Inspection on 29/04/08 for Acorn House Residential Home Ltd

This inspection was carried out on 29th April 2008.

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 26/04/07

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 Sue McGrath Unannounced Inspection 29th April 2008 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.V361253.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.V361253.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.V361253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th April 2007 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 £455 per week. Contact should be made with the manager for further information. Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate, quality outcomes. This was a Key Unannounced inspection that took place in accordance with the Inspecting for Better Lives (IBL) process. Key inspections are aimed at making sure that the individual services are meeting the standards and that the outcomes are promoting the best interests of the people living in the home. The IBL process for a Key inspection involves a pre-inspection assessment of service information obtained from a variety of sources including an annual selfassessment and surveys. It is now a legal requirement for services to complete and return an Annual Quality Assurance Assessment (AQAA). This assessment is aimed at looking at how services are performing and achieving outcomes for people. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable The Commission for Social Care Inspection (CSCI) to be able to make an informed decision about each outcome area. Further information can be found on the CSCI website with regards to the IBL process including information on KLORA’s and AQAA’s. The actual site visit to the service was carried out over one day by one inspector, who was in the home from approximately 09:30 until 16:00. The main focus of the visit was to review any improvements made since the last visit and the well-being of the service users. Time was spent touring the building, talking to people living in the home, talking to staff and reviewing a selection of assessments, service user plans, medication records, menus, staff files and other relevant documents. Prior to the site visit the AQAA had been returned. At all times the manager and staff were helpful and demonstrated a pro-active approach to ensuring that service users were being supported to the best of their abilities and resources. This report contains evidence and judgements made from observation, conversation and records. Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The provider and staff have worked hard to comply with the requirements made at the last inspection. Several improvements have been made to the internal environment since the last inspection and these include the main corridors and both lounges being decorated. The conservatory has been replaced and new ceiling blinds have been installed. Carpets in seven bedrooms have been replaced. The same rooms have been redecorated. The kitchen has new cupboards and the tiles have been re grouted. The ceiling has also been painted. One of the bathrooms has had some tiles replaced and a new bath seal has been fitted. Contracts have been supplied to the private residents to ensure they are fully aware of the terms and condition within the home. Care plans are now stored more securely. Some areas of the medication administration have improved but progress does need to continue in all areas of administration. The home is now keeping better records of any complaints and the owner has started to respond to residents and their families following a quality review. Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 7 Staff supervision has improved and annual appraisals are now taking place. A clearer procedure for dealing with accidents has also been produced following the last report. First aid training has improved 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. The summary of this inspection report can be made available in other formats on request. Acorn House Residential Home Ltd DS0000066977.V361253.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.V361253.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families are provided with the information they need to make an informed choice about moving into the home. Residents’ benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. Residents and families also benefit from the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the service. EVIDENCE: The home had a current statement of purpose, which the manager confirmed was given to all prospective residents. It met with Schedule 1 of the Care Standards Act 2001. The owner is advised to look at the statement regarding caring for people with mild dementia, as the home is not currently registered for dementia care and staff training records indicated that staff have not Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 10 received training in the care of residents with dementia. The service user guide was informative and both documents were dated as being updated on the 29/04/08, the day of the inspection. Information given by the manager and confirmed in the AQAA, indicated that each new resident would have their needs assessed by the home prior to admission. Further information was seen to have been obtained from other parties, including relevant health care professionals to assist in assessments. Residents confirmed that they and their relatives had been invited to visit the home prior to admission, where they were given a tour of the home and introduced to other residents. When the resident had made the decision to move into the home they were allocated a key worker who would be the primary person to help them settle in. A four-week trial period was automatically offered. All privately paying residents had a contract stating terms and conditions and a copy was held on