Inspection on 17/04/09 for Acorn House Residential Home

This inspection was carried out on 17th April 2009.

CQC found this care home to be providing an Good 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 Residential Home 12/05/09

Acorn House Residential Home 18/04/08

Acorn House Residential Home 18/09/07

Extracts from inspection reports are licensed from CQC, this page was updated on 24/11/2009.

Key inspection report Care homes for older people Name: Address: Acorn House Residential Home 310-312 Norton Road Stockton-on-Tees TS20 2PU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Stephen Ellis     Date: 1 7 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Acorn House Residential Home 310-312 Norton Road Stockton-on-Tees TS20 2PU 01642559378 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Carol Lynn Trainor care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 14 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: Old Age, not falling within any other category, Code OP - maximum number of places 6 Dementia Code DE, maximum number of places 8 Date of last inspection Brief description of the care home Acorn House is a care home registered to provide care for 14 older people. There is one unit for 8 people who have dementia and another unit for 6 older people. The home is a two storey building converted from two Victorian terraced houses. It stands on an elevated site overlooking Norton Road. Access to the front is via a path with steps, a handrail is fitted. At the back of the building there is ramped access to the home. The garden and elevation of the building allow for privacy. Acorn House is located near to local shops, post office, public houses, social clubs and churches. It is situated on a bus route providing access to Stockton town centre. The weekly fees Care Homes for Older People Page 4 of 24 Over 65 0 6 8 0 Brief description of the care home vary between £356 and £374, but the actual amount payable depends on peoples individual circumstances. Care Homes for Older People Page 5 of 24 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: two star good 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: This key unannounced inspection was carried out on 17th April 2009. The last key inspection was carried out on 18th April 2008. This current inspection benefited from information received prior to the fieldwork visit, including the homes annual quality assurance assessment (AQAA) completed on 9th March 2009 , plus 10 surveys completed by people who use the service and 3 surveys completed by staff and returned to the inspector in March 2009. The process of the inspection included discussions with 6 people who use the service, 2 visitors and 4 staff. There was also a tour of the building, sampling rooms and facilities, plus an examination of a selection of records, including maintenance, plans of care, staff files and reports. The weekly fees charged vary between £356 and £374, but the actual amount payable depends on peoples individual circumstances. Care Homes for Older People Page 6 of 24 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 24 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 8 of 24 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. People who use the service have their needs assessed and their wishes and views are respected wherever possible. Intermediate care is not provided. Evidence: The plans of care of 5 people who use the service were examined and these showed that full assessments of need were carried out prior to admission. These covered all the activities of daily living and included inputs from health and social care professionals where appropriate. People who use the service said that they felt the home met their needs very well and that these were well understood by the staff team. Typical comments included: I always receive the care and support I need. I am very happy with the care provided. The manager confirmed that full assessments were carried out prior to admission, unless it was an emergency, when assessments would be completed as quickly as possible within a few working days of the person being admitted. Care Homes for Older People Page 9 of 24 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. The health and personal care that people who use the service receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Five plans of care were examined and these were comprehensive and detailed concerning health and personal care needs. They addressed all of the activities of daily living and included information concerning pre-admission assessment, pre-review questionnaire, risk assessments, action plan to minimize assessed risks, falls assessment, falls monitoring, body map, personal emergency evacuation plan, life history, lifestyle choices, weight chart, doctors visits, hospital appointments, district nurse visits, activity record and night check agreement. They would nonetheless benefit from being more specific in some instances so that clear guidance is given. According to the manager, plans of care were being regularly reviewed and evaluated at monthly intervals. However, this was not always clearly recorded, partly due to the fact that care plan formats were being updated. The home needs to ensure that each plan of care for each person using the service is evaluated and reviewed at monthly intervals, or more often if necessary, and that the review is dated and recorded. Also, Care Homes for Older People Page 10 of 24 Evidence: not all of the plans of care had signed consents from the person using the service or their representative. People who use the service said that their health and personal care needs were well met. Typical comments included: I always receive the medical support I need and I always receive the care and support I need. These observations were supported by comments received from 2 relatives who were visiting. There were good arrangements observed for the safe storage, administration and disposal of medicines, as confirmed by a recent pharmacy inspection completed by the Primary Care Trust in December 2008. People who use the service may selfadminister. However, in practice, most people who use the service delegate this responsibility to the staff at the home. All staff members responsible for medication have completed training in the safe handling of medicines and the manager and senior staff carry out regular audits. 