Inspection on 26/04/07 for Acorn House Residential Home Ltd

This inspection was carried out on 26th April 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 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 11/09/06

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 26th April 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 Ltd DS0000066977.V335631.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.V335631.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.V335631.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th October 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 £415 to £465 per week. Contact should be made with the manager for further information. Acorn House Residential Home Ltd DS0000066977.V335631.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 3:30 p.m. During that time the inspector spoke with some residents, the manager and the proprietor, some relatives and staff. Some judgements about the quality of life in the home were taken from observations and conversation. Some records and documents were looked at. In addition a tour of the building was undertaken. Residents and relatives indicated they were generally satisfied with the standards of care in the home. Statements made during the visit included: “The home offers real value for money.” “Acorn House is clean and always very welcoming.” “They really do try to do their best here”. And “The staff are so good to me. I can’t be at home any longer, so this is the next best thing.” The Proprietor, manager and the staff gave their full cooperation throughout the inspection. What the service does well: The home offers the people who live there a clean and homely environment. Residents meetings are arranged at regular intervals to encourage residents to be involved in the daily life of the home. Staff are kind and caring and the manager and proprietor approachable and understanding. Residents enjoy a wholesome and varied menu of meals, with choices available daily. Residents’ visitors are made welcome. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Documentation and records required to meet the demands of regulation must be available in the home for inspection purposes. Further work is required to ensure care plans are held in a secure manner to protect residents’ personal and sensitive information. The home must ensure that all residents have a comfortable environment in which to enjoy their meals and one that does not comprise their welfare. Some work is required in one of the communal bathrooms to ensure infection control procedures can be adequately followed to protect residents from any potential for harm. The home’s formal processes need to be further developed to ensure that procedures designed to secure the welfare of residents are understood and consistently applied in the home. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 7 Although the home notifies the Commission of any circumstance that affects the health, welfare or wellbeing of residents in line with the requirements of regulation, this is not consistently undertaken in a timely manner. Although recent improvements in access to staff training have been made, not all staff can evidence the skills and knowledge required to ensure that a consistent high standard of care is being delivered. Training staff must remain a firm focus for the home. 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 Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 8 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.V335631.R01.S.doc Version 5.2 Page 9 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): 123456 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People accessing this service have up to date information about the home to help them make an informed decision about whether the service is right for them. The people who live in the home are given a written contract/statement of terms and conditions, which clearly tells them what they can expect from the service and the amounts they have to pay. Regulation requires such documents and the amounts paid by or in respect of each resident to be kept in the home to evidence good practice. The personalised needs assessment means that people’s diverse needs are identified and planned before they move to the home and they have been assured that these needs will be met. The home is largely responding to the need for improvement in staff training programmes. Residents will benefit from staff that can evidence they have the knowledge and skill to deliver the service and care the home offers to provide. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home has an up to date Statement of Purpose and a Service User Guide, which provide residents or their representatives with the information they need to make a firm decision about moving to the home. The documents have been revised since the last inspection. The manager stated that the home’s information documents would in future be reviewed annually or more frequently if there were a need. The home’s complaints procedure had also been revised to include details of the timescale within which a complaint would be investigated, as required in the last inspection report. The complaints procedure benefits from a brief statement that informs residents or their representatives that the Commission can be involved at any stage of a complaint and not just as a final resort. The requirement awarded at the last inspection in relation to improvements necessary to the home’s information documents has been met. 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 and Provider stated that each resident or their representative was provided with a written contract or statement of terms and conditions between the home and themselves at the point of moving in. Although a blank contract template was provided, no actual contracts illustrating a record of the fees charged in respect of each resident were available for inspection in the home on the day of the site visit. The Provider retains these documents at his home address. Regulation requires such documentation to be available for inspection. This requirement remains outstanding from the last inspection. Although it was clear on this inspection that access to training for staff is improving, records evidence that staff have not received all the elements of mandatory training. This issue continues from previous inspection reports. The manager continues to work towards 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.V335631.