to the care plan. The home has introduced daily pressure and skin chart checklists in consultation with district nurses. We looked at medication for three residents. Medication is securely stored and well organised. Where medication is to be taken as required (PRN) there should be written guidance on the medication file for the guidance of staff. In practise, the staff responsible for medication did know the correct procedures in each case but it is important that these are recorded. One controlled drug was being used and was properly recorded and securely kept. The manager should check that the cabinet it is stored in complies with the relevant regulations. Care Homes for Older People Page 13 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides activities which enhance the residents quality of life. Meals are imaginative, well cooked and meet the residents needs and preferences. Evidence: Acorn House employs an Activities Co-ordinator who works 30 hours a week. She works with residents in small groups, using reminiscence materials (images of everyday life in the war years and the early fifties), games, music and any other diversions which the residents say that they like. We saw her working with a group in the smaller upstairs lounge. The residents were joining in a reminiscence game and appeared to be enjoying themselves. The activities co-ordinator said that she has organised some trips out (minibus trip to New Brighton, visit to a pantomime) but on the whole these had not been a great success. Residents seem to prefer short expeditions in small groups or on their own (accompanied by staff or relatives, obviously). These are of course more expensive as they need more staff support, so they are limited. Most residents do go out with friends or relatives and we spoke to some relatives who did just that. In the surveys several staff did suggest that a if the home had its own minibus they could arrange more outside activites. An exercise therapist and a crafts worker also visit the home and residents especially enjoy the Care Homes for Older People Page 14 of 25 Evidence: exercise sessions. On the afternoon when we visited there was a busy, bustling atmosphere in the home as residents, staff and visitors moved around taking part in group or individual activities. From time to time a musician is also employed to entertain the residents. In the AQAA the manager said that on these occasions the home provides a buffet and invites families in to make it a special event. Relatives and friends are welcome into the home at any time and several visited whilst we we there. They confirmed that they are always made welcome. One relative told us in a survey that there is always something going on to stimulate mum and all the other residents. The manager has written to local schools to encourage links with them but the response so far has been a bit limited. Where possible residents have individual activities - one of them grows lettuces and tomatoes in the garden for instance. The menu at Acorn House is unusually varied and imaginative. Dishes for the week when we visited included pasta carbonara, chicken goujon caesar salad, sweet and sour pork with rice and hotpot. The chef said that he serves curries several times a month and the residents enjoy them. A relative told us the meals are lovely ....... if you dont want what Mark and his staff have prepared they will always find an alternative. All of the residents we spoke to said that they enjoyed the food. New dishes introduced recently include paprika pork with penne pasta, goats cheese and cherry tomato tart, beer battered goujons of sole and beef cobbler. No formal choices are set down on the menu and the policy on choice is set out in an explanatory document. The chef speaks informally to residents and has drawn up a list of likes and dislikes which is kept in the kitchen. Meals are prepared with these in mind and if anyone does not like the meal of the day they are offered a good quality alternative. One example given by a relative was when a resident declined a curry she was offered gammon, egg and chips. We saw, not for the first time, the chef talking to residents as they walked around the home together. The chefs policy document states that he finds that residents enjoy a wide range of cuisines from many different countries.................although we do a lot of traditional home cooking we like to add something modern once or twice a week and if it goes down well with our clients it goes down on the menu. The main meal of the day is served in the evening, with lunch a lighter affair (when we called it was freshly made celery soup and rolls, with a pudding). Menus are balanced, with an emphasis on fresh ingredients, including fresh fruit. The dining room now includes a new conservatory which provides a bright, congenial atmosphere for meals. Some residents eat in the first floor lounge. Care Homes for Older People Page 15 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures for making complaints and safeguarding adults are in place, providing protection for residents. Evidence: The home has an appropriate complaints procedure and in the AQAA the manager stated that the home prides itself on being open and transparent. Most complaints are resolved informally and most of those that are put in writing concern mislaid items of laundry. The home has appointed a new laundry assistant and introduced some new procedures with a view to resolving the laundry issue. Staff are trained in the safeguarding of adults. Care Homes for Older People Page 16 of 25 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 good 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, well furnished and well lit, providing a comfortable environment for the people who live there. Evidence: New lighting has been fitted in the main lounge and in most of the bathrooms and toilets. Before buying the new lights the manager and administrator consulted the University of Stirlings dementia unit to make sure that they were suitable. The new system provides lighting which appears similar to natural daylight and its effect is most noticeable in an area of the main lounge which was previously rather gloomy. This has improved the whole atmosphere in the large main lounge. The manager said that she and her staff also believe that the new lighting has improved the mood of many of the residents. The manager is considering other changes to decor to help the residents, such as colour coding of doors. Strip lighting in the corridors should be protected by suitable covers. We looked round all of the home and found that it was clean, well maintained and well decorated. All bedrooms are single and 18 of them have en suite facilities; most of the bedrooms had been personalised either by the resident or their family. The owner employs a maintenance worker who spends as much time as is needed at Acorn house. Many of the carpets have been