their individual files. Residents funded by Social Service do not receive any formal terms and conditions and therefore may not be aware of any extras they may be asked to pay for, such as hairdressing, chiropody or any other items. It is recommended that Social Service residents be provided with such a document. National Minimum Standard 2 clearly states each service user has a written contract/statement of terms and conditions with the home. This was discussed with the manager during the inspection. Access to training continues to improve however not all staff have received the mandatory training required. Evidence was seen that training in basic food hygiene, fire awareness, manual handling, first aid, adult protection and medication training had been applied for but had not yet been completed. Intermediate Care is not offered at Acorn House. Acorn House Residential Home Ltd DS0000066977.V361253.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have an individual plan that meets their needs; further development of these plans would benefit residents. However their safety may be put at risk, as the care plans are not supported by risk assessments that address how to fully support service users in meeting their needs. Residents have the potential to be at risk from poor administration of medication. Resident’s benefit from being treated with dignity and respect by all staff. EVIDENCE: Each resident had a care plan that was drawn up by staff with the involvement of the residents and /or their relatives. Evidence was seen that most were signed by residents or relatives to say they agreed the plans. A requirement was made at the last inspection that care plans must be kept securely in the home to protect service users personal information. These are Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 12 now kept in a locked cupboard and staff had access to them. All care plans were kept in an individual files. The daily notes completed by staff were adequate but the content could be improved. It was evident in some care plans that professional visits had been made but not always appropriately recorded and often outcome could not be traced. The care plans held a section for health professional visits but often staff had not completed these. This could make any follow up arrangements difficult and the concern was that these were not always followed through. For example, one resident was beginning to develop problems with skin integrity and staff had recorded ‘speak to S about it’. The instructions in the daily notes written by care staff stated ‘apply cream’, but the name of the cream was illegible. Further notes indicated that the District Nurse ordered a supply of medication three days later. None of this information was recorded on the professional notes section. Staff must ensure they take prompt action when they identify a problem and record their action clearly. Risk assessments remain in place but again could be improved. Outcomes must be given and if a high risk is identified, clear instruction must be given to staff to reduce the identified risk where possible. Detailed information on the care of residents with specialist needs such as diabetes or sensory loss could be improved. Documentation seen confirmed that all residents have access to a GP and visits from other health professionals were arranged and enabled. No residents currently had 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. The AQAA confirmed that all residents were treated as individuals and all staff respected their dignity and privacy. Help with personal care was always carried out in private and any one needing medical attention is attended to in their own bedrooms. A recommendation was made at the last inspection for the home to have suitable facilities to weigh residents. The home has now purchased suitable equipment and staff regularly record weights. Following the previous inspection, when a Pharmacy Inspector visited the home, it had decided by the home to move the storage of the medication to the basement. Temperatures are recorded but care must be taken to ensure the area is not damp as the laundry is also in the basement. The Medication Administration records were viewed and five errors were found where staff had not signed for the medication but the medication was not in the blister pack. The manager was confident the medications had been given. Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 13 The manager was aware of the problem and was intending to speak to the staff concerned. The manager stated it was the same member of staff and their competence must be called into question. The manager confirmed she would be taking action. The manager stated that she did audit the records but had not recorded this in writing. It is advised that these records be maintained. At the last inspection a requirement had been made that staff must be trained to administer medication to residents and must be regularly assessed for their ongoing competency to do so safely. The manager confirmed that ten members of staff had completed a one day medication course, three were currently undertaking an Assett course in the safe administration of medication. Competencies are now being assessed every six months. Evidence was seen that the home held injections of Morphine in the home. These were for a resident who had passed away the previous day. The District Nurses administered the injections but the home did not have appropriate storage facilities for controlled drugs. It is recognised that this was to assist the staff with palliative care but the home must have appropriate facilities. The storage of controlled drugs was discussed and the home needs to obtain a controlled drugs cabinet and must record the administration in a dedicated hard backed controlled drugs book. The home remains responsible for the storage of medication held on the premises. The manager prefers to write her own Mar sheets and this was discussed with the Pharmacy Inspector after the inspection. Her advice was as follows: • When MAR charts are handwritten or printed in the home, there must be a robust system to check that it is correct before it is used. It is recommended that the person completing the MAR and the person checking it, sign and date the MAR. To ensure the prescribers current directions are in use the check needs to be against a reliable information source such as the dispensing label on the current supply or the current FP10 repeat request. They also need to check against the previous MAR to ensure that any recent changes have been included. There was not a robust checking system in place, with only one member of staff checking medication in. The manager must review this procedure. 