Inspection on 18/09/07 for Acorn House Residential Home

This inspection was carried out on 18th September 2007.

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 Residential Home 12/05/09

Acorn House Residential Home 17/04/09

Acorn House Residential Home 18/04/08

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

CARE HOMES FOR OLDER PEOPLE Acorn House Residential Home 310-312 Norton Road Stockton-on-Tees TS20 2PU Lead Inspector Ray Burton Key Unannounced Inspection 18th September 2007 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 Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acorn House Residential Home Address 310-312 Norton Road Stockton-on-Tees TS20 2PU 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) 01642 607101 Mrs Carol Lynn Trainor Mrs Angela Roberts Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Acorn House is a care home registered to provide care for 15 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 rear 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. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection covering all of the key standards of the National Minimum Standards. It commenced on 18th September 2007 and was concluded on 5th December 2007. The lead inspector was accompanied for one day of the inspection by a Regulation Manager. Several visits were made to the home. The Provider, Registered Manager and all members of staff and residents were interviewed. Documents, including care plans and personnel records were examined. During the inspection concerns were raised by both residents and staff regarding the atmosphere in the home at times when the provider was in the building. This issue was referred into Adult Protection. What the service does well: What has improved since the last inspection? What they could do better: The provider must ensure that all future admissions are preceded by comprehensive assessments so that only those people whose needs can be met would be admitted to the home. Improved staffing levels would afford residents the opportunity to access community facilities. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 6 The homes recruitment procedure must be improved so that all prospective members of staff receive the necessary clearances before commencing employment. All money held on behalf of residents must be lodged in individually named accounts and not in the homes general account. The Provider must clearly define her role and that of the Registered Manager so that the home can function in an orderly and efficient manner. The provider must promote a positive environment for residents to live in and should refrain from any behaviour that may have a negative influence on residents. 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. The summary of this inspection report can be made available in other formats on request. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4. People who use the service experience poor quality outcomes in this area. Assessments to determine the suitability of the placement and the capacity of the home to meet a prospective resident’s needs were not always conducted prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of five service users files showed that in most cases a suitable pre-admission process had been followed that included assessments, conducted by the manager or a senior member of staff, to determine if the prospective resident’s needs could be met at Acorn House. One file however, whilst containing an assessment from the referring social worker that detailed the complex needs of the prospective resident, did not contain evidence that the home had conducted its own assessment to determine the suitability of the Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 9 placement or had taken into account the impact the prospective resident would have on existing residents, or whether the staff team had the necessary skills and training to meet the person’s needs. It was explained to the inspector that the provider, without the knowledge of the registered manager, had arranged this admission. It is imperative that all admissions to the home are subject to a robust preadmission assessment procedure conducted by a suitably qualified and experienced member of staff; and that only those people whose needs could be met would be admitted to the home. The home does not offer intermediate care therefore Standard 6 does not apply. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People who use the service experience adequate quality outcomes in this area. The homes care planning process ensured resident’s needs were identified and met. Personal care was conducted in a sensitive manner that upheld dignity and privacy. Systems were in place to ensure the safe handling of medication. The location of the telephone made it difficult for residents to have a private conversation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager and staff had good knowledge of each resident’s health and social care needs and were able to demonstrate how those needs would be met. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 11 Each resident’s file contained good background information – medical, social, family, employment, likes and dislikes etc. Care plans were in place covering all areas of care needs including specific health related needs. Risk assessments were in place and were regularly reviewed. Risk management strategies had been developed; however in some cases greater detail was needed to ensure that the management of the identified risk was properly documented. There was evidence that regular monthly reviews of all care plans was taking place; however the assessor’s notes did not always specify the areas that had been assessed, if any changes had occurred since the last review, or if any action was required. Care plans and daily records showed that monitoring of health was undertaken and healthcare needs addressed by District Nursing Services, resident’s