Inspection on 10/01/06 for Acorn Lodge

This inspection was carried out on 10th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Acorn Lodge 06/02/07

Acorn Lodge 21/03/06

Acorn Lodge 01/03/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Acorn Lodge 12 Grand Avenue Southbourne Bournemouth Dorset BH6 3SY Lead Inspector Sophie Barton Unannounced Inspection 10 January 2006 09:00 th DS0000062108.V277593.R01.S.doc Version 5.1 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 DS0000062108.V277593.R01.S.doc Version 5.1 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 Adults 18-65. 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. DS0000062108.V277593.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Acorn Lodge Address 12 Grand Avenue Southbourne Bournemouth Dorset BH6 3SY 01202 426085 01202 426085 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) Acorn Lodge (Bournemouth) Ltd Mrs Angela Kay Druce Care Home 9 Category(ies) of Learning disability (9) registration, with number of places DS0000062108.V277593.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2005 Brief Description of the Service: Acorn Lodge is registered to provide residential care for up to nine younger adults (aged 18-65). The property is a large family style home, located in a tree-lined avenue close to the centre and to the beaches of Southbourne. The Proprietor maintains one of the bedrooms for short term care. The service users are accommodated on the ground, first and second floor. All bedrooms are single and two have the benefit of en suite facilities. There are bathrooms on each floor. The communal areas are on the ground floor and consist of a lounge, conservatory/dining room and a kitchen. Accessed from the conservatory is the garden, which is level and private. Acorn Lodge is staffed 24 hours a day, with two waking night staff. The Proprietor works in the home full time as the Manager. DS0000062108.V277593.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection has been undertaken as part of the statutory inspection process in accordance with the Care Standards Act 2000. This was an unannounced inspection on Tuesday 10th January 2006 at 9.00am to 4.00pm. The Registered Manager was present for part of the inspection, as was the Deputy. Three service users were spoken with briefly. The main part of the inspection involved examining service user care files. The Inspector also sought feedback about the home from the funding authority responsible for a number of the service users. A number of policies were examined and the Inspector had a tour of the building. The Inspector acknowledges that this was a limited inspection which only focused on 19 standards. Inspector time with service users and staff was limited. What the service does well: What has improved since the last inspection? There has been continual improvement of the physical environment. Service users continue to be involved in choosing trips and visits away from the home and these are varied and adventurous. DS0000062108.V277593.R01.S.doc Version 5.1 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. DS0000062108.V277593.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000062108.V277593.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 Prospective service user’s needs are assessed, with the home clearly demonstrating their ability to meet the needs. However, improvement is needed in ensuring that service users views and aspirations are obtained and recorded. The home has a good admissions process with service users having flexible opportunities to visit and make an informed choice about living there. EVIDENCE: The inspector examined three care files, one of a new service user, one respite file and one randomly chosen file of an existing service user. These three files evidenced that Care Management Assessment and Care Plans had been obtained and that the home had then developed their own care plan based on identified need and risk. Prospective service users are able to visit and stay at the home (usually through the short term care bed and service) before making a decision to move there permanently. The files contained no record of discussions with the service users about their preference about moving into the home, and no mention that an advocate or representative have been met with. Feedback from Care Managers confirm that the home has clearly demonstrated their ability to meet the needs of service users, even those that have challenging needs. There have been no recent placement breakdowns. Where specialist needs are identified there was clear evidence on file of specialist assessments being sought. DS0000062108.V277593.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Each service user has a person centred plan, clearly informative to staff and the service user, however the care planning review systems do not provide adequate evidence of seeking service users or representative views. There are good risk management procedures within the home, ensuring that service users welfare is safeguarded while allowing them to take responsible risks. EVIDENCE: As stated earlier, three files were examined to gather evidence for these standards. As well as each service user having a Care Management plan and assessment the home has also developed ‘Essential Lifestyle Plans’ with service users. These are person centred and focus around the service user’s goals and aspirations. They clearly identify risks and record good clear action on how the risks are to be managed, especially in relation to challenging behaviour. A record is made of the date the plans are reviewed but no record made of who was involved in the review or the service user’s views. Care Management feedback to the Commission confirmed that care plans are followed and that there is good management of behaviour and risks with positive outcomes and progress made by service users. DS0000062108.V277593.