Inspection on 11/09/06 for Acorn House Residential Home Ltd

This inspection was carried out on 11th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 Residential Home Ltd 29/04/08

Acorn House Residential Home Ltd 26/04/07

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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 Ltd 39 Maidstone Road Chatham Kent ME4 6DP Lead Inspector Marion Weller Key Unannounced Inspection 11th September 2006 9:30 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 Ltd DS0000066977.V311519.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 Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acorn House Residential Home Ltd Address 39 Maidstone Road Chatham Kent ME4 6DP 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) 01634 848469 01634 813889 Acorn House Residential Home Limited Mrs Susan Kim Attaway Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2006 Brief Description of the Service: Acorn House is within easy reach of Chatham town centre; the home is located on a main road with bus stops a short walk away. There are local shops, surgeries, churches etc. within the local vicinity. The home occupies detached premises with accommodation arranged over two floors. All the bedrooms currently offer single accommodation; one of the bedrooms can be converted for occupation by two people if this required; fourteen of the bedrooms offer en-suite facilities. There are call bells and television points in each bedroom; some bedrooms also have a telephone point fitted. There are two allocated parking bays adjacent to the building. A manager is employed at the home that has day-to-day control. The manager works closely with the Proprietor whom visits the home regularly and maintains frequent contact. Current fees range from £395 to £445 per week. Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Marion Weller, Regulatory Inspector who was in Acorn House form 9:30 a.m. until 3 :00 p.m. During that time the inspector spoke with some residents, the manager and some staff. Parts of the home, some records and documents were inspected and care practices observed. Some comment cards were received prior to the inspection. Responses received from residents and relatives indicated they were generally satisfied with the standards of care in the home. Statements on comment cards included: • • • • “Glad to say the cleaners and staff do a good job” “Sometimes they are very busy, but always sort things out.” “Just now and again something goes awry, but mostly all is well” “Staff don’t always listen and act on what I say.” The manager and the staff gave their full cooperation throughout the inspection. What the service does well: What has improved since the last inspection? Staff recruitment has been ongoing to ensure continuity of care for residents. Some progress has been made in accessing staff mandatory training and the implementation of staff supervision and appraisal practices to ensure residents are in safe hands at all times. Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 6 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 Residential Home Ltd DS0000066977.V311519.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 Ltd DS0000066977.V311519.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2.3.4.5.6. Quality in this outcome is adequate. This judgement has been made using available evidence including a site visit to this service. People using this service have most of the information about the home they need to make an informed decision about whether the service is right for them. Residents would benefit further from information that is kept up to date for them to base their decisions upon. The personalised needs assessment means that people’s diverse needs are identified and planned before they move to the home. Residents cannot be confident that their needs can be fully met at all times. Not all staff evidence they have the skills, knowledge and experience to deliver the services and care the home offers to provide. EVIDENCE: The home has a Statement of Purpose and a Service Users Guide, which is incorporated into the information provided to residents before they move in. Although descriptive of the aims, objectives and philosophy of care, services, Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 9 facilities and terms and conditions of Acorn House. Some documents were dated 18/9/2003 and now require review and revision to ensure that the most up to date information is available to current and prospective residents. The complaints procedure mentions the name of a previous manager and also speaks of the National Care Standards Commission, which was replaced by the Commission for Social Care Inspection. Current information has the potential to cause confusion. The manager visits prospective residents prior to admission to make a decision as to whether the home could meet the person’s needs. Information was seen to have been obtained from other parties, including relevant health care professionals to assist in assessments. The manager was able to demonstrate a clear understanding of the category and needs of residents the home could meet. Residents spoke of themselves or their representatives having the opportunity to visit the home to see if it was suitable for them before moving in. The manager stated that each resident or their representative was provided with a written contract between the home and themselves at the point of moving in. The contract should clearly state the fees payable and by whom and the responsibilities of the organisation and the rights of the resident. No contracts were available for inspection in the home on the day of the site visit. Although access to training for staff is improving, records evidence that not all staff have received all the required training. This issue continues from previous inspection reports. The manager continues to work towards recruiting a permanent staff team and securing sufficient training to ensure that staff individually and collectively have the skills and experience to deliver the services and care the home offers to provide. Intermediate Care is not offered at Acorn House. Acorn House Residential Home Ltd DS0000066977.V311519.