50 of care staff members have achieved National Vocational Qualifications (NVQ) in Care at level 2 or above, helping to reinforce good social care principles, such as respecting peoples privacy and dignity. People who use the service were positive and complimentary in their comments about the quality of care experienced and how they were treated with respect. They also felt that their privacy was respected. Typical comments included: The staff always listen and act on what I say. Care Homes for Older People Page 11 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to choose their lifestyle, social activity and keep in contact with family and friends. Social, cultural and recreational activities meet peoples expectations in a positive way. People receive a healthy, varied diet according to their assessed requirement and choice. Evidence: People who use the service said they were satisfied with the range of social and recreational activities on offer. People who use the service commented positively about the atmosphere in the home that supported their needs for social and recreational activities, whilst respecting peoples individuality and personal choices. Visitors to the home said they were made welcome and the home clearly valued their involvement and the contact with the wider community. A warm and welcoming atmosphere was evident. The interests of people who use the service are recorded and the home tries to ensure that programmes of activities and social events are suitable. The home encourages people who use the service to pursue their individual interests, such as contact with friends and family, social and cultural involvement and religious activities where desired. Typical comments received included: There are always activities arranged by the home that I can take part in. The programme includes pamper sessions, music and movement, dominoes, walks in the garden, sing-a-longs, Care Homes for Older People Page 12 of 24 Evidence: television and DVDs, recall and reminiscence, plus occasional outings and visiting entertainers for special events. A hairdresser visits each fortnight. People said that they did not have to take part in anything if they did not want to and they could choose how they spent their day, including when they got up and went to bed, and what clothes they wore. People who use the service were also satisfied with the quality of the meals, saying that the catering was good and there was always a good choice of menu. As one person said: There is always a choice at each mealtime. People were able to take their meals in one of the two dining rooms or, if they preferred, in their own room. Dining areas were observed to be pleasantly decorated and well equipped with dining furniture. A relaxed atmosphere was evident. Care Homes for Older People Page 13 of 24 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. People who use the service have access to a robust, effective complaints procedure and are protected from abuse. Evidence: People who use the service said that they were confident about raising any concern or complaint with members of staff. These views were reflected in comments received from relatives who were visiting. Typical comments included: I know how to make a complaint. I know who to speak to if I am unhappy. People who use the service said that staff members were approachable and friendly and they knew that any complaint would be taken seriously. Staff members confirmed that they listened carefully to any concern or complaint and would always try to resolve matters speedily and effectively, in line with the homes complaints procedure, available in the service users guide. Any complaint is recorded by the service, along with all actions taken to resolve matters to the satisfaction of the complainant. All staff members are carefully recruited after full pre-employment checks have been completed, including enhanced criminal record bureau checks and the taking up of two references. All staff members undergo training in safeguarding adults procedures, whereby any suspected abuse or neglect is reported and investigated, in line with the local multi-agency safeguarding procedures, led by the Local Authority for Adult Social Care. Staff files confirmed that staff had undergone sound recruitment procedures and staff comments confirmed awareness of local safeguarding procedures, plus whistleblowing about suspected abuse. Care plans showed that risk assessments were carried out to minimize the risk Care Homes for Older People Page 14 of 24 Evidence: of harm befalling people who use the service, by offering clear guidance to staff about how best to act to protect and promote the safety and welfare of people who use the service. Care Homes for Older People Page 15 of 24 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 physical design and layout of the home enables people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. Evidence: People who use the service said that they liked the premises and felt that they were well-equipped, safe and hygienic. Typical comments included: The home is always fresh and clean. There is always a friendly atmosphere. The home was observed to be pleasantly decorated and comfortably furnished. All members of staff have completed training in infection control and hygienic practices were observed throughout the home, such as the use of paper towels and liquid soap in communal bathrooms and toilets. All bedrooms are spacious and comfortably furnished, with the majority being single rooms. These were observed to be personalised. People who use the service expressed satisfaction with the homes facilities, aids and adaptations, such as assisted bathrooms with hoists. There are a number of spacious lounge and dining areas on the ground floors of both units. Accommodation is provided on ground and first floors and there is reasonable access around the building for people with mobility problems, with the aid of a stairlift. To the rear is a paved garden area with seating and tables, pot plants, plus a gazebo and aviary, which was very popular. Maintenance records were sampled and confirmed that procedures and practices are in place to ensure the home is safe and maintained to an acceptable standard. Care Homes for Older People Page 16 of 24 Evidence: Nonetheless, it is desirable