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It is clear improvements have been made to the formulation, content and review of residents care plans. Further work is required to ensure they are held in a secure manner to protect residents’ personal and sensitive information. People who live in the home are now better protected by the home’s polices and procedures for dealing with medicines. Staff who administer medication or have responsibity for medication administration in the home must all receive appropriate levels of medication training to avoid any risks to the welfare of residents. EVIDENCE: All residents had a care plan. Some were inspected in detail. It was clear on this inspection that improvements have been made to the formulation, content and review of residents care plans. Documents seen had been signed by the Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 12 resident or their representative to show their involvement in and agreement to the plan of care. Staff demonstrated a sound understanding of residents needs. Up to date care plans are now readily available to staff for guidance, which ensure they know exactly how to care for the person. Residents’ daily monitoring records were being adequately maintained and although the amount of detail in entries is not always consistent and remains dependent on the skill and knowledge of the staff member completing the record. Daily records did show clear improvement and sufficiently evidenced that staff are following the assessment of a residents needs and the demands of their care plan. Risk assessments were completed for each resident where necessary. They recorded desired outcomes and identified levels of risk involved. Their content had been further developed to illustrate actions staff needed to take to eliminate or reduce the risk to individuals. Since the last inspection residents’ care plans and daily monitoring records were being maintained separately in the home in accordance with Regulation. They are accessible to the person to whom they relate and would now be in a form that facilitates this. They are stored on open shelves in the staff rest room due to pressure on space to accommodate them elsewhere. The room is not kept locked and leads onto a main corridor. The home is reminded that all sensitive personal documentation should be kept securely in the home. 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 and the Community Nursing Team would support and treat them. Not all care plans evidenced weight monitoring records for residents. The manager states the home has access to ‘stand on’ scales only. Not all residents are able to weight bear. A recommendation was made at the last inspection for the home to have suitable facilities to weigh residents as the standards demand. This recommendation will be made again on this inspection. At the last inspection staffing levels and the home’s written policies and procedures did not always allow residents to choose when they showered or bathed. A bath rota was operated which generally determined when this took place for people in the home. The manager stated that procedures have now been revised to ensure bathing takes place at the resident’s request where practicable and in line with their care plan. The manager has recruited to all vacant staff posts. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 13 Following the last key inspection, the Pharmacist Inspector also visited unannounced and inspected the medication administration procedures. Additional requirements for improvement in some areas of medication administration were awarded on this visit. As a result the home has made significant changes in the way they handle residents medication administration. Medication received into the home is now clearly recorded. Medication records inspected were up to date and evidenced no obvious gaps in recording. The manager checks their comprehensiveness regularly. The home’s written admission procedure has recently been revised and now allows for situations where a new resident coming to live at the home may potentially wish to keep and administer their own medication in line with current good practice guidelines. The manager could evidence a risk assessment the home would use for establishing a resident’s capacity to safely self medicate. The home has a lockable medicines fridge for cold storage of medication and maintains temperature records for this and other medication stored in the medication room. Temperature records seen were on occasions exceeding the upper limit for safe storage. The home is now considering a change of storage area to ensure they maintain optimum temperatures and thus ensure the safety of residents medication held. The home’s medication procedures have been reviewed and revised and the manager has access to good practice guidelines to assist her. The home currently supports some residents who are diabetic in their treatment regimes. Staff who administer medication have now received diabetes training and community nurses are supporting their work to ensure the safety of residents. The home is reminded that they must update the training and evidence regular competency testing for designated medication administrators involved in the care of residents’ treatment regimes. Access to medication training for some staff has improved. Four staff attended a one-day medication administration course in February 2007. The manager stated that more training is booked for May and June 2007. It was advised that a more in-depth training is required for the manager and senior staff that have responsibity for the supervision of medication administration procedures in the home. This will ensure medication and health care practice offered by the home remains up to date and is safe for the people who live there. 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. Relatives spoken with were largely satisfied with the level of care the home offers. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a 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 have been reviewed and now ensure residents’ rights and choices are better promoted. Opportunities for residents to participate in meaningful social activities are arranged and family and friends are welcomed at the home. Meals in the home are varied, wholesome and offer people choice. Residents would further benefit from the planned improvements being made to the dining room to ensure they can enjoy their meal in comfort during hot weather and it is a pleasurable and safe environment for them to use at all other times. EVIDENCE: The atmosphere within the home was relaxed and pleasant, with residents seen to be interacting and involved in conversation with one another and their visitors. There was positive and supportive interaction and conversation observed between residents and staff. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 15 Since the last inspection the manager has spoken with residents about daily activities. Some significant changes have been made. There are now craft sessions offered every other Tuesday. A member of staff has dedicated time to offer these activities. The home has also arranged outside entertainers to visit on occasions. Events were organised at Christmas and again at Easter. There is ‘prize’ Bingo offered every Thursday, which residents mentioned they enjoyed. There are quizzes held every other Friday. The ‘Pat Dog’ service visits the resident group regularly. Religious services are held; some residents spoke of these and enjoyed the people from the local Church visiting them. Care staff offers residents manicure sessions weekly on a Monday. Residents felt they could approach staff easily should an issue of concern arise or they wished to express their view. Residents meetings are held every three months and time permitting a newsletter is formulated which includes information relating to the home’s activities programme. The home offers a library service and regular exchange of books by Kent County Council Libraries Service. The manager stated that she has recently arranged for a clothes vendor to visit the home so that people can make purchases if they wish. There is a pleasant garden with tables and chairs laid out at the rear of the premises to which residents and their visitors have full access. Most residents spoken with were generally happy with the flexibility the home offered in regard to meeting personal preferences where practicable. Written policies and procedures have been reviewed by the manager to ensure the home’s routines of daily living ensure residents’ rights and choices are promoted. For example, at the last inspection a bath rota was operated which generally determined when residents could have a bath or shower. Procedures have now been revised to ensure bathing takes place at the resident’s request where practicable and in line with their care plan. Residents’ 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. Food was considered to be important and meal times a social occasion. Breakfast is taken to resident’s bedrooms on trays with the two other main meals of the day served in the home’s dining room. 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 always offered at the main meal. 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. On the previous inspection concerns were expressed by some residents that meal times can be very uncomfortable when the sun is shining directly above them. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 16 The situation has the potential to spoil the enjoyment of the meal offered and compromise their welfare. On this inspection there had been no changes to the layout of the residents dining area. The provider however has stated his intention to the Commission of arranging for a new conservatory to replace the existing build. It is intended that ceiling blinds and fans will be provided in the new build to avoid the discomfort currently experienced by some residents when the weather is hot. Until this change takes place, dining tables are regularly moved to the small communal living space at the front of the house when the weather is particularly warm and sunny. Residents most affected by the heat are asked if they would prefer to have their meal in there. The Requirement from the last inspection will remain on this report until the completed work has been evidenced. It is acknowledged that the home is mow managing this situation better and to the benefit of people who live in the home. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home feel safe and listened to. The home’s formal processes however need to be further developed to ensure that procedures are understood and consistently applied in the home and to ensure that other agencies involved with the care of residents are informed of situations that affect their welfare in a timely manner. EVIDENCE: The home’s complaints procedure had been revised to include details of the timescale within which a complaint would be investigated, as required in the last inspection report. The procedure benefits from a brief statement that informs residents or their representatives that the Commission can be involved at any stage of a complaint and not just as a final resort and uses the regulators correct title to avoid confusion for people who live in the home or their representatives. The requirement awarded at the last inspection in relation to the home’s complaints procedure has been met. Pre inspection information provided to the inspector shows no formal complaints or concerns have been raised with the home since the last inspection. The home’s manager has received no training on dealing with complaints and currently the provider deals with any formal complaint issues raised. The manager remains the first point of contact for residents however and people spoken with in the home found her and the staff helpful and easy Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 18 to approach if they had a concern. All said they felt safe and secure in the home. Six further staff had received one day adult protection training in November 2006 making a total figure of thirteen out of seventeen care staff in the home that are now trained. Another four are booked to attend training this year. The manager stated her intention of ensuring that all staff receives this mandatory training in line with the demands of Regulation. The home’s policies in relation to adult protection have benefited from review and updating in line with legislation and guidance. The review date for the documents provided to the Commission was September 2006. Since the last inspection the home has notified the Commission of events affecting the welfare of residents, as regulation requires. A recent notification was discussed with the provider and the manager. A delay of five days had elapsed between the accident occurring and the home’s notification to the Commission. As a result the inspector requires the home to revisit their policy on accidents to service users and their procedures for staff to take in relation to when they access the emergency services and when they notify other agencies who are also involved in the welfare and safeguarding needs of residents. It is important that the home does not make clinical decisions as to someone’s condition following an accident; they are not medically qualified to do so. As Acorn House is a residential home it is prudent to access sound medical opinion to secure and safeguard residents welfare. This is especially important as records show that only four staff have a current first aid certificate. The Registered Manager has previously been trained in first aid but her certificate has now expired. The manager has secured seven places on a first aid training course scheduled for June 2007. It is recommended that she attend this course to update her skills. The home is also reminded to ensure that they alert other agencies in a timely manner of any situation that compromises the welfare of a resident. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 19 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): 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 being made to the dining room and the safeguarding of all hot surfaces in the home. EVIDENCE: Acorn House offers the people who live in there a largely comfortable and homely environment with a choice of communal space. There is a large lounge with a 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 and their visitors have access. The residents’ dining room is part conservatory and has a half glazed roof. On the previous inspection concerns were expressed by some residents that meal Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 20 times can be very uncomfortable when the sun is shining directly above them. The situation has the potential to spoil the enjoyment of the meal offered and may compromise their welfare. On this inspection there had been no changes to the layout of the residents dining area. The provider however has stated his intention to the Commission of arranging for a new conservatory to replace the existing build. It is intended that ceiling blinds and fans will be provided in the new build to avoid the discomfort currently experienced by some residents when the weather is hot. Until this change takes place, dining tables are regularly moved to the small communal living space at the front of the house when the weather is particularly warm and sunny. Residents most affected by the heat are asked if they would prefer to have their meal in there. The Requirement from the last inspection will remain on this report until the completed work has been evidenced. It is acknowledged that the home is mow managing this situation better and to the benefit of people who live in the home. The home’s mobile hoist is stored in the residents dining area. The manager stated that storage is limited in the home. Some wheelchairs are stored under the stairs. The home is reminded that storage should be provided for the home’s equipment. Stored items should not encroach on residents’ communal space. 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 are serviced regularly and in good order. It was noted that the residents’ communal bathroom on the top landing has tiles that are broken, chipped and some that were missing; leaving gaps in what should be an impervious finish. The bath strip is in poor condition around the bath and soggy wood is in evidence beneath. These items require repair, as it is difficult to clean the area adequately. The current conditions compromise effective infection control procedures. The bars of soap seen in communal bathrooms and toilets on the last inspection, which if accessed by a number of individuals may compromise the home’s infection control procedures, were not in evidence on this visit. The home provides liquid soap and paper towels in all communal toilets and bathrooms. Residents’ bedrooms offered fairly comfortable accommodation and were personalised to reflect the taste and interests of the people who lived there. Individuals said they liked their bedrooms. Some rooms inspected were looking very tired and would benefit from some refurbishment and redecoration. It was noted that radiators in residents bedrooms are not guarded and not of a guaranteed low temperature surface type. The home has undertaken Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 21 environmental risk assessments for residents where the surface temperature does present a risk. The inspector is still of the opinion that residents who are increasingly frail upon admission and at risk of falls are having their safety compromised unnecessarily. Residents in this home stated that they choose to spend time alone in their rooms and staffing levels are known to be reduced in the evenings and at night, this potential risk to peoples welfare when they are not being supervised by staff should be eliminated by the provision of radiators guards in all areas accessed by residents. Chemicals were stored appropriately on this visit and the home has safety information in the form of ‘safety data sheets’ in place. COSHH procedures in the home are covered on staff induction by the manager but the home’s records evidence that no staff have received formal training. This will be included in the staff training requirements in this report Residents can have a 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 lounge area and some corridors have been decorated recently. The home could not evidence a written programme of routine maintenance or renewal to the home’s fabric. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is adequate This judgement has been made using available evidence including a site visit to this service. The provider and the manager have plans to further improve access to training to ensure staff have all the skills necessary to deliver the care the home offers to provide. This capacity to improve should result in better outcomes for people using the service. EVIDENCE: At the last inspection the manager was experiencing some difficulty recruiting sufficient staff to cover the home’s duty rosters. The manager has now overcome these constraints and was able to evidence a permanent and stable staff team on this visit. The home does not use agency staff, which is to the benefit of residents and provides them with continuity of care from people they know and trust. Vacant hours on the rosters are covered by the manager or staff undertaking additional hours when necessary. The manager continues to work closely with her staff and works ‘hands on’ whenever this is required. The manager and staff were seen to take their responsibilities to residents seriously and concentrated on making sure residents received the attention they required. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 23 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 the staff’s current staff training/ qualification certificates are now on view around the office wall. Photos of staff would improve the content of staff files inspected. The manager stated that this work is in hand. 