Inspection on 25/01/06 for Acorn House Care Centre

This inspection was carried out on 25th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Care Centre 11/04/07

Acorn House Care Centre 13/09/05

Acorn House Care Centre 08/03/05

Acorn House Care Centre 24/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Acorn House Care Centre Whalley New Road Roe Lee Blackburn Lancashire BB1 9SP Lead Inspector Mrs Janet Proctor Unannounced Inspection 25th January 2006 09:30 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 Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 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 Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Acorn House Care Centre Address Whalley New Road Roe Lee Blackburn Lancashire BB1 9SP 01254 679395 01254 677686 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) Ashbourne Homes Limited Mrs Jennifer Howorth Care Home 32 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (22) of places Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 32 service users to include: Up to 22 service users in the category of OP - old age (aged over 65 years of age), not falling into any other category. Up to 10 service users in the category of DE (Dementia under 65 years of age) or DE(E) (Dementia over 65 years of age). Dementia care to be provided in the designated dementia unit and bedrooms numbered 21,22,23,26,27,28,29,30,31, and 32. The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. 13th September 2005 2. 3. Date of last inspection Brief Description of the Service: Ashbourne Homes Ltd own Acorn House Care Centre. The responsible individual for the company is Mrs Julie Marie Ablett. Mrs Jennifer Howarth is the registered manager and is responsible for the day-to-day management of the home. The home is registered to offer accommodation and personal care for twenty-two older people, and ten older people with dementia. The home is located in a busy community on the edge of Blackburn. It is on a main road with access to shops, a church and other community facilities. Bus services are nearby. The front of the home looks onto the shops and road and at the rear there are views of the garden and patio. There are ample car parking facilities at the rear. The home is a purpose built two-storey building with accommodation in two parts. The dementia unit is on the first floor. There are lounge and dining areas for each unit. There are bathrooms on each floor. Every resident in the home has a single bedroom, with an en suite toilet and wash hand basin. Bedroom doors are lockable. There is a passenger lift to the first floor area. Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day on the 25thJanuary 2006. The previous inspection was done on 13th September 2005 and information on the findings of this can be obtained from the home or from www. CSCI.org.uk . No additional visits have been made since the previous inspection. On the day of the inspection there were 28 residents at the home, 10 residents with dementia and 18 older people. Information was obtained from staff records, care records, and policies and procedures. Information was also got from talking to 6 service users, the Manager, 2 staff members and the Hairdresser. Four comment cards were returned from residents. Wherever possible the views of residents were obtained about their life at the home. Due to memory and communication difficulties, some of the residents were unable to engage in conversation or make comment about their experience of living in the home. Detailed notes were taken, which have been retained as evidence of the inspection findings. What the service does well: The service was very good at ensuring that all residents received a full assessment prior to coming to live at Acorn House Care Centre. This meant that their needs were known and arrangements could be made to ensure that these were fully met. Residents said, “We’re well looked after. They’re so good to us” and “All the staff are good – you can have a laugh with them”. . All four of the comment cards said that the residents thought that they staff treated them well. All four of the comment cards said that the residents liked living at the home. There was information about what each resident liked and disliked and what their usual routines were. The staff were good at making sure that residents choices were followed. The daily notes included many statements such as “still in bed as she’s fast asleep” and “put to bed at 6.30 pm as she wanted to go to bed early”. This meant that residents were able to make choices about their life at the home and that their preferred lifestyle was followed. The food offered at the home was varied and residents could have a hot meal for breakfast, lunch and tea if they wished. The residents said, “Lunch was good. The food here always is” and “The food’s OK – you never hear anyone grumble about it. There’s more than enough to eat”. Drinks were always available. One resident said, “I woke up at 3.00 am this morning and was gagging for a cup of tea. I rang the buzzer and they brought me one. You’ve only to ask and they bring you what you want straight away.” The Hairdresser said, “The residents are well looked after – staff always bring them a cup of tea Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 Page 6 when they ask.” All four of the comment cards said that the residents liked the food. The carers were given opportunity to do the NVQ level 2 in care and 63 of the care staff had obtained this qualification. This meant that they had the knowledge and skills to do their work in a competent manner. 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 contacting your local CSCI office. Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 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 Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 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): 3 Residents received a full assessment prior to moving into Acorn House Care Centre, with the result that their needs were known and met. EVIDENCE: Four residents’ files were viewed. These contained copies of assessments completed by health and social care professionals. It was evident that it was also usual practice for the Manager to visit and assess prospective residents before offering them a place at the home. The individual care records inspected contained copies of these assessments. Following the assessment the prospective resident was sent a letter confirming whether their needs could be met at the home. Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 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 and 9 Some of the plans of care did not have enough information about how to care for residents. This meant that the residents’ health, personal and social care needs may not be met in a correct or consistent manner. The management of medications ensured that residents received these in a safe manner. EVIDENCE: The plans of care viewed contained good details on the personal care needs of the resident and how staff were to meet these. There was evidence in some plans of care that the resident or their relative had been involved in the care planning process. The care plans gave a good picture of the service user’s background, preferred routines, likes and dislikes. On the dementia care unit not all of the plans of care gave staff directions on what to do to meet particular needs. For example, what to do if a resident was anxious, agitated or aggressive. They contained evidence that they were reviewed on a monthly basis. One of the care plans seen had been reviewed but did not give a current and accurate picture of the resident’s abilities and care needs. This meant that staff who were unfamiliar with the resident may not be aware of the full range of needs and may not give the correct care. Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 Page 10 Appropriate assessments for prevention of pressure sores, nutrition, falls and moving and handling needs were undertaken. Pressure mattresses and cushions were seen to be in use. One plan of care stated that a pressure mattress and cushion was to be used but staff said that this had been discontinued. One resident had had two falls over the past month. The fall risk assessment had not been reviewed. The moving and handling needs of a particular resident were not fully specified. There were no directions on how to move this resident when he was in bed. This meant that staff who were unfamiliar with the resident may not use the correct techniques of equipment. An alternative hoist was in the process of being obtained for this resident. There was evidence of the actions to be taken in respect of any weight loss and regular weight checks were done. These were sometimes done weekly dependant on the condition of the resident. The plan of care made reference to continence needs and any aids required for this were specified. One resident was using continence pads but had not received any of these from the PCT. This meant that she was using the supplies allocated to other residents. Residents were able to register with a General Practitioner of their own choosing. Appropriate arrangements were in place to ensure that they had access to specialist medical, nursing, dental and chiropody services according to need. Hearing and sight tests were arranged for individual residents when required. There were policies and procedures for all aspects of medication management. There were records for all aspects of medications. On each unit the medications were stored in a separate, clean, room that locked. The temperature of these rooms were monitored daily. There were adequate cupboards for the storage of the medications. There was little excess stock kept on the residential unit. On the dementia care unit there was a very large quantity of medications for one resident. These should be disposed of. The Controlled Drugs were stored and recorded properly and the balance was correct. No resident administered their own medication, this was done by the Senior Carer on duty. Each resident had a Medication Administration Recording chart that listed their medicines, when they were to be given, and who had given them. These were completed accurately. On the residential unit handwritten additions to the MAR charts were not always signed and witnessed. There was a current British National Formulatory. Patient information leaflets should also be obtained from the Pharmacy. These give easy to read information about the particular medicines. They can also be given to resident or their relatives if they have any queries about the medication being given. Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 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 and 15 Residents were able to make choices about their life at the home. This meant that their preferred lifestyle was followed. The meals offered at the home were to the liking of the residents and ensured that their individual dietary needs were met. EVIDENCE: The known likes and dislikes of the residents were noted in the plan of care. Their usual routines e.g. what time they liked to go to bed and get up, were also noted. Choice was encouraged and the routines at the home were flexible and were ‘resident led’. All residents spoken to said that they were able to make choices about what they did and when they did it. They were able to use their rooms when they wanted to. There was an activities person who visited every week day morning and played music, sang songs and did a small range of other activities. On the day of the inspection all residents enjoyed the sing a long and the short quiz. There was a current programme of these on the notice board and in each resident’s room. The activities done with residents were recorded in the daily notes. The initial ‘A’ was put in the margin so that it could be seen at a glance how often they had been involved in activities. Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 Page 12 The residents said that the meals served at the home were very good. They had a choice of a hot option at all three meals. There was a four-week cycle of menus. Residents were asked the day before which choice they would like from the menu. On the dementia care unit a supply of both options was sent up so that resident could make a visual choice at the time of the meal. Alternatives to the menus were also available. Drinks and snacks were always available. No resident was currently receiving a liquified diet. The Cook said that if this were needed then all components would be pureed separately. The atmosphere at lunchtime was calm and pleasant. The tables were set with place mats and a table decoration. All the tables had condiments available. Staff were seen to assist residents in a discrete and sensitive manner. Residents were prompted to eat independently before help was given. The kitchen was clean and tidy. All records were kept relating to food ordering, delivery, storage and cooking. There was a cleaning schedule. The records showing what food options had been taken by residents were not all dated. This meant it could not always be determined what a resident had eaten on a particular day. Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 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): None of these standards were assessed on this inspection. They were all assessed on the inspection done on 13th September 2005 and no requirements or recommendations were made. EVIDENCE: Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 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): None of these standards were assessed on this inspection. They were all assessed on the inspection done on 13th September 2005 and no requirements or recommendations were made. EVIDENCE: Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 Page 15 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 and 30 There were sufficient numbers of staff on duty to meet the needs of the residents. Failure to obtain a reference from the previous employer means that the recruitment procedures are not thorough. This may potentially affect the safety of residents. Staff received training to enable them to complete their duties in a competent manner. Further training in the care of residents with a dementia was needed. This is to ensure that all staff who work on this unit have the knowledge needed to care for these residents. EVIDENCE: There were designated staff for each unit. Each unit had its own rota, which showed the name of staff and the hours they worked each day. There were sufficient numbers of staff on duty to meet the needs of the residents. Staff spoken to said that there was generally enough staff on duty for them to do all the things that they needed to do. Ancillary staff were employed so that there was a Cook, Kitchen Assistant and Domestic on duty each day. A Handyman was also employed. The files for three staff members who had been recruited since the previous inspection were viewed. All prospective employees completed an application form and had a face-to-face interview. A Criminal Records Bureau clearance was done. A POVA First check had been completed prior to employment. Two references were requested and received for all prospective employees. For two of these employees a reference had not been taken from the previous employer. All new staff received a copy of the Staff Handbook and the GSCC code of conduct and practice. Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 Page 16 Staff had received some training and education in Dementia Care before the unit opened. From discussion with staff it was evident that further ongoing training was needed to ensure that they felt confident to deal with all aspects of dementia care. There were 19 carers employed of which 12 had completed NVQ level 2 or above. This meant that 63 of the care staff had the knowledge to enable to do their work in a competent manner. Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 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): 38 All certificates relating to the servicing of appliances were up to date. This protected the health, safety and welfare of residents and staff. EVIDENCE: A requirement was made at the last inspection was made in respect of the gas safety certificate and a recommendation in respect of the cleaning of the water storage tanks. Evidence that these issues had been addressed was received by CSCI in November 2005. Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 Page 18 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 Page 19 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. 1. Standard OP29 Regulation 19 Schedule 2 Requirement A reference must always be taken from the previous employer. Timescale for action 26/01/06 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. 3. 4. 5. 6. Refer to Standard OP7 OP7 OP8 OP8 OP8 OP9 Good Practice Recommendations The plans of care should be written with enough detail so that staff are aware of all actions to be taken in a situation. All personal, health and social care needs should be reviewed and the plan of care updated so that the information contained in it is current and accurate. The falls risk assessment should be reviewed if a resident’s falls start to increase. The actions and equipment needed for all aspects of moving and handling should be specified in the plan of care. Residents should be assessed and allocated their own continence aids. The amount of medications kept in stock for a specific resident should be reduced and the excess disposed of. DS0000022479.V278094.R01.S.doc Version 5.1 Page 20 Acorn House Care Centre 7. 8. 9. 10. OP9 OP9 OP15 OP30 All handwritten entries to the Medication Administration Recording charts should be signed and witnessed. Patient information leaflets should be obtained from the Community Pharmacist. The records of meals taken by residents should always be dated. Training on dementia care should be arranged and made available to all staff on Oak Tree unit. Acorn House Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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 Care Centre DS0000022479.V278094.R01.S.doc Version 5.1 Page 22 - 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!