to have liquid soap and paper towels in the laundry to minimize the risk of cross-infection. Also, signs warning people of hot water at wash hand basins should be removed, if the hot water outlet has been controlled by thermostatic mixer valve so that the temperature of hot water does not exceed 43 Celcius. Care Homes for Older People Page 17 of 24 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. Staff in the home are trained, skilled and in sufficient numbers to fulfil the aims of the home and meet the changing needs of people who use the service. Evidence: People who use the service said that they were satisfied with the care and support provided by members of staff. Typical comments included: I always receive the care and support I need. 50 of care staff members have achieved National Vocational Qualifications (NVQ) in Care at level 2 or above and the remainder are working towards the qualification. Several senior staff have achieved NVQ level 3 in Care or are working towards it. On the day of inspection there were 13 people being accommodated, with 8 people on the dementia care unit and 5 on the older persons unit. Typically, there are 3 members of care staff on duty during the day from 8 am to 5 pm, plus a cook 7 days per week. During the evening and at night, there are 2 members of care staff on duty. There is always a senior carer or above on duty on each shift during the day. The hours of the full time manager are not included in the care hours available. Staff members confirmed the good induction and training they had received, including all manadatory training plus NVQ in Care. Typical comments included: Staff are always encouraged to undertake relevant training. Our new acting manager is very approachable, always listens and tries to help where she can. Staff files provided evidence of training and qualifications obtained. Training needs analysis is carried out at regular intervals and monitored by the homes manager. A Care Homes for Older People Page 18 of 24 Evidence: full staff training and development programme is in operation, including dementia care and awareness. Staff files also confirmed the good recruitment practices, whereby new staff are only taken on after thorough pre-employment checks, including enhanced criminal records bureau checks, protection of vulnerable adult checks and the taking up of 2 references, including one from the last employer. Care Homes for Older People Page 19 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, with effective quality assurance systems, developed by a manager who will be applying for registration soon. Evidence: People who use the service said that they had full confidence in the management of the home. They described management and staff as being approachable, willing to listen and help wherever possible. Typical comments included: The staff are always available when I need them and are always willing to help. Typical comments from staff included: Since the acting manager took over, the atmosphere and general running of the home is 110 better. The residents appear to be a lot happier. They are able to go out regularly and it is a pleasure to come to work. The manager has substantial, relevant experience, holding National Vocational Qualifications (NVQ) in Care at level 3. She is working towards NVQ level 4 in Management. She has an open door policy and was described as being accessible and communicative, welcoming contact from people who use the service and their representatives. The service is Care Homes for Older People Page 20 of 24 Evidence: supported by the registered provider who carries out visits to the home under regulation 26 of the care homes regulations, providing reports of her findings. Feedback from people who use the service and their representatives is actively sought through face to face consultations and written surveys. Staff files confirmed comments received from members of the care team, that staff felt appropriately supervised and supported. The home endeavours to ensure that each member of the care team receives 6 one- to-one supervision sessions per year, including an annual appraisal of their performance. Health and Safety matters are taken seriously by the home, as evidenced in records of kitchen food temperatures and hygienic practices, staff meetings, training and maintenance. Staff confirmed that they had undergone mandatory training in Health and Safety issues, including infection control, food safety, fire safety, control of substances hazardous to health and first aid. A sample of maintenance records showed that the services and eqipment in the home are subject to regular testing, audit, repair and replacement, including laundry and kitchen items. The majority of people who use the service either manage their own personal monies or receive assistance from their families. A minority receive help from the Local Authority financial protection teams. Where the home does assist people with looking after their personal monies for essential purchases, such as hairdressing or toiletries, individual accounts are kept, along with receipts, and transactions are witnessed by 2 signatures. Care Homes for Older People Page 21 of 24 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 22 of 24 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 7 The plans of care for people using the service would benefit from being more specific in places about the care interventions required to be perfomed by staff. Wherever possible, signed consent for the plan of care should be obtained from the person using the service or their representative. The dates and results of monthly reviews of plans of care should be clearly recorded in the plan of care. Warning notices at hot water outlets used by people being accommodated should be removed, if the temperature of hot water has been controlled at a maximum of 43 Celsius by thermostatic mixing valves. It is desirable to have paper towels and liquid soap in the Laundry to minimize the risk of cross-infection. The manager should apply for registration in the near future because the home requires a registered manager and the manager has been carrying out the role for the past year. 2 25 3 4 26 31 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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. 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