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 satisfied with the level of care the home offers. ‘Staff are very good to me’ Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 14 ‘I am very happy at Acorn House’ ‘The home is always clean’ ‘The carers do all they can’ The home works hard to ensure they can meet the needs of residents when they are nearing end of life. They work closely with the District Nurse team and provide care to the best of their ability and in a supportive and caring manner. Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s social and recreational interests and needs are provided for with a range of activities organised. Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. Residents receive a wholesome appealing balanced diet in pleasing surroundings. 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. Residents confirmed they were offered activities and mostly these were enjoyed. Some said they enjoyed the bingo sessions and the library was complimented. The home does recognise that not all residents wish to participate and it was evident that some residents preferred to remain in their Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 16 rooms. Staff were aware of their preferences and acted accordingly. Several residents said that routines were flexible and that they felt they were able to make their own decisions about daily living preferences. Some visitor were spoken with and confirmed they could visit at any reasonable time and that the home always kept in contact with them if any changes occurred in their relatives conditions. One relative said: ‘The manager is very supportive and will always listen’. Several resident spoke about the food and some had mixed opinions. Most said the food was good but one indicated that it was not always as good on some days as others. All said there was always sufficient food and drinks available at all times. 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. Residents could have a light supper if they wished and bedtime drinks were always offered. The menu plan was seen to be varied, balanced and nutritious. Residents likes and dislikes were taken into consideration and an alternative choice was 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. Since the last inspection a new conservatory has been completed and this has improved ventilation. Ceiling blinds to prevent the high temperatures found last year had been fitted. The residents appreciated this. Acorn House Residential Home Ltd DS0000066977.V361253.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives/representatives can be confident that their complaints are taken seriously and acted upon. Adult protection procedures within the home serve to safeguard residents. EVIDENCE: The home had a complaints procedure in place that was comprehensive. Evidence was seen that the home now records all complaints appropriately and responds effectively within the allocated timescales. The home had received one complaint since the last inspection and had managed the situation well. Evidence was also seen that the owner responds in writing to any negative comments made during the quality assurance exercise. 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 to approach if they had a concern. All said they felt safe and secure in the home. The Commission had not received any formal complaints regarding the home. The home had prepared its own policy regarding adult protection and it is advised to obtain a copy of Kent and Medway’s Safe Guarding Vulnerable Adults Policy to ensure it fully complies with the correct procedures. Some staff had been trained in Safe Guarding Adults procedures and protocols and this in an ongoing process. Further training courses had been applied for. Several Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 18 staff were spoken with and were able to demonstrate a good understanding of Safe Guarding Adults protocols and concerns. Since the last inspection the home has notified the Commission of events affecting the welfare of residents, as regulation requires. Acorn House Residential Home Ltd DS0000066977.V361253.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 good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, homely and clean environment with well maintained gardens. EVIDENCE: Acorn House offers a comfortable and clean place to live. Residents had their own private rooms and some had en-suite facilities. There were two lounges, a dining room and large conservatory. The conservatory had been replaced in the last year and was a pleasant place to sit. There were televisions and music centres in the lounges. Residents’ bedrooms offered comfortable accommodation and were personalised to reflect the taste and interests of the people who lived there. Individuals said they liked their bedrooms and they were comfortable in them. Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 20 Since April 2007 the main corridors and both lounges had been decorated. The conservatory had been replaced and new ceiling blinds had been installed. Carpets in seven rooms had been replaced. The same rooms had been redecorated. The kitchen had new cupboards and the tiles had been regrouted. The ceiling had also been painted. One of the bathrooms highlighted in the last report had the broken tiles replaced and a new bath seal had been fitted. It was noted that radiators in residents bedrooms and other areas in the home were not guarded and not of a guaranteed low temperature surface type. As at the last inspection the home has undertaken environmental risk assessments for residents where the surface temperature does present a risk. The National Minimum Standards state that pipe work and radiators should be guarded or have low temperature surfaces. Residents who are increasingly frail and some who are visually impaired upon admission are at risk of falls and are having their safety compromised unnecessarily. The owner did say that he has received quotes for the work to be undertaken but had not arranged for the necessary work to be completed. It was also noted that the hot water in all of the outlet points was very hot and had the potential to scald residents if, for example, they washed their hands. Thermostatic mixers valves are not fitted. The National Minimum Standards state that to prevent scalding, pre set valves of a type unaffected by water pressure and which have fail-safe devices be fitted locally to provide water close to 43 degrees centigrade. This is considered an unnecessary risk and efforts must be made to reduce the risk and fit the necessary valves. Water temperatures are not recorded or monitored. This does not evidence that the responsible individual is showing due diligence in the health and safety of residents or staff. The home had two hoists to enable them to manage the moving and handling of some of the residents identified as needing assistance. However, one had not been serviced and the manager stated that it was not used. The home must ensure all equipment in the home is suitably serviced and maintained, as it may need to be used in an emergency. It remains stored behind chairs in the conservatory. Chemicals were stored appropriately on this visit and the manager confirmed 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. 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. Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 21 The gardens are well maintained. The laundry was in the basement and did not meet with infection control guidelines. There are no separate hand washing facilities and the manger confirmed commodes were cleaned in the same sink as hand washing of clothes etc. The floor to the room was not impermeable and the wall finishings were not readily cleanable. The room was not very clean and cobwebs were observed hanging from the ceiling. The home does not have any adequate sluicing facilities or procedures for staff to follow. A requirement will be made to improve this area Acorn House Residential Home Ltd DS0000066977.V361253.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ benefit from being cared for by staff who have a good understanding of their needs. Some gaps in mandatory staff training mean that some staff may not be fully trained. EVIDENCE: The home employs seventeen care staff, the registered manager is also very hands on. The home employs four other staff as domestics and cooks. The normal deployment of staff is three carers in the morning, one of which is a senior carer, two in the afternoon/evening and two waking staff at night. Currently the home has only fifteen residents but when full the home may need to reconsider the number of evening staff depending on the dependency levels. The home does not use agency staff. Evidence seen in four of the staff records confirmed the home has a robust employment procedure in place to ensure the safety of residents in the home. Applicants were asked to complete an application form, with written references requested and a Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check was undertaken before staff were offered employment. Staff files contained most of the elements required by regulation. Copies of the staff’s current staff training/ qualification certificates remain on view around the office wall. Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 23 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 training is undertaken in house and then National Vocational Qualification (NVQ) training is offered. The home is advised to ensure their induction programme meets with the Common Induction Standards framework. More information can be found on the Skills for Care website. Staff training is ongoing and the home does have a basic training matrix. There remain some gaps in mandatory training but the manager confirmed several courses had been booked for the coming months. Currently over 50 of staff had a National Vocational Qualification (NVQ) to level two or above. Two more staff were working towards their award. During observation on the day of the site visit there was every indication that staff try there hardest to meet residents’ needs efficiently and effectively. Residents spoken with praised staff for their kindness and care. A lot of positive care practices were observed and staff clearly were dedicated to their roles. Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a manager who is clearly committed to promoting individuals independence, rights and choices and is assisted by a stable staff team who offer a good quality of support to the residents. Residents health and safety would further be protected by safe systems in place for water control and hot surfaces. EVIDENCE: The manager is qualified and continues to gain additional experience in Regulation and the standards required of residential homes. A more in depth knowledge of what is required from the home in the form of regulation would be advantageous. The home had had an improvement plan in place since the last inspection, which has been agreed with and monitored by the Commission. Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 25 The manager and provider continue to have insight into specific areas of the service that require improvement and progress is slowly being made. Both staff and residents commented that the manager’s approach to the home created an open, positive and inclusive atmosphere. Residents and staff said the manager was approachable and helpful. The owner now undertakes quality assurance reviews. Responses are not yet collated in a form that can be shared and the Commission has not been informed of the results of these quality assurance exercises. The owner is reminded that he must produce the results of the surveys and make them available to the current and prospective residents and other interested parties, including the commission (NMS 33.6). It is recognised that he does answer individual concerns raised by the consultation programme. Residents meetings are held every three months and items discussed recorded and acted upon as necessary. Residents confirmed these meetings were normally productive. 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 some responsibility. The home’s Policies and Procedures have been reviewed since the last inspection to ensure they met with good practice guidelines and the demands of current regulation. Their next review has been diarised. Work had been undertaken with the home’s Accidents to Service Users policy to safeguard resident’s welfare as mentioned in the last report. Evidence was seen in staff files and staff confirmed that supervision was happening on a regular basis and was productive and helpful. Yearly staff appraisals are also undertaken and nearly all staff had received this. The manager also undergoes an appraisal with the owner. A requirement was made at the last inspection for regular supervision and this has now been met At the last inspection the owner was required to 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. This was under regulation 26. So far one report has been received from the owner. When discussed he stated that he was in the home at least three days every week and could not understand the need for such a report. Discussion took place around how best to continue to meet this requirement. Some health and safety concerns were highlighted during the visit and discussed with the manager. These included the lack of thermostatic mixers valves on water outlets, the non-recording of water temperatures, the lack of Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 26 radiator guards and the hoist that was not being serviced. Some areas of mandatory training also need to be provided. Staff are now mainly trained in first aid as required from the last inspection. The effect of these concerns is that service users could be at risk and therefore this has affected the overall scoring for the management section. The outcome will remain as adequate because of these concerns. Fire precautions are managed well with regular checks in place on equipment and systems. Fire drills are also carried out on a regular basis. Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 27 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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 2 3 3 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 1 Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 28 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 Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP18 Regulation 18 (1) (a)(c ) (i) Requirement 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 COSHH requirements Infection Control Risk Assessment Basic Food Hygiene Fire safety (Timescale of 02/07/07 not met) An improvement plan detailing how the service will address this will be required within the timescale indicated The registered person shall make 31/05/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines in the care home. The registered person shall 30/06/08 revise the service user plan to DS0000066977.V361253.R01.S.doc Version 5.2 Page 29 Timescale for action 30/06/08 2. OP9 13(2) 3. OP7 15(2)(c) Acorn House Residential Home Ltd 4. OP26 13(3) ensure daily notes are thorough and risk assessments are detailed. The registered person shall make 30/06/08 suitable arrangements to prevent infection, toxic conditions and the spread of infection in the care home. In that the laundry room does not meet the required standard of infection control. An improvement plan detailing how the service will address this will be required within the timescale indicated 4 OP38 23(2)(c) The registered person shall 31/05/08 having regard to the number and needs of the service users ensure that equipment provided at the care home for use by the service users is maintained and in good working order. In that all hoists are kept serviced and well maintained. 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. Refer to Standard OP22 Good Practice Recommendations 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. It is strongly recommended that 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 DS0000066977.V361253.R01.S.doc Version 5.2 Page 30 2. OP25 3. OP27 Acorn House Residential Home Ltd kept under review to ensure that sufficient staff are deployed to meet the needs of the people who use the service. 4 5 6 OP38 OP30 OP2 It is strongly recommended that thermostatic mixer valves be fitted to all water outlet to ensure service users are protected from the risk of scalding It is recommended that the home induction programmes meets with the Common Induction Standards framework It is recommended that residents funded by Social Services should be provided with written terms and conditions Acorn House Residential Home Ltd DS0000066977.V361253.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone 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. 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