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 staff are undertaking the formal induction and foundation training which is required for all new care staff within the first six months of employment. A significant improvement was noted in staff’s access to training courses although there is still some distance to go. The manager has a simplistic training matrix for staff. Improvements could be made to the document. It needs to record staff training completed with dates. Training planned for individuals with scheduled dates and also needs to record when an individual’s mandatory updates are due. This would provide for a better and more informative overview of staff training needs and provide the manager with an effective planning tool. Most of the training undertaken or booked was of the one-day type. This can be sufficient for some mandatory types of training in a residential home but there needs to be more in-depth training for some members of staff. For example, those individuals who have responsibity for medication administration and those who need to be qualified first aiders. The home is reminded that there should be at least one first aider on duty at all times in the home to secure residents welfare. This is currently not the case on all occasions. Some areas of staff training still require further improvement, including some mandatory training to ensure residents basic needs are met, such as Adult Protection, Manual Handling, Health and Safety, Basic Food Hygiene and COSHH procedures. The manager and provider are considering training one of the senior carers to be a ‘trained trainer’ in moving and handling techniques. This would enable the home’s staff to be trained ‘in house’ and would provide for a consistent monitoring presence to reinforce good practice. Data provided by the manager showed that the home continues to train and encourage staff to achieve NVQ qualifications in care at Levels 2 and 3. Currently the home is just below the 50 required standard, but a couple of staff are due to complete their qualification at level 2 and 3 soon. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 24 The home operates a daytime roster pattern of 8am – 4pm with 3 carers plus the manager on duty weekdays. A 4-10pm shift with two carers on duty and a night shift, which covers 10pm –8 am, with two carers on duty. Because of concerns raised at previous inspections that there may not be sufficient staff on duty at certain times to secure residents welfare, the provider undertook a risk assessment, the results of which were provided to the Commission. This shows that additional staff can be made available at particularly busy times and can be contacted for work at short notice if there is an emergency situation that arises. Records were evidenced on this inspection of occasions when this had happened to secure residents welfare. The situation will continue to be monitored at future inspections and the provider is recommended to keep staffing under review. During observation on the day of the site visit there was every indication that staff try there hardest to meet service users needs efficiently and effectively. Residents spoken with praised staff for their kindness and care. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 25 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 33 35 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Provider and Manager are largely responding to the need for improvements to be made to the service. The home’s policy and procedure documents have been reviewed to ensure residents’ rights and best interests are safeguard. Some specific safe working practices require further development. The manager has plans to further improve staff training and meet the standards required in relation to offering formal staff supervision six times a year. This capacity to improve should result in better outcomes for people using the service and ensure that staff have the necessary skills to meet their needs. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager is qualified and gaining additional experience in Regulation and the standards required of residential homes. The home has had an improvement plan in place since the last inspection, which has been agreed with and monitored by the Commission. The manager and provider have insight into specific areas of the service that require improvement and clear progress is now being made. The manager continues on occasions to spend time working ‘hands on’. 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 time however her office-based work sometimes suffers as a consequence. She finds it understandably difficult to manage and evidence all that is required of her. The home has no other administrative support although the provider undertakes some administrative tasks himself and visits the home regularly to support her. The manager has recently increased her hours and now works five days a week. Residents meetings are held every three months and items discussed recorded. The home has received no complaints and has no record of any concerns risen by stakeholders in the service. The Provider undertakes an annual survey of residents, staff and relatives regarding their views about the service. Responses are not collated in a form that can be shared and the Commission has not been informed of the results of these quality assurance exercises. Staff records largely complied with regulation. Some improvements could be made to the administration of files and the availability of staff photos. The manager has this work in hand. Evidence was seen that access to formal supervision has improved for staff. The content of supervision notes seen were constructive, well-recorded and identified staff training needs. The manager complains of having little free time to undertake formal staff supervision to the standard required of six sessions a year for each staff member. She is currently considering different approaches to satisfy the standard. Some supervision sessions need to include competency checks for medication administrators. The manager receives a formal annual appraisal with the owner. The owner visits the home quite regularly but his 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 on numerous previous occasions. He has now informed the Commission that formal visits will be undertaken in line with the home’s improvement plan. This is good practice and evidences that Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 27 effective quality assurance and quality monitoring systems are in place in the home, which add