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a site visit to this service. The variable practice regarding the planning and delivery of care means service users cannot be sure that their health and personal needs will be met. Poorly completed medication records, staff knowledge and systems of work put service users at potential risk of harm. EVIDENCE: All residents had a care plan. Some were inspected in detail. Although it was clear efforts were being made to improve care planning and some staff had received a one-day training course since the last inspection, they were not adequate in regard to the detail and consistency of information in some parts. Those seen had not been formally reviewed on a monthly basis and had not been signed by the resident or their representative to show their involvement in and agreement to the plan. Some staff demonstrated a sound understanding of residents’ needs and were able to fill in gaps in information. However it is necessary that current information is recorded and readily available to all staff for them to be able to meet residents’ needs, especially as Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 11 the home continues to suffer from rota staffing difficulties and there have been some new staff recruited. Residents’ daily monitoring records were being maintained. Evidence was seen of an entry that recorded ‘all care given’ which is not helpful or adequate. Daily records when well written, help senior staff to audit the care provided and ensure that staff are following guidelines given in the care plan. It is in the home’s interests to be able to show what they have done for a resident and provides evidence on which to base reviews and to record they are following the assessment of a residents needs. The amount of detail in entries is inconsistent and dependent on the staff member completing the record. Records did not always stipulate the time the report was completed and the time events took place or care was provided. Simplistic risk assessments were completed for each resident. Assessments made recorded outcomes and identified levels of risk but not the actions to be taken by staff to eliminate or reduce the risk, neither did they establish safe systems of work to inform and guide the work of staff. Residents’ individual care plans and daily monitoring records are not maintained separately in accordance with regulation. They need to be accessible to the person to whom they relate and need to be in a form that enables this. Documentation seen confirmed that all residents have access to a GP and visits from other health professionals are arranged and enabled. No residents currently have pressure areas. The manager said that risk assessments and treatment plans would be maintained for the individual if this were the case. Not all care plans evidenced weight monitoring records for residents. The manager states the home has access to stand on scales only. Some files require audit. Information that has been superseded or changed needs to be removed to eliminate confusion and to ensure that files remain current at all times. Staffing levels and the home’s written policies and procedures do not always allow residents to choose when they shower or bath, for example a bath rota is operated which generally determines when this will happen. Medication records whist being up to date evidenced gaps in recording. The home’s written admission process does not encourage residents to keep and administer their own medication in line with current good practice guidelines and the home has no formal process for establishing their capacity to do so. The home has a lockable medicines fridge but maintains no formal temperature records. The home’s medication policy has not been reviewed since 2003 and the manager said she had no access to the Royal Pharmaceutical Guidelines for the Administration and Control of Medicines in Care Homes. The home supports residents who are diabetic in their treatment regimes but have no Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 12 records of training or updates for the home’s thirteen medication administrators to evidence competency in this area. The manager said some staff have received training in the past and some have attended a one-day medication administration course recently. It was advised that more in-depth training is required to ensure medication and health care practice offered by the home is safe for residents. The home has a contract with a local dispensing chemist for support and advice on their medication systems. No record of a recent visit to the home by the Pharmacist could be evidenced. The manager spoke of her intention to arrange this. From observation and discussion with residents it was clear that staff treated residents with respect and promoted their privacy and dignity. Residents said they felt well supported by staff. Some residents survey remarks received prior to the inspection indicated that staff do not always listen or act on what they say. To some degree the manager felt this could be due to the home’s staffing difficulties and recent changes in the staff team. Those individuals spoken with on the day of the visit commented that they were aware of staffing difficulties but it had not affected the overall support that is given to them. Death and dying in the home were handled appropriately. Not all residents’ wishes were recorded but staff were able to give verbal accounts of the arrangements required for individuals. Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Residents find the lifestyle experienced in the home largely matches their expectations and preferences. The home’s routines of daily living would benefit from review to ensure residents’ rights and choices are promoted. Opportunities for residents to participate in social activities within the home and the community have been variable due to inconsistent staffing levels. Residents meals are varied and wholesome and offer choice. Residents would further benefit from making the dining room more pleasurable and comfortable to sit in during hot weather. Residents’ family and friends are welcomed at the home. EVIDENCE: The atmosphere within the home was noted to be relaxed, with residents seen to be interacting and involved in conversation with one another. There was much conversation and positive interaction observed between residents and staff. Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 14 The home offers some afternoon activities in which residents can choose to be involved. Sometimes delivery of such events is affected by staffing levels. The majority of surveys received from residents indicated that activities are available ‘sometimes’ in the home and they would generally like more activities and outings to be arranged. Most residents spoken with were generally happy with the flexibility the home offered in regard to meeting personal preferences where practicable. The home’s written policies and procedures do not always allow residents to choose when they shower or bath, for example a bath rota is operated which generally determines when this will happen. One resident spoke about ‘everyone’ going up to bed after tea. On the day of the visit only two residents were in the lounge. One resident said most people keep to their rooms unless it was a mealtime. The home’s routines of daily living would benefit from review to ensure residents’ rights and choices are promoted. Residents meetings are held every three months and time permitting a residents newsletter is formulated which includes information relating to the activities programme and any changes in the home, including changes to the staff team. Residents felt they could approach staff easily should an issue of concern arise or they wished to express their view. Family and friends felt welcome and knew they could visit the home at any reasonable time. The design of the home provided a small seating are within the communal living area of the home where residents could entertain their visitors in addition to the privacy of their own room. The home encouraged individuals and groups from the community to visit. Food was considered to be highly important and meal times considered a social occasion. Breakfast is taken to individual residents bedrooms on trays with the two other main meals of the day served in the home’s dining room. The home has a cook vacancy, with a careworker cooking on the day of the inspection. The menu plan was seen to be varied, balanced and nutritious. A resident likes and dislikes are taken into consideration and an alternative choice is offered at the main meal. Care plans did not always give a consistent message to staff about some individual’s preferences regarding food. The manager said staff gave assistance to those residents who needed help to eat in a discrete and sensitive manner. The residents’ dining room is part conservatory and has a half glazed roof. One resident expressed concern that meal times can be very uncomfortable when the sun is shining directly above. The situation has the potential to spoil the enjoyment of the meal offered. The home needs to make some changes to achieve a level of comfort during meal times for residents. The home’s two mobile hoists are also stored in the residents dining area. Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 15 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 17 1 8 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Residents feel safe and listened to. However formal processes need to be further developed and updated so that the home’s procedures are available, understood and consistently applied. EVIDENCE: The home has a complaints procedure, which was dated 26/05/02. The document makes reference to a previous manager and mentions the name of the National Care Standards Commission, which was replaced by the Commission for Social Care Inspection. This can cause confusion. The manager stated that no complaints or concerns have been raised with the home and therefore no records are currently maintained. The home’s manager has received no formal training on dealing with complaints and currently the owner of the home would deal with any issues raised. Residents spoken with knew how to complain and who to complain to. All said they felt safe and secure. The manager said residents’ legal rights are protected and they are enabled to participate in the civic process if they wished. Postal votes can be arranged by the home. Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 16 Some staff have now received one day adult protection training. It is vital that all staff receive this training. Adult Protection is included in the induction of new staff although this consists of an ‘in-house’ brief from the manager. Some of the home’s policies in relation to adult protection would benefit from review and updating in line with new legislation and guidance. For example, policy on restraint dated August 1997. Policy on aggression, restraint and abuse dated November 1998. The home’s policy in relation to staff recruitment and the home’s policy regarding the use of volunteers (dated January 1999) makes no mention of obtaining CRB checks. The home currently has no voluntary members of staff. The home does not notify of events affecting the welfare of residents, as regulation requires. CSCI guidance documents were left for the manager to follow and use in future. Money held for residents by the home was managed appropriately. Records kept were inspected, balance checked and counted and found to be in order. Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 17 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 22 23 24 25 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Residents benefit from living in a clean and largely comfortable environment where they are able to access all communal areas. They would further benefit from improvements in the home’s health and safety systems including those for for infection control, and the safeguarding of all hot surfaces. EVIDENCE: The home offers residents a largely comfortable and ‘homely’ environment with a choice of communal space. There is a large lounge with chairs arranged around the edge of the room and a large screen television for residents use. There is a smaller adjacent lounge and a separate dining room, which leads out to the rear garden and to which residents have access. The dining room incorporates a conservatory area with some dining tables and chairs arranged under or near the glazed roof. One resident expressed concern that meal times can be very uncomfortable in the summer when the Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 18 sun is shining directly above. The situation has the potential to spoil individuals’ enjoyment of the meal offered and means that residents do not always have a comfortable environment in which to enjoy their food. The home’s two mobile hoists are also stored in the residents dining area. The manager stated that storage is limited in the home. Some wheelchairs are stored under the stairs. On a tour of the home, the premises were noted to be clean, odour free and pleasant. Domestic staff are employed within the home. A number of the residents’ bedrooms are ensuite and there are two communal bathrooms for residents use with bath hoists. These were serviced regularly and in good order. There were several bars of soap seen in communal bathrooms and toilets, which if accessed by a number of individuals is an infection control issue. The home provides liquid soap and paper towels. The manager undertook to ensure this oversight to good practice ceased forthwith. Residents’ bedrooms offered comfortable accommodation and were highly personalised. Individuals liked their bedrooms. It was noted that radiators in residents bedrooms are not guarded and not of a guaranteed low temperature surface type. The home could not evidence that an environmental risk assessment had been undertaken to identify where the surface temperature does present a risk to residents. Any service user whose sensory capacity to recognise danger from heat should also have this risk detailed in their care documentation. Most chemicals were stored appropriately. However, there were cleaning chemicals seen in communal bathrooms, which could pose a risk to residents and visitors to the home. These were removed by the manager and put away securely when it was pointed out. The manager said she would remind staff to always store these items appropriately. Residents can have the choice of their own personal telephone line installed in their room at market cost to them. There is also a public telephone available for residents use. There is a call system to alert staff to residents needs. The home currently has no written programme of routine maintenance or renewal to the home and parts were looking a little tired. The home’s handyman has left Acorn House employ. Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a site visit to this service. Whilst there is usually sufficient staff on duty during day time and night hours staffing levels must be reviewed during the remaining period to reflect residents individual care needs versus numbers and competencies of staff on duty. Although recent improvements in access to staff training have been made, not all staff has the skills and knowledge required to ensure that a consistent high standard of care is being delivered. EVIDENCE: The home continues to experience difficulty recruiting and building a substantive staff team. The manager stated that there had been a number of staff changes and was holding recruitment interviews on the day of the inspection. The manager said there were three care staff vacancies on the home’s roster, another for a cook and the handyman post was vacant. A member of the care staff was cooking dinner for the residents in the absence of a cook. The manager continues to work closely with staff and works ‘On the floor’ whenever this is required. The manager took her responsibilities to residents seriously and concentrated on making sure all residents received the basic care they need. An entirely admirable attitude but in practice this often takes her away from meeting the responsibilities of her own role. The home does not use agency staff to maintain adequate staffing levels. Vacant hours Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 20 are covered by the manager or the home’s staff undertaking additional hours whenever possible. The home’s recruitment procedure was found to be robust. Applicants are asked to complete an application form, with written references requested and a CRB/POVA check is undertaken before staff are offered employment. A selection of staff files were viewed which evidenced this practice. Staff files contained most of the elements required by regulation. Copies of staff training/qualification certificates and photos of staff would improve the content. Staff are issued with a contract of employment and a job description and are subject to an initial probationary period during which time they follow an induction-training programme. Induction is undertaken ‘in house’. To date no new staff are undertaking the formal induction and foundation training which is required for all new care staff within the first six months of employment. It was noted that there had been some recent improvement to staff access to training courses. The manager has a simplistic training matrix for staff. Improvements could be made to the identification of training needs through formal supervision and appraisal processes. Most of the training recently undertaken was of the one-day ‘awareness’ type. There needs to be more indepth training for some members of staff. For example, those individuals who undertake medication administration in the home. Of which, data provided prior to the inspection identifies, thirteen staff with this responsibity. Some areas of staff training still require improvement, including ‘safeguarding