own medical practitioner, chiropodists etc. There was a suitable policy and procedures for the receipt, recording, storage, handling, administration and disposal of medicines. Medicines were held in a suitable and secure facility and administered by members of staff who had undergone appropriate training. Medication Administration Record (MAR) sheets were examined and found to be in order. Residents had been asked if they wished to look after their own medicines, and assessments were conducted to determine each resident’s ability to manage his/her own medication. None of the current residents looked after their own medicines. It was observed that residents were treated with respect and addressed appropriately by their preferred name. Staff knocked on bedroom doors and sought permission before entering. Residents spoken to during the inspection expressed satisfaction with the way in which care and support was given and felt they were always treated with respect by the manager and staff and that their right to dignity and privacy was respected, particularly when being assisted with personal care. Concern was expressed by residents that they felt unable to make or receive telephone calls in private as the telephone was in the hallway and anyone passing or standing nearby would be able to overhear the conversation. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use the service experience adequate quality outcomes in this area. Staffing levels were not always sufficient to allow social needs to be met. The Registered Provider must conduct herself in a manner that does not cause distress or anxiety to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records and conversation with residents and staff showed a variety of appropriate in-house activities were available: TV, board games etc. On one of the days of the inspection residents were helping to dress the Christmas tree and put up decorations. It was apparent though that staffing levels precluded outside activities from taking place. Two residents commented that they would like to go shopping or go on a day trip but were unable to go out alone and staff did not have the time to take them. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 13 Residents said they liked living at Acorn House; felt it was a good home and considered they were well looked after. The following comments were made: “I think Acorn House is a good home and would not like to leave. The manager is lovely and approachable and the carers are good.” “Angela (manager) is a nice lady, the carers are excellent – they are a good crowd of girls, they would do anything for you.” Whilst making many very positive comments about the home and staff, several residents expressed concern that interference from the proprietor sometimes made life difficult for them and also for staff. They spoke of feeling uncomfortable and intimidated in her presence. Examination of menus showed there was a healthy, balanced and varied diet provided and alternatives were always available on request. Residents said that the food was good and “there is always plenty of it.” Staff helped residents to maintain contact with their family and friends by assisting with telephone calls and sending cards for special occasions such as Christmas and birthdays. Residents said staff always made visitors welcome and offered them a cup of tea. They said they could receive visitors in private if they wished. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People who use the service experience poor quality outcomes in this area. The home had appropriate policies and procedures in place to enable residents to make complaints and to protect them from abuse; however residents were reluctant to complain because of a possible negative response. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had suitable policies and procedures to safeguard residents and to respond to any suspicion or allegation of abuse. A copy of the “No Secrets” adult protection procedure was available to staff who were able to demonstrate knowledge of what constituted abuse and what to do in the event of such an incident being brought to their attention. All staff had received “No Secrets” training. The home had an appropriate complaints policy and procedure and residents knew what to do in the event of their being dissatisfied with any aspect of the service; however the inspectors were told by residents they could not always speak to the manager as she was rarely in the home and they were reluctant Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 15 to complain to the proprietor because they were afraid of her likely response and of possible repercussions. The manager stated that she did most of the administrative work from her own home, as Acorn House did not have a computer. The proprietor told the inspectors she had now purchased a computer and there would be no need in the future for the manager to work from her own home. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. People who use the service experience good quality outcomes in this area. The environmental standard was good, providing residents with a homely and safe place in which to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides comfortable and homely accommodation with sufficient communal space. Furniture was domestic in style, comfortable and suitable for purpose. Bedrooms had been provided with a wash hand basin and all had been personalised by the inclusion of furniture and other items brought from the occupants own home. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 17 The internal and external fabric and décor of the building was maintained in good condition. Regular checks and servicing was undertaken of all equipment. All areas of the home were centrally heated and radiators had been covered with suitable guards to ensure a low surface temperature. Hot water outlets accessible to residents had been fitted with pre-set valves to provide water temperatures close to 43 degrees centigrade. Toilet facilities were accessible from all communal areas and residents bedrooms. Sufficient and appropriate specialist disability equipment was available to meet the assessed needs of the current residents. A walk around the building revealed it to be clean and hygienic and free from offensive odours. Since the last inspection several communal areas had been recarpeted. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. People who use the service experience poor quality outcomes in this area. Staffing levels did not allow social needs to be met. The homes recruitment procedure was poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the days of the inspection it was observed that staff were employed in sufficient numbers to meet the assessed needs of residents. Examination of staffing rosters indicated appropriate staffing levels were maintained at all times to enable residents personal needs to be met, however there were not always sufficient numbers of staff on duty to meet social needs. Conversation with the manager and with members of staff revealed an effective staff team with good knowledge of each resident and their individual needs. Members of staff were encouraged to undertake training and all were qualified to a minimum of NVQ level 2 in care. Examination of all staff personnel files revealed poor recruitment and selection practices in that: Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 19 All necessary checks, including Criminal Records Bureau (CRB) and two appropriate references were not always obtained prior to commencement of employment. A notice of immediate requirement, in respect of deficiencies in recruitment and selection procedures, was served on the provider. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 35, 38. People using the service experience poor quality outcomes in this area. The Registered Manager has the necessary experience and qualifications. The respective roles of the Provider and Registered Manager have not been clearly defined; this has led to confusion and friction within the home. Money held on behalf of residents has not always been kept in individual named accounts. This judgement has been made using available evidence including a visit to this service. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager has the required experience and qualifications to be the registered manager of a residential home; she is the holder of the City & Guilds D32/33 Assessors Award, Registered Managers Award and the NVQ level 4 in Care. Members of staff and residents expressed confidence in the manager and said she was supportive and approachable; however many expressed concern that because of her frequent absences from the home, and because of interference from the provider, she was not able to properly carry out the duties of registered manager. The inspectors have met with the provider and stressed the importance of clearly defining her role and that of the Registered Manager so that the home can function in an orderly and efficient manner. Examination of financial records indicated residents’ money held for safekeeping in the home was properly administered and appropriate records maintained; however one resident’s personal allowance was held in the homes general account. The provider must put in place arrangements to ensure that any money held in this account on behalf of residents is transferred to separate accounts in the name of individual residents. Policies and procedures were in place to promote safe working practices and to safeguard the health, safety and welfare of residents and staff. Records were suitably maintained. Staff had received training in areas such as: First Aid, Moving & Handling etc. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 22 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 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 2 X 1 X X 3 Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 23 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 OP3 Regulation 14(a)(d) Requirement The Provider must not admit anyone to the home unless assessments have been conducted to determine the suitability of the placement and the capacity of the home to meet needs. The Provider must conduct herself in a manner that does not cause distress or anxiety to residents. Staffing levels must be sufficient to allow social needs to be met. The Provider must ensure that the homes complaints procedure is adhered to and all complaints are properly investigated and documented. The Provider must consult with the Registered Manager to agree the parameters of their respective roles and must issue her with a job description stating the hours to be worked and the role and functions of the post. A copy of the job description must be supplied to the Commission for Social Care Inspection. Money held on behalf of DS0000068682.V350144.R01.S.doc Timescale for action 05/12/07 2 OP12 7(1) 05/12/07 05/12/07 3 4 OP12 OP16 16(2)(m) 22 05/12/07 5 OP32 12(5)(a) 07/01/08 6 OP35 16(l) Acorn House Residential Home Version 5.2 Page 24 7 OP29 19 Sch 2 residents must be kept in 05/12/07 individually named accounts. The Provider must not employ anyone to work at the care home unless two suitable references 05/12/07 have been received and a satisfactory enhanced Criminal Records Bureau check has been received. 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 Refer to Standard OP7 OP10 OP7 Good Practice Recommendations Risk assessments would benefit from further development to ensure the management of all identified risk has been properly documented. Consideration should be given to the re-siting of the telephone so that residents can make telephone calls in private. Monthly care plan reviews should specify all areas that have been reviewed. Acorn House Residential Home DS0000068682.V350144.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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