Inspection on 15/11/05 for Acorn House

This inspection was carried out on 15th November 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 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 15th November 2005 08:45 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.V267478.R01.S.doc Version 5.0 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.V267478.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Acorn House Address 18 Cearns Road Oxton Birkenhead Wirral CH43 1XE 0151 653 0414 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.V267478.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 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 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 s the dining room. There is a smaller lounge/diner on the first floor, which is used by residents who prefer a quieter room. Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced inspection the inspector spoke to a number of residents, staff and the Registered Manager. He also briefly met the Responsible Individual. He examined documents including care plans, medication, staffing files and fire safety records. He also toured the building, including all of the lounges, some residents’ rooms and the kitchen. What the service does well: What has improved since the last inspection? What they could do better: 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 Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 Page 6 contacting your local CSCI office. Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 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.V267478.R01.S.doc Version 5.0 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): 1, 3, 4 and 5. The Registered Manager carries out comprehensive pre-admission assessments, thereby ensuring that residents are appropriately placed and receive care that meets their needs. EVIDENCE: The Registered Manager has revised the service user guide to meet the Care Homes Regulations. The guide does not include a copy of the latest CSCI report but advises service users and their families how to obtain a copy in the home. The latest resident admitted to the home had been assessed by the Registered Manager and there was documentation from the South Wirral Primary Care Trust to support that assessment. The manager and staff are receiving training in the care of people with dementia to help ensure that the care provided is based on current good practice in this field. Prospective residents and their families are encouraged to visit Acorn House if possible before making a decision on whether to move in Acorn House does not provide intermediate care so Standard 6 does not apply. Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 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. Care planning at Acorn House 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 fully recording the administration of all medicines to ensure the safety of residents. EVIDENCE: There are detailed care plans for each resident which are reviewed every month by the manager and senior staff. The Registered Manager said that GPs will attend the home to do reviews if they are asked. Changes to the care plans are recorded on a separate sheet, which is potentially confusing. In one case up to date information on a resident’s continence was only on the amendment sheet – simply consulting the main care plan would have given out of date information and been misleading. The manager confirmed that she is planning to put the plans on a computer, which would make them easier to amend following review. Daily reports are made in loose-leaf folders and individual sheets are then transferred to the main file. The Registered Manager said that she intends to provide care plan summaries for the daily report file to aid staff in compiling the reports. 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 Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 Page 10 system ensures that a full record of accidents is available for each individual. Residents have access to community and specialist health services. A chiropodist visits the home regularly. 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 there were several gaps in the records of the administration of one drug. It is important that staff complete the Medication Administration Record (MAR) sheet on every occasion where medication is prescribed. Blank entries give no information about whether the mediation was taken or refused. Staff had not signed when prescribed creams are applied – the use of all prescribed medication must be recorded on a MAR sheet. All senior staff responsible for medication have received approved training in the administration of medicines. Controlled drugs (CD) are appropriately stored in a CD cupboard and their administration is properly recorded in a bound CD register. Homely remedies for one resident had been left unlocked in her room. The resident in question was considered to be capable of using such medication safely but no written risk assessment had been completed. Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 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. The home provides a range of activities to enhance its 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 has an activities organiser who works 24 hours a week; a care assistant also provides some activities for the residents. The schedule of activities includes cake decorating (which was being done during the inspection) music and dancing, model making, ‘pampering’ sessions (hair and make up) and trips out. The home provides transport to take residents out, though the manager said that some of them are reluctant to go. Trips tend to be local, so that the residents do not have to spend too much time travelling, and trips during the summer included visits to Parkgate and the nearby Williamson Art Gallery. The home has a pleasant enclosed garden that is used for activities such as barbecues in the summer months. Visitors are welcome to Acorn House at any time and most of the residents have contact with family and friends. The menu for the home provides a balanced diet and the chef and his assistant discuss the residents’ likes and dislikes with them. If an individual resident wants a particular meal the chef is happy to provide it. Lunch is usually a Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 Page 12 lighter meal, though often cooked, and the main meal is normally served at tea time. The main meal on the day of the inspection was home made ‘minted lamb stew’. The chef puts the emphasis on home cooking from fresh ingredients and makes his own soup and puddings. The catering staff make an effort to provide varied meals and recently served a mild curry, which most of the residents enjoyed. Any who did not want it were given an alternative. Staff discreetly help those residents who need help with eating. Residents who spoke to the inspector said that they enjoyed the food at Acorn House. Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 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 and 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 Registered 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 and whistle blowing procedures and adult abuse is covered in the induction process. Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 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, 23, 24, 25, 26. Acorn House is well maintained, 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 but some required further adjustment to ensure that they close fully and safely into the rebate, providing full protection against the spread of fire and smoke. The Registered Person employs a maintenance worker 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. The seat on one of the supported baths is about to be replaced. Thermostats are being fitted to wash handbasins in bedrooms and Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 Page 15 en suites but some taps tested were still delivering water that was much too hot and therefore still presented a potential risk of scalding. Until all of the thermostats have been fitted and checked, the manager should complete risk assessments for 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 as raised at the last inspection. The Registered Manager said that this was being arranged and she had requested a visit from Wirral Borough Council’s Environmental Health department though this had not yet taken 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, though nobody was using it on the day of the inspection. All radiators are fitted with safety covers. Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 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. Acorn House employs sufficient staff to meet the needs of the residents. Specialist training in dementia care is being provided to ensure that the interests of residents are best served. The home’s recruitment procedures have been improved to ensure that residents are not put at risk through the employment of unsuitable staff. 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 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 provide additional cover when needed. Ten care staff have now completed their NVQ2 (and are awaiting their certificates) and a further carer is studying for it. One senior carer has NVQ3 and the other two are studying for the qualification. The kitchen assistant is working towards his NVQ2 in catering. All care staff are in the middle of a course on dementia care provided by the Alzheimer’s Society and the senior carers will also be doing the course. Staff said that they are enjoying the sessions and find them relevant to their care for older people with dementia. Other recent training has included food hygiene and personal safety. The Registered Manager and senior staff are planning to do CLAIT (computer) training. No new staff had been employed since the last inspection but the manager said that the home’s recruitment practices had been amended to ensure that no new staff are employed without POVA clearance. Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 Page 17 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, 33, 35, 36, 37, 38. The home is efficiently managed, with financial procedures that protect the interests of the residents. Care needs to be taken with the rotation of dry food stores to ensure residents’ safety. EVIDENCE: The manager has been in post since May 2004 and has completed her NVQ4. She is an experienced manager and was previously registered under the Care Standards Act 2000 in a different post. She has recently attended a two day conference, organised by a specialist magazine, on Developing the Best Environment for Dementia Care and the latest developments in this specialist subject. Through this she has made valuable contacts and will shortly be attending a course in Dementia Care Mapping organised by the University of Bradford who are specialists in the field of person-centred dementia care. Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 Page 18 Staff are now receiving regular supervision. 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, with respectful relationships between staff and residents. The Registered Person visits the home regularly and submits written reports to the Commission for Social Care Inspection under the Care Homes Regulations. The visits are 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 being 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 and the small domestic fridge in the kitchen had been replaced. Several items in the dry stores were beyond their sell by date and the Registered Manager needs to ensure that food stocks are properly rotated to ensure that out of date food is not kept. Fire safety records were properly kept and safety certificates were in place, but the fire door selfclosers referred to earlier need to be adjusted. Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 Page 19 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 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 x 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 3 2 Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2) Requirement Timescale for action 15/11/05 2. OP26 13(4) 3. OP38 13(4) The Registered Person must ensure that proper arrangements are in place for the recording and storage of medication, in particular: *all prescribed medication, including creams, must be accounted for an the MAR sheets; *risk assessments must be completed if residents retain any medication. The Registered Person must 01/12/05 ensure the safety of residents by ensuring that: *hot water is delivered to all bedrooms at a safe temperature and risk assessments are completed in the meantime; *water storage facilities are tested for Legionella. The Registered Person must 01/12/05 ensure the safety of residents by: *repairing the self closers to the identified fire doors; *rotating food stocks so that no out of date supplies are used. Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Acorn House DS0000018852.V267478.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 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. 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