adults’ and mandatory training to ensure residents basic needs are met, such as manual handling and health and safety. Data provided by the manager showed that 33 of the home’s carers have a NVQ qualification in care. It was not evident that staffing levels were adequate at some times of the day. The home operates a daytime pattern of 8am – 4pm with 3 carers plus the manager on duty for four days of the week. A 4-10pm shift with two carers on duty and a nighttime shift, which covers 10pm –8 am with two carers on duty. The two 4-10 pm shift care staff are alone in the home with a potential maximum of twenty residents at any one time and with resident accommodation arranged over two floors. They have between them the responsibility for preparing the teatime meal, carrying out a teatime medication administration round prior to serving the meal and generally attending to the needs of residents as required. This has the potential to be an extremely busy time of day with residents also needing help and supervision to retire during the evening. It will be a requirement that a risk assessment is undertaken in relation to individual residents care needs, maintenance of their choices and preferences in daily living versus numbers and competencies of staff on duty. The completed assessment must be forwarded to the Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 21 Commission. Residents Survey forms received prior to the inspection indicated that there are occasions when staff are ‘sometimes’ not available to meet residents needs. One comment indicated that staff do not always listen and act upon requests for assistance. During observation on the day of the site visit there was every indication that staff try their hardest to meet service users needs efficiently and effectively. However, comments such as those made are entirely understandable with the heavy demands placed upon staff at certain times. Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 22 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 32 33 34 3 5 36 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The management arrangements are largely meeting the needs of the service. However residents are not fully protected. Safe working practices require further development. The home’s policy and procedure documents require review and revision to ensure residents’ rights and best interests are safeguard. The home is beginning to address the training and supervision requirements of its staff have the necessary skills to fully meet the needs of the residents. Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager has completed her NVQ level 4 Registered Managers Award. Throughout the inspection the manager clearly had the residents welfare at heart and demonstrated openness and commendable honesty. Staff and residents feel comfortable in her presence and find her approachable and supportive. Residents spoken with said the manager and staff try hard to be as responsive to their requests as possible, but were always busy. The manager states that due to vacant roster hours she has to spend a lot of time working ‘on the floor.’ It was evident from observation that staff welcome her presence and residents benefit from the practice. Because she works with residents for a proportion of her day, her office-based work suffers as a consequence. The manager currently works four days out of seven. The manager stated that the owner undertakes some administrative tasks and visits the home regularly. Residents meetings are held every three months and items discussed recorded. The home has received no complaints and has no record of any concerns raised by stakeholders in the service. The manger was aware that the owner undertakes an annual survey of residents, staff and relatives regarding their views about the service. However, responses are not collated in a form that can be used by the manager to inform and direct future service planning. The Commission has not been informed of the results either. The manager was currently not aware of the need to develop a continuous selfmonitoring system based on a systematic cycle of planning, action and review. It was her intention to discuss this with the owner. Staff records mainly complied with regulation. Some improvements could be made to the administration of files as mentioned in a previous outcome. Formal staff supervision had been implemented for some staff but not conducted for all and not as regularly as required. The content of supervision notes viewed was constructive, well-recorded and identified staff training needs. The manager receives a formal annual appraisal with the owner. The owner was said to visit regularly but provider visits are not formalised and no written records are maintained of the contact and support between the owner and the manager despite advice being given by a previous Inspector to the home that this should be considered as good practice and evidences that effective quality assurance and quality monitoring systems are in place in the home. The home encouraged residents’ relatives/ representatives to give assistance with the management of their finances. There was sound system for holding and recording residents cash for those individuals for whom the home took Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 24 some responsibility, which facilitated ease of monitoring. A sample balance of money held by the home was checked and was correct. A sample of the home’s policies and procedures were looked at. Some are now out of date and most need to be reviewed and revised to ensure they comply with current legislation and good practice guidelines. Work schedules compiled in January 2003 and meant to provide staff with guidance during the course of a shift also require revision. They need to be checked for terminology used and adherence to good practice requirements. Records were seen to be largely kept in a manner that preserved confidentiality. However, residents’ individual care plans and daily monitoring records are not maintained separately in accordance with regulation. They need to be accessible to the person to whom they relate and need to be in a form that enables this. Some health and safety concerns were highlighted during the visit, not least that all staff must receive appropriate guidance and training in safe practices and this must include the safe administration of medication for the home’s medication administrators, First Aid, Food Hygiene, Risk Assessment, Moving and Handling training, and Fire safety. Diligence needs to be paid to COSHH requirements and infection control procedures. It is noted that the home has made some progress with booking training for staff. Due to the current staffing situation and the ongoing recruitment of new staff, there is need for this to remain a firm focus for the home. Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 25 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 2 2 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 2 2 3 3 3 3 2 2 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 1 3 3 2 2 1 Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 26 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 OP1 OP16 Standard Regulation 6 (a) Requirement The registered person shall keep under review and where appropriate, revise the home’s Statement of Purpose and Service User Guide. In that: The home’s statement of purpose and service users guide must be revised to ensure prospective and existing residents have all the information they need. The contents must be clear, up to date and include a revised complaints procedure with appropriate timescales for response. A copy to be sent to the Commission within 28 days of the revision. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. The Registered Person shall ensure that records are at all times available for inspection within the home by any person DS0000066977.V311519.R01.S.doc Timescale for action 23/10/06 2 OP2 17 (3) (b) 23/10/06 Acorn House Residential Home Ltd Version 5.2 Page 27 authorised by the Commission to enter and inspect them. In that: Service users terms and conditions of accommodation/contracts must be available for inspection and illustrate a record of the fees charged in respect of each service user. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. The Registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that: staff individually and collectively must have the skills and experience to deliver the services and the care the home offers to provide. • The home must ensure that all staff receive Adult Protection training and this element of good care practice is included in induction. All staff to undertake training in safe practices covering Infection Control, Risk Assessment, First Aid, Food Hygiene, Health and Safety, Moving and Version 5.2 Page 28 3 OP4 OP18 OP27OP30 OP38 18 (1) (a) 23/10/06 • Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Handling and Fire Safety. COSHH Requirements. (Previous timescale of 01/03/06 partly met.) An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. The Registered person shall prepare a written plan as to how the resident’s needs in respect of their health and welfare are to be met and keep the plan under review. In that; Care plans must be more comprehensive, accurate and illustrate consistency of information. The service user or their representative must be included in their formulation and they must be signed. They must be regularly reviewed and revised with the service users or their representative’s involvement. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 5 OP7 17 (1) (b) The Registered Person shall ensure that care plans are kept securely within the home. In that: Residents’ individual care plans and daily monitoring records are not maintained separately in accordance with regulation. They need to be accessible to the person to whom they relate and need to be in a form that enables this. An improvement plan detailing DS0000066977.V311519.R01.S.doc 4 OP7 15 23/10/06 23/10/06 Acorn House Residential Home Ltd Version 5.2 Page 29 6 OP9 OP30 13(2) 18 1(a) how the service will address this must be forwarded to the Commission within the timescale indicated. The Registered Person shall make arrangements for the recording, handling, safe administration and disposal of medicines received in the care home. In that: • The home’s medication policy and procedures must be revised and updated to ensure that medicines in the custody of the home are handled according to the requirements of The Medicines Act 1968, guidelines from the Royal Pharmaceutical Society, ‘Administration and Control of Medicines in Care Home’s’, The Misuse of Drugs Act 1971. • Staff must adhere to the home’s policy and procedures for the safe administration of medicines. Staff must be suitably trained to administer medication. Staff must be assessed for competency with regard to the administration of medication. Service users are able to take responsibity for their own medication if they wish within a risk assessment framework and the home must have a formal process for establishing service users 23/10/06 • • • Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 30 7 OP15 23 (2) (a) capacity to do so. Medication administration records must be comprehensively maintained. • Written temperature records for the correct storage of medicines in the home must be maintained. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. The Registered Person shall, 23/10/06 having regard to the number and needs of service users ensure that the design and layout of the premises meets the needs of service users. In that: The home needs to make some changes to the layout of the dining room to ensure residents’ meals are taken in a congenial setting where all residents can achieve a level of comfort away from the severity of the sun. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. • 23/10/06 The registered person shall maintain in the care home a record of all complaints made by service users or representatives or relatives of service users or by persons working at the care home about the operation of the care home and the action taken by the registered person in respect of any such complaint. All such records must be kept in the care home by the given date if not sooner 8 OP16 17 (2) Schedule 4 Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 31 An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 9 OP25 13 (4) (a) (c) The Registered Person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety and any activities in which service users participate are so far as reasonably practicable free from avoidable risks. Unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. In that: Radiators in residents bedrooms are not guarded and not of a guaranteed low temperature surface type. A risk assessment must be undertaken to identify where the surface temperature does present a risk to residents and these radiators must be replaced or guarded. Any service user whose sensory capacity to recognise danger from heat should also have this risk detailed in their care documentation. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. The Registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably DS0000066977.V311519.R01.S.doc 23/10/06 10 OP27 18 (1) (a) 23/10/06 Acorn House Residential Home Ltd Version 5.2 Page 32 qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that: a risk assessment is to be undertaken in relation to individual residents care needs, maintenance of their choices and preferences in daily living versus numbers and competencies of staff on duty between the hours of 4pm-10pm. The risk assessment, the methodology used and the outcome are to be forwarded to the Commission. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated 11 OP33 12 1(a) The registered Person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. In that: The home’s policies and procedures must be reviewed and revised to ensure they comply with current legislation and good practice guidelines and kept under review thereafter. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 12 OP33 26 (1) (3) (4) (5) The Registered Provider must visit the home once a month and this must be unannounced. This DS0000066977.V311519.R01.S.doc 23/10/06 23/10/06 Acorn House Residential Home Ltd Version 5.2 Page 33 (a) (b) must include interviews, with consent, of residents, their representatives and staff in order to form an opinion of the standard of care provided; inspection of the premises, its records of events and complaints; and prepare a written report on the conduct of the home. The Registered Person must supply a copy of the report to the CSCI and the Registered Manager. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 13 OP36 OP37 18 (2) The Registered Person shall ensure that people working at the home are appropriately supervised, including for the duration of a new workers induction. In that: members of staff must be provided with formal supervision at least six times a year and records of such meetings maintained. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 23/10/06 14 OP38 37 (1) (a)-(g), (2) The Registered Person shall notify the Commission without delay of the occurrence of – any event in the care home, which adversely affects the well being, or safety of any service user. In that: The home must notify as 23/10/06 Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 34 above. To date no notifications have been received by the CSCI. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 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 Refer to Standard OP8 OP8 OP7 OP12 OP14 Good Practice Recommendations It is strongly recommended that the home provide suitable facilities to weigh service users whether they are weight bearing or not. It is strongly recommended that all risk assessments should include the action needed in order to reduce the risk and provide safe systems of work for staff to follow. It is recommended that the home review the activities offered to residents both within and outside the home, in order to ensure that these are sufficiently regular and appropriate to individuals needs. It is strongly recommended that the home’s routines and working schedules are reviewed to ensure residents rights and choices are promoted. In particular the current use of a residents bath rota, which determines when bathing happens in the home. It is recommended that the home produce a written programme of routine maintenance and renewal of the fabric and decoration of the premises. Copy should be sent to CSCI upon completion and included in the home’s improvement plan. It is strongly recommended that storage areas be provided for aids and equipment, including wheelchairs that does not impinge on residents’ communal living areas or is potentially detrimental to their safety. The home should seek the Fire Officers advice as to the current practice of storing wheelchairs under stairs, which provide safe egress from the building. It is strongly recommended that the manager fulfil the stated intention of ensuring infection control procedures are known to all staff and are adhered to in the home. DS0000066977.V311519.R01.S.doc Version 5.2 Page 35 5 OP19 6 OP22 7 OP26 Acorn House Residential Home Ltd 8 9 10 11 OP28 OP28 OP30 OP33 It is strongly recommended that the home continue in its efforts to achieve a minimum ratio of 50 of staff trained to NVQ level 2. It is recommended that staff files should contain copies of staff qualification certificates gained and a recent photograph. It is strongly recommended that the manager complete their stated intention to further develop the home’s training matrix, which provides a ready and clear overview of staff training needs. It is recommended that effective quality assurance and monitoring systems based on a systematic cycle of planning-action-review are introduced. Acorn House Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Residential Home Ltd DS0000066977.V311519.R01.S.doc Version 5.2 Page 37 - 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. 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