to the provider’s annual quality assessment. The home encourages 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 some responsibility, which facilitated ease of monitoring. The home’s Policies and Procedures have been reviewed since the last inspection to ensure they meet with good practice guidelines and the demands of current regulation. Their next review has been diarised. Some further work needs to be undertaken with the home’s Accidents to Service Users policy to safeguard resident’s welfare as mentioned elsewhere in the report. Records were seen to be largely kept in a manner that preserved confidentiality. The home must improve the security of residents care plans held in the staff rest room. Some health and safety concerns were highlighted during the visit and discussed with the manager. Some areas of staff training still require further improvement, including mandatory training to ensure residents basic needs are met, such as Adult Protection, Manual Handling, Health and Safety, Basic Food Hygiene, Medication Administration, First Aid, Infection Control measures and COSHH procedures. Although progress has been made since the last inspection, there is need for this to remain a firm focus for the home. A further improvement plan will be required following this inspection. Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 x x x x x 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 2 1 Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 29 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. Standard OP2 Regulation 17 (3) (b) Requirement Service users contracts/terms and conditions of accommodation must be available in the home for inspection and illustrate a record of the fees charged in respect of each person. (Timescale of 23/10/06 not met) An improvement plan detailing how the service will address this will be required within the timescale indicated Staff must individually and collectively have the skills and experience to deliver the services and care the home offers to provide. Staff must be appropriately trained in: • Adult Protection • Moving & Handling • Health & Safety to include COSHH requirements • Infection Control • Risk Assessment • Basic Food Hygiene • Fire safety DS0000066977.V335631.R01.S.doc Timescale for action 02/07/07 2. OP4 OP18 OP27 OP30 OP38 18 (1) (a) (c ) (i) 02/07/07 Acorn House Residential Home Ltd Version 5.2 Page 30 (Timescale of 23/10/06 partly met) An improvement plan detailing how the service will address this will be required within the timescale indicated Care Plans must be kept securely 02/07/07 in the home to protect service users personal information. An improvement plan detailing how the service will address this will be required within the timescale indicated Staff must be trained to 02/07/07 administer medication to residents and must be regularly assessed for their ongoing competency to do so safely. Records of medication administrators’ competency tests must be maintained in the home. (Timescale of 23/10/06 partly met) An improvement plan detailing how the service will address this will be required within the timescale indicated 5 OP15 23 The glazed section of the service 02/07/07 users dining room must be replaced or the room made fit for the purposes for which it is used. An improvement plan detailing how the service will address this will be required within the timescale indicated A record of complaints and 02/07/07 concerns made by service users, their relatives, representatives or staff must be maintained in the home and show the actions taken by the registered person. DS0000066977.V335631.R01.S.doc Version 5.2 Page 31 3. OP7 17 (1) (b) 4. OP9OP30O P38 13(2) 18(1)(a) 6 OP16 17 (2) Schedule 4 (11) Acorn House Residential Home Ltd (Timescale of 23/10/06 not met) An improvement plan detailing how the service will address this will be required within the timescale indicated. The damaged tiles in the bathroom and the bath seal must be replaced and made good within the timescale given if not sooner. The Registered Provider must visit unannounced once a month and prepare a written report on the conduct of the home. Sending a copy of the report to the CSCI and the manager. (Timescale of 23/10/06 not met) An improvement plan detailing how the service will address this will be required within the timescale indicated. 9 OP36 18 (2) The Registered person must ensure care staff receives formal supervision at least six times a year and records are kept of planned meetings. An improvement plan detailing how the service will address this will be required within the timescale indicated. The home’s procedures must be revised to ensure that staff have clear guidance for dealing with accidents to service users. An improvement plan detailing how the service will address this will be required within the timescale indicated. Suitable arrangements must be made for staff to be trained in First Aid. DS0000066977.V335631.R01.S.doc 7. OP 26OP38 13 (3) 01/06/07 8 OP33 26 02/07/07 02/07/07 10 OP33 OP38 12 1 (a) 02/07/07 11. OP38 13 (4) (c) 02/07/07 Acorn House Residential Home Ltd Version 5.2 Page 32 An improvement plan detailing how the service will address this will be required 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 OP19 OP22 OP25 Good Practice Recommendations The registered person should provide suitable facilities to weigh all service users in their care. The registered person should produce a written programme of routine maintenance and plans for renewal of the fabric and decoration of the premises. The registered person should ensure that suitable provision is made for storage of the home’s equipment that does not encroach on residents’ communal space. The registered person should ensure that pipe work and radiators are guarded in areas of the home to which service users have access to avoid unnecessary risks to their safety. The staffing arrangements for the evening shift should be kept under review to ensure that sufficient staff are deployed to meet the needs of the people who use the service. Staff files should contain a recent photograph of the employee. The registered person should develop a training matrix, which provides a clear and comprehensive overview of staff training needs. The registered person should ensure that they notify the Commission without delay of any event in the home that adversely affects the well being or welfare of a service user. 5 OP27 6 7 8 OP29 OP30 OP37 Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Acorn House Residential Home Ltd DS0000066977.V335631.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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