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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 and 16 Links with the community are good and regular, enriching service users social and leisure opportunities. Considerable focus is given to supporting service users in maintaining contact with family and friends, allowing continued and positive relationships to develop. The home provides a good level of support and advice to service users in relation to education, training and other appropriate day opportunities, ensuring service users engage in valued activities. The home’s routines and care practices promote choice for service users, but lacked focus in achieving more independence for service users. EVIDENCE: In discussion with the Manager and Deputy, by examining care files and speaking with service users it was evidenced that service users engage in a number of different activities inside and out of the home. One service user stated that he goes to the shop and pub regularly. Daily notes evidenced that DS0000062108.V277593.R01.S.doc Version 5.1 Page 11 trips to other towns and places of interest at weekends are regularly made and service users were given the opportunity of going on many day trips, weekend breaks and a holiday last year. The service users informed me that there is an Austria holiday arranged for two weeks time. The majority of service users attend local day centres or college, and have made the choice of attending part time or full time. Service users stated that they do sporting activities through the day centres, and the Manager is currently arranging swimming sessions at a local swimming pool. The ‘Essential Life Plans’ and daily care records evidenced that service users are supported to visit family and friends, encouraged to make and receive phone calls and that family are enabled to visit the service user regularly and flexibly. The staff clearly have a knowledge of the service user’s family and friends network. The Manager spoke about service users going to see friends with staff support, and also where specialist support has been requested in relation to supporting a service user with more specialist relationship needs. From observation and by reading daily care notes there was limited evidence that service users are supported to be as independent as possible. For example no record was made that service users had been involved in meal preparation, shopping, cooking or in any laundry/cleaning tasks. In relation to choice, there was clear evidence that service users could lock their bedroom doors if they wished, could join in an activity or not, and had unrestricted access to the home. DS0000062108.V277593.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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 There is evidence of good multi-disciplinary working taking place, ensuring service users holistic and specialist health needs are met to a high standard. EVIDENCE: The majority of service users have a ‘Personal Health Record’ which are person centred and detail the health needs of the service user as well as recording clearly the health services the service user needs to access. A clear record is made on file of health appointments and outcomes. Care Management feedback confirmed that the staff are proactive in accessing health services for service users and always support service users with any health issues. One care file seen showed that dental and optician check ups had been regular. Hearing tests are requested only when a need is highlighted and not as routine. The Manager and Deputy had a good clear knowledge of the service users’ health needs, and were able to articulate the procedures in place to meet these needs. Appropriate referrals had been made for Community Nurse and Psychiatry input. DS0000062108.V277593.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The complaint and adult protection procedures and policies within the home need to improve considerably to ensure that service users rights are met and that they are protected by staff actions. EVIDENCE: In order to review these standards the Inspector examined the home’s policies. The home’s ‘Abuse Guidance Policy’ is considerably inadequate and needs revising. It informs staff to take inappropriate action and makes no links with the Department of Health’s ‘No Secrets’ guidance. It has not been made applicable to Acorn Lodge, and does not inform staff of what to do if the Manager / Proprietor is suspected of abuse. The policy on Sexuality and Relationships also needs updating to include recent legislative changes. The complaints procedure is limited in detail. It does not inform service users of their right for advocacy support, or that they can complain to any member of staff. Again it does not specify what to do if the complaint is against the Manager. The procedure does not inform staff of how to act when a complaint is raised, and the procedures they need to follow. Service users are asked in resident meetings if they have any concerns or complaints. However these meetings are infrequent (every 3 months ). The home has a whistle blowing and bullying policy which are adequate, and the manager confirmed that the No Secrets policy is kept in the home. DS0000062108.V277593.