replaced recently. In one room where a resident has a particular problem the carpet has been replaced with an attractive wood effect floor. The owners have a rolling programme for replacing Care Homes for Older People Page 17 of 25 Evidence: furniture and there was new furniture in a number of rooms. A new dining area has been created, using the new conservatory which was built with the assistance of a government capital grant. The new dining area is bright and airy. Some residents eat in the small lounge upstairs which is also used for some activities. A relative told us that her relatives new room was redecorated and a new carpet and new bedroom furniture provided before she moved in. The home has sufficient baths and toilets including two assisted (Apollo) baths. The garden is accessible from the main lounge and some residents were sitting out on the warm day when we visited. Care Homes for Older People Page 18 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient well trained staff to meet the needs of the people who live in the home. The homes recruitment procedures protect against the employment of unsuitable staff. Evidence: The home is adequately staffed. In the day time there is one senior carer on duty and three or four care staff as well as the manager. As well as that, the activities coordinator works 30 hours a week, there are four domestics, three kitchen staff (including the chef) and - as described earlier - a maintenance worker. At night there is a senior and two care staff, all of whom are on waking night duty. Staff who responded to our survey confirmed that the home is fully staffed and if a gap arises, for instance if somebody is sick, then the manager arranges for someone to cover the shift (by herself or agency staff if necessary). 75 of the care staff have NVQ2 or better, well in excess of the national standard. Most of those staff who do not have NVQ2 are on a training programme to achieve it. The chef is qualified and all of the kitchen staff have NVQs. An external agency is employed to provide all of the mandatory training (such as health and safety, moving and handling) and training in safeguarding adults is done by Wirral Borough Council. The home buys specialist training in dementia care from the Alzheimers Society who are of course, one of the leaders in the field of dementia research and training. We checked the records for all Care Homes for Older People Page 19 of 25 Evidence: new staff and they all had proper references and Criminal Records Bureau (CRB) checks. In some cases, in order to maintain staffing levels, a member of staff had started work a few days before the CRB check was received but in these cases a clear Protection Of Vulnerable Adults (POVA) check had been obtained and the member of staff was closely supervised until the final CRB check was received. There were proper references on file for all of them and they had all received induction training. All staff have a copy of a detailed booklet called How to be great care assistant which gives a great deal of useful advice on how to carry out their duties for the benefit of the residents. Staff tend to stay at Acorn House so residents get to know them, providing valuable stability for them. Staff said in the survey that they enjoy working at Acorn House and they are proud of the service they provide. We spoke to a number of relatives and they all spoke very highly of the staff. One resident said in a survey I know all the girls and they all keep me very, very happy. In the AQAA the manager wrote We are very proud of our equal opportunities policy and all of our staff are able to attend courses. Care Homes for Older People Page 20 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is efficiently managed and has financial procedures that protect the interests of the residents. It has quality assurance procedures that ensure the home is run in the best interests of its residents. Evidence: The Registered Manager has run Acorn House for the last four years and is qualified and experienced. She regularly attends the annual conference on dementia run by Bradford Universitys highly respected dementia care unit and this is the source of many ideas for improvements to the service provided to the residents. Staff are regularly supervised by senior staff who in turn receive one to one supervision from the manager. Supervision sessions are recorded. When we visited we found there was a relaxed and friendly atmosphere in the home. All staff, including non-care staff such as the chef and the maintenance worker, had a relaxed, positive relationship with the residents. The home has the Investors In People award. This is a national quality assurance award and has been re-confirmed following a recent review. The home uses Care Homes for Older People Page 21 of 25 Evidence: a range of quality assurance measures to help maintain and review their standards. The owners regularly visit the home and complete written reports on how the home is being run. Relatives complete surveys on their views on the home and these are used to improve particular aspects of the service. The also recently attended a meeting with the manager and some staff, which was facilitated by an employee of the Alzheimers Society. The manager felt that the meeting had been helpful and she intends to hold further ones in the future. The meeting suggested name badges for staff and the manager is arranging to buy some. There have also been meetings for those residents who wish to attend. Twelve attended the last one, which is a high percentage given the difficulties they face. The owners administrator is now based in the home which the manager feels has helped families, who can now easily approach her if there are any issues with, for instance, finance. Residents personal finances are dealt with either by relatives or their legal representatives. The home itself pays for many items such as toiletries, newspapers and treats on any trips out. A hairdresser and a chiropodist visit the home regularly and bill relatives directly. Fire safety records, including safety certificates were well maintained and up to date. The chef uses the Environment Agencys Safer Food Better Business programme to manage food safety and hygiene. This had recently been checked by the Environmental Health Officer. Care Homes for Older People Page 22 of 25 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 23 of 25 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 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 Where medication is prescribed to be taken as required there should be written guidance as to the exact circumstances in which it is to be given. Care Homes for Older People Page 24 of 25 Helpline: 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 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 © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - 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!