CARE HOMES FOR OLDER PEOPLE
Acorn Lodge 183 Reads Avenue Blackpool Lancashire FY1 4HZ Lead Inspector
Mrs Jackie Riley Unannounced Inspection 1st August 2006 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 Lodge DS0000009866.V299242.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 Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Acorn Lodge Address 183 Reads Avenue Blackpool Lancashire FY1 4HZ 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) 01253 300036 Mr Anand Seedheeyan Mrs Savitree Seedheeyan Mr Daniel Lea Care Home 10 Category(ies) of Dementia (6), Mental disorder, excluding registration, with number learning disability or dementia (4) of places Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th September 2005 Brief Description of the Service: Acorn Lodge provides residential care for ten service users and can accommodate four service users with a mentally disorder and six people with dementia. The care home is situated in a residential area close to all community amenities, including shops and the public transport system. Access to the home requires service users to be mobile without the need for mobility aids. The care home has two floors accommodating service users. They include five ground floor single rooms one with en- suite facilities and five first floor rooms, one double and four single. There is a ground floor shower and toilet room, close to the entrance of the home. There is no lift access to the first floor therefore service users occupying first floor rooms must have good mobility. At the time of the site visit the weekly cost of living at the home is £329.60, based on local authority contractual arrangements and with the home having received a quality care award. Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This site visit was a key inspection for the year April 2006 to March 2007. This unannounced inspection took place during a daytime period and used information gathered through the pre inspection process. In total 5 hours were spent at the home. The inspection included discussion with all residents living at the home. Discussion with the management team and members of staff on duty took place which provided general information about the service. There were no comment records received prior to the inspection process, however discussion with residents confirmed they are very pleased with the service they receive. The inspection included observation of records, discussion with the manager and staff and included a tour of the home. What the service does well: What has improved since the last inspection?
The way activities are planned is now based upon individual choices. Residents spoken to say they like to do things they like when they like. Most residents enjoy going out to a local club. One resident said “I go and see my friends in the club most days”. Residents currently living at the home are able to express their wishes in respect of what activities they like to be involved in. Staff have access to update training in respect of areas where there are timescales involved including first aid. Staff spoken to and staff files seen demonstrated there has been recent certified training in this area, so staff are equipped with the knowledge and skills to provide first aid treatment. Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 The quality outcome is good. This judgement was made using available evidence including a visit to the service. Residents are provided with information and a full assessment at the point of moving into the home, so they know their needs will be met. EVIDENCE: The home has revised its Service User guide, which is made available to all users of the service. It provides clear information about the home and its services, so that people living there know home the home will meet their individual needs. Included in the document is a personal contract, laying out the terms and conditions of residency at the home. All contracts were seen to have been signed by the resident or their representative at the time of admission. Three residents files were examined and all had in place a full joint health and social care needs assessment, so that the home are informed of the residents needs prior to being admitted to the care home. Two residents spoken to were aware of their individual assessments, and stated they had been part of the planning process.
Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality outcome is adequate. This judgement was made using available evidence including a visit to the service. Healthcare systems are in place to meet resident’s needs. Control of medication is generally good however accurate and accountable administration records are not always maintained. Staff respect residents rights to privacy and dignity in how they deliver personal care. EVIDENCE: The home has a good system for recording resident’s healthcare needs. There was evidence seen of residents attending optition appointments, and other health related appointments, so that their health needs are being met. Monitoring and review is taken seriously with evidence of residents being involved in the planning and review process. Residents spoken to knew of the plans in place and commented on how they know they are being looked after. Observation of the homes management of medication demonstrated the system has been reviewed. There is good evidence of stock control of medication and there is good liaison with the community pharmacist. It was noted however, one resident discharged from hospital with prescribed medication had no record for recording the administration of it. Whilst the
Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 10 inspector was informed that the resident consistently refuses the medication, there must be evidence of this fact being recorded so that there is a clear audit trail available. Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality outcome is good. This judgement was made using available evidence including a visit to the service. Resident’s interests are provided for at the home as well as daily activities being undertaken. Residents receive a healthy and varied diet according to their needs and choice. EVIDENCE: The home promotes choice in all aspects of resident’s daily lives, so that their individual needs are recognised and fulfilled, based upon individual risk assessment. Residents spoke of going out and using community facilities either independently or with the assistance of staff. Some residents choose to remain in their rooms at various times of the day, this is not seen as a problem and staff spoken to know the residents individual choices and respect them at all times. Diet and nutrition is seen as important in the home so that residents receive a balanced diet in the interest of their health. Meals are varied and residents spoken to say, “they know what I like and don’t like”. There is no formal approach to entertainment, as the home prefers to encourage residents to make choices in what activities go on in the home and in the community. Residents and staff spoken to gave examples of going out to
Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 12 the local club, and playing cards and other activities including regular parties in the home. One resident said “there’s always something going on here”. Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality judgement is adequate. This judgement was made using available evidence including a visit to the service. There is access to complaint information which is available in the homes written literature, but contact adresses for independent agencies are not currently included. Abuse procedures are in place, for the proteciton of users of the service, but training is not extended beyond the induction period. EVIDENCE: The home has a written complaints procedure in the homes written literature, which is available to all residents living in the home. It provides residents with information relating to what the home will do if a resident or representative is unhappy about any aspect of the service. Whilst there is reference to the commission in respect of making complaints, it is necessary to include the full address and contact number of the commission to aid residents or their representatives in talking to an independent agency. There are in place local polices and procedures for adult protection, so that the home has a system to follow if abuse of any kind is suspected. Whilst adult protection is looked at as a topic for induction this should be an area included in the homes training portfolio. This would make sure staff have regular periodic updates to ensure they can follow appropriate procedures should abuse of any kind be suspected. Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26 The quality judgement is poor. This judgement was made using available evidence including a visit to the service. There are areas in the home where the decorations are poor and where there are evident risks to service users. EVIDENCE: Observation of the home confirmed there is a requirement to make sure it is well maintained, in that some rooms and corridors require light shades. Decoration is necessary in two of the resident’s rooms as wallpaper was damaged due to previous water leaks. The ground floor bathroom had an unpleasant odour, which needs to be addressed. In this bathroom, whilst window covering is in place it would benefit from a non- transparent glass to ensure residents privacy and dignity is protected at all times. The window restrainers usually in place on the first floor bathroom window were missing, resulting in a potential hazard for residents. This must be replaced for the safety of residents.
Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 15 Residents spoken to commented on how they like their rooms and the home in general as they are encouraged to bring in things they like including ornaments and occasional pieces of furniture. Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality outcome is good. This judgment was made using available evidence including a visit to the service. Staff recruitment processes and access to training means that the staff team have been appropritely vetted and trained to work in the home. EVIDENCE: Staff recruitment process has been improved at the home, to ensure the protection of users of the service. Staff undertake induction training so that they know how the home works and what systems are in place. This training is assessed following a trial period before a permanent contract is offered. Staff training is taken seriously by the home, with most staff achieving qualifications in care. There is a regular review of training undertaken in the home so that all staff have access to training applicable to their individual roles. Staff spoken to were found to be highly motivated. They were eager to demonstrate the individual training they had received so far. Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The quality outcome is adequate. This judgement was made using available evidence including a visit to the service. The home is managed well and systems, policies and procedures are in place for the protection of staff and residents. EVIDENCE: The homes management team has developed the systems in place to ensure the home is well managed. There is evidence the home is ensuring the health and safety of users of the service is maintained, by way of having in place current certificates for electric, gas, environmental health and appropriate insurance cover. Staff spoken to said we feel supported by the management team. Individual supervision and appraisal is seen as essential in the personal development of
Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 18 the staff team, and also measures the effectiveness of the homes stated aims and objectives. There is no formal approach in gaining residents and users of the service views about how the home is run, however through discussion with residents and staff throughout the inspection process they are pleased with the service they receive. Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 19 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement The home must maintain accurate medication administration records, which demonstrate all medicines administered are recorded. The name and address and contact details of the Commission for Social Care Inspection must be included in the homes Service User Guide. The home must be maintained to a satisfactory standard including decoration and fittings. All light fittings must be covered with shades. The home must have in place suitable cleaning systems to manage offensive odours. Window restrainers must be in place in the first floor toilet for the health and safety of residents. Timescale for action 30/09/06 2 OP16 5(f) 30/09/06 3. 4. 5. 6 OP19 OP25 OP26 OP38 23 23 23 23 30/09/06 30/09/06 30/09/06 31/08/06 Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP31 OP30 OP21 Good Practice Recommendations The registered manager should continue to develop and manage the systems, which are designed to underpin good practice in the home. Staff should be receiving on-going training in areas specific to their role, including adult protection. The ground floor bathroom would benefit from nontransparent glass being in place at the window to ensure the privacy and dignity of users of the service. Acorn Lodge DS0000009866.V299242.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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