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 The standard of the environment and cleanliness within this home is good providing service users with an attractive and homely place to live. EVIDENCE: The Inspector had a tour of the premises, and was invited to see two service user bedrooms. The communal areas were spacious and comfortable providing adequate seating for 9 service users. The size of the kitchen was adequate but is small for the number of residents and staff it needs to cater for. Furnishings and fixtures are domestic. All areas were bright and cheerful and free from offensive odours. The bathrooms and the kitchen were clean. There is a separate laundry area and staff have undertaken training in infection control. The home has one short term care bed, with a number of different service users occupying this bed throughout the year. They share the communal space with the long-term service users, although the National Minimum Standards advise against this. The Manager showed the Inspector surveys confirming that the service users are in agreement with the current arrangements and state that there are benefits to all. The premises has an excellent position for those wanting close access to shops and to the beach, as well as good public transport links to the bigger towns of Christchurch and Bournemouth. DS0000062108.V277593.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34 and 35 The service users are supported by an effective staff team which allows for the home to be run efficiently and service user’s individual needs met. The home’s recruitment practices are sufficient ensuring the protection of service users. Staff have been provided with adequate training, with staff having the skills to meet service users needs. EVIDENCE: The inspector examined the staff rota. This showed that either two or three staff on are each shift – 8am to 2pm, 2pm to 8pm, 8pm to 8am, approximating 390 hours per week. The Manager confirms that this is suitable for the current needs of service users. The staffing provided meets the recommendations of the Department of Health staffing guidance. A changeover of shift at 8pm, may be restrictive for supporting service users with evening activities and this will be monitored at the next inspection. The Manager stated that the staff team is stable and there is low use of agency staff. All staff are over 18 years old. The house is staffed 24 hours a day. The necessary administrative tasks and training are easily undertaken throughout the day when the majority of service users at out at work or education. One recruitment file of a newly appointed staff member was examined. This evidenced that safe recruitment practices have been followed, with a CRB DS0000062108.V277593.R01.S.doc Version 5.1 Page 16 check received prior to the workers start date, two references obtained and notification recorded of the workers previous experience and qualifications. Copies of identification had also been made and kept. The Manager was not aware of the most recent guidance relating to Criminal Record Bureau checks. The Deputy Manager confirmed that the training provided meets Sector Skills Council workforce targets, with staff completing TOPSS and LDAF units. Eight out of twelve staff members have an NVQ 2 or higher qualification. The other staff are due to start the NVQ 2 course in care shortly. The Manager confirmed that all statutory training is up to date for staff members. Staff complete a number of in house training courses (e.g. fire, adult protection, challenging behaviour), as well as the occasional external training courses (e.g. effective customer care). DS0000062108.V277593.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 The home has insufficient quality assurance systems, with service users and representatives not receiving appropriate feedback on the homes quality of care and development plans. EVIDENCE: The Manager arranges for service users and their representatives to complete a questionnaire yearly in relation to the quality of care provided by the home. The completed questionnaires are made available to visitors to the home. The Manager confirmed that at the service user’s annual review, the views of all interested parties are sought on how the home is achieving goals for service users but these discussions and outcomes are not recorded. The Manager does not formally collate the views of others, and no annual development plan is produced which reflects the aims and outcomes for service users. DS0000062108.V277593.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 2 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 2 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 x x x x 2 x x x x DS0000062108.V277593.R01.S.doc Version 5.1 Page 19 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations There should be clear evidence that the service user’s views are sought in relation to their assessment of needs. There should be evidence that the service user has agreed with any restrictions placed on them. The home should ensure that the service users have access to an independent advocate in relation to moving into the home. Service user’s views should be sought and recorded when reviewing their care plan. The daily routines in the home should allow for service users to be more independent with day-to-day living tasks. Service users’ responsibility for housekeeping tasks should be specified in their individual plans. The complaints procedure should contain more detail about how staff are to manage complaints and how service users can raise complaints (verbally, with advocacy etc). The home’s policies on adult protection need to be redeveloped to ensure they give accurate & up to date advice There should be an annual development plan for the home made available to the Commission and to other interested parties. A record should be kept of the discussions and DS0000062108.V277593.R01.S.doc Version 5.1 Page 20 1 YA2 2 3 YA6 YA16 4 5 6 YA22 YA23 YA39 outcomes following service user statutory reviews. 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