Inspection on 13/12/07 for Acorn Lodge

This inspection was carried out on 13th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 30/01/07

Acorn Lodge 21/10/05

Acorn Lodge 07/06/05

Acorn Lodge 25/10/04

Acorn Lodge 07/06/04

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

CARE HOMES FOR OLDER PEOPLE Acorn Lodge 14 Abbotts Lane Kenley Surrey CR8 5JH Lead Inspector Liz O`Reilly Key Unannounced Inspection 13th December 2007 9:00 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 DS0000048034.V356015.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 DS0000048034.V356015.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acorn Lodge Address 14 Abbotts Lane Kenley Surrey CR8 5JH 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) 020 8660 0983 Medicrest Ltd Miss Angela Caroline Bradley Care Home 39 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (39) of places Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A variation has been granted to allow one specified service user under the age of 65 to be admitted. As agreed on 12/05/2006, 2 service users with Dementia between the ages of 60 - 65 years old can be accommodated within the home. Date of last inspection Brief Description of the Service: Acorn Lodge is a modern building situated in the rural area of Kenley. The only possible disadvantage of its pleasant location is that it is located some distance away from public transport. The main entrance to the home is by driving or walking up a steep lane from the nearest bus route and rail link. The Lodge adjoins a similar home (Acorn House), also managed by Medicrest Limited. The two homes share a large rear garden. The home’s stated aims and Objectives are to ‘provide a home from home, friendly atmosphere where staff is approachable and an open relationship is encouraged between residents, staff and relatives to ensure a happy home and ensure the well being of the residents’. Fees for this service are from £400 to £420 per week. Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one regulation inspector. The inspector had the opportunity to speak with people who use the service, staff and the registered manager during this visit. A sample of records were examined. Surveys were provided for people who use the service, their relatives and staff. The registered manager has completed an assessment of the service as required by the CSCI. The judgements made in this report are based on information from all of these sources as well as observations made by the inspector during the visit to the service. What the service does well: What has improved since the last inspection? Since the last inspection the home has been assessed by an occupational therapist to ensure that the environment and equipment provided meets the needs of people who use the service. Auditing of accidents has been implemented which will ensure that actions are taken to reduce risks. The manager has started looking at expanding the opportunities for outings for those people who are less mobile. Staff have continued to take part in training to increase their knowledge and skills. A staff appraisal audit has been developed to address any outstanding issues. Acorn Lodge DS0000048034.V356015.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. The summary of this inspection report can be made available in other formats on request. Acorn Lodge DS0000048034.V356015.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 DS0000048034.V356015.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People who use this service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People are provided with good information about the service before and when they move into the home. Assessments are completed before people move in to make sure that their individual needs can be met and that staff have some information on the person before they arrive. EVIDENCE: People are provided with information on what they can expect from the service in a welcome pack. A copy is available to anyone visiting the service and a copy is available in each bedroom. One person told us that they were “happy to come with the information they were given”. Feedback from relatives showed that people felt they were given enough information. Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 9 People who use the service told us “I like it here” and “it is very comfortable here, I like my room”. Comments on the service from relatives included “they provide a home like environment”, and “This home feels like her home now”. We saw that assessments are carried out before anyone moves into the home. This gives staff some understanding of the needs and wishes of individuals before they arrive. This information is also used to set up an ‘at a glance’ care plan which is added to and amended during the first few weeks. This is then used to set up a more detailed care plan. This home does not provide intermediate care. Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Care plans are in place but could be more person centred and contain more detail. The health care needs of people are met and medication is well managed. Staff are aware of the importance of maintaining privacy and dignity. EVIDENCE: We saw staff providing care and support to people in a considerate and sensitive manner. The privacy of people who use the service was preserved and staff spoke with people in a respectful manner. Staff were seen to listen carefully and approach people in a friendly way. Feedback from relatives about the care provided was positive, surveys indicated that they felt their relatives were given the support they expected. Comments included ‘We are all very pleased with the level of care my mum gets. Her wellbeing seems to be the top priority’ and ‘they provide swift medical care, look after all of her needs’. Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 11 Everyone is registered with a local GP practice and can keep their own GP if feasible. District and community psychiatric nurses will visit if needed. Arrangements are in place for dental and optical care. A chiropodist visits every three months and the manager is planning for staff to be provided with training on foot care which will improve the service. We found medication to be well managed with records well maintained. Staff are provided with information on the medication they administer, its uses and possible side effects. Each person is provided with a care plan which sets out their needs and how these will be met. A copy of the care plan is sent to relatives every six months to give them an opportunity to add to or comment on. Improvements could be made on the care plans by making these more person centred. The addition of strengths as well as needs, much more detail on personal preferences, activities relating to daily living, and how these would be met would provide a more individualised framework. Staff complete a keyworker sheet every two weeks. We found the quality of information on these forms to be variable. We found staff were carrying out risk assessments but this work needs to be completed by including what actions they were going to take to reduce risk and support people to live as independent a life as possible. Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service receive adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The home offers a good range of activities. There is scope to improve this by making sure there is a full social care plan for each person. Staff are committed to supporting people to maintain contact with family and friends. People are offered a good variety of food but improvements could be made to make mealtimes a more social occasion for everyone. EVIDENCE: All but one person spoken to and who returned surveys said they enjoyed the food. Comments included “this is a very good cook”, “I think it makes me eat too much”, “I like fish and chips and skate”, and “I can’t remember what it was but I liked it”. Relatives felt they were kept in touch with what was happening in the home and felt welcome when they visited. Relatives felt staff met the needs of people from different backgrounds and that they supported people to live the life they chose. Comments included “they give her a social life she wouldn’t have had anywhere else”, “we have been encouraged to visit as often as we can manage at anytime day or night. This was very important in the early Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 13 days” and “staff are more than willing to spend time with us if there are any problems”. We observed good activities going on with both people who use the service and staff enjoying themselves. One member of staff has taken part in training on activities at a further education college. Consideration should be given to providing training to more staff on engaging people with dementia and involving keyworkers in more one to one daily living activities in line with the personal preferences to individuals. Entertainment is arranged every month and regular outings take place particularly in the warmer months. We saw a group of people going out to visit a local school on the day we were there. The manager is looking at involving more people in outings over the next year by tailoring the outings to the preferences and abilities of individuals. We were informed that a reflexologist visits the home every two weeks as does a hairdresser. Aromatherapy and Reflexology every two weeks and hairdresser every two weeks. We saw people who use the service helped with eating in a sensitive manner. However mealtimes could be improved. At lunchtime we saw no condiments on the table, plastic glasses used for drinking, food was served already plated, and bibs were used. A board lets people who are able to read know what was on offer at mealtimes. This was not accurate on the day we visited. Consideration should be given to making the menu more easily accessible. Staff should look at making mealtimes more of a homely social event with people supported to help serve themselves at the table, staff taking the meal with people who use the service, setting tables more fully, and using napkins. Consideration could be given to protecting mealtimes from outside interruptions which would allow all staff working in the home to join in the meal. We found staff were aware of the importance of giving people the chance to make their own choices. Staff described the way in which they encourage people to make choices on things like toiletries by showing different items and allowing people to smell them. Representatives from both Roman Catholic and Church of England churches visit the home and provide services. Staff told us they would support people from other religious faiths to attend places of worship of their choice. Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use the service are protected from abuse. Concerns about the care provided are listened to and acted on. EVIDENCE: We found people were well informed on how to make a complaint and who to speak to. One person commented that ‘So far we have had no reason to complain and any problems that have occurred have been dealt with very well’. Staff were aware of what they should do if anyone comes to them with a complaint. Systems are in place for recording complaints along with actions taken and outcomes. The complaints procedure is available in each welcome pack and is on display in the home. Records showed that all staff have been provided with training on safeguarding adults. Copies of the local authority procedure which was to be followed were available in the home. Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 15 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): 19 , 25 & 26 People who use this service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People living at the home enjoy a comfortable, homely living environment. Although certain areas could benefit from redecoration the manager and owners are aware of this and planning this work. The premises are kept clean and generally well maintained. EVIDENCE: Acorn Lodge is not a new building and as such needs regular attention. We found the manager working on an audit of the building to prioritise the redecoration and purchase of new furnishings. However people are provided with a good homely environment. People were supported to individualise their own bedrooms with personal items, photographs, pictures and if they wish their own furniture. Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 16 The use of different wallpapers in bedrooms and some bathrooms adds to the domestic, homely atmosphere. We found the home to be clean and free from offensive odours. People who use the service told us “I have never seen the place dirty” and “it is very nice it is too clean”. Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. There are enough staff on duty to meet the needs of people using the service. Staff are provided with good opportunities for training. The recruitment process protects people who use the service but the procedure needs to be up dated. EVIDENCE: People who use the service told us “staff are really good to me”, “they are very nice” and “these people take care of me”. Comments from relatives included, ‘I feel the staff are doing a very difficult job very well and I thank them for it’, and ‘they spend time on the residents talking to them’. We found sufficient staff on duty to meet the needs of the present group living in the home. We examined a sample of staff files. These were found to be well maintained with appropriate checks including Criminal Records Bureau checks and references being carried out. In order to further safeguard people who use the service, in future, a full record of employment history with explanations for any gaps must be recorded for each member of staff. A statement that the Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 18 member of staff feels they are physically and mentally fit enough to do the work needs to be on file. Staff are provided with frequent opportunities to take part in training. Five staff have completed NVQ level two training, five have achieved level three and one person is in the process of completing level four. Two staff are completing a course in health and social care. In order to continue to meet the needs of individuals, improve the care provided and keep up to date with good practice staff need to have on going training on providing care and support for people with dementia. Staff should also have access to dementia care publications. Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People live in a home which is well run. Checks are carried out to make sure that the health and welfare of people using the service is protected. The views of people who use the service are taken into account. EVIDENCE: The manager has considerable knowledge and experience of running a care service for older people. Positive comments were received from relatives and staff on the support provided by the manager. The organisation has a quality assurance system in place which ensure that the views of people who use the service and or their representatives are taken into Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 20 account in the day to day running and planning for the home. Residents meeting are held on a monthly basis. Regular checks are carried out and recorded to make sure the home and equipment is safe for people who use the service, staff and visitors. To further ensure the safety of people who use the service staff must check the temperature of hot water before they assist anyone into a bath or shower. A record of these tests must be kept. Following our visit the home received an inspection from fire brigade and a number of requirements were made. The organisation must provide CSCI with information on how these have been addressed. Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? 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 OP29 Regulation 19 Schedule 2 Requirement To ensure that people who use the service are protected the recruitment procedure must be reviewed to include; • A full employment history with explanations for any gaps in employment. • Staff to sign a statement indicating their physical and mental fitness to carry out their role. To make sure that staff continue to have the skills and knowledge to meet the needs of people who use the service on going training in dementia care must be provided. In order to protect the health and safety of people who use the service staff must check the temperature of the water before they assist anyone into the bath or shower. In order to ensure the safety of people who use the service, staff and visitors the home owners must take action to comply with advice received from the Fire Officer. DS0000048034.V356015.R01.S.doc Timescale for action 03/03/08 2. OP30 18(c) 03/03/08 3. OP38 13(4) 04/02/08 4. OP38 13(4) 04/02/08 Acorn Lodge Version 5.2 Page 23 Information on how this has been actioned must be sent to the CSCI. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP12 OP14 OP15 Good Practice Recommendations Care plans should be more person centred and include more detail of, individual needs and strengths, how the needs of individuals will be met and personal preferences. A full social care plan should be produced for each person which includes meaningful activities of daily living. Risk assessments should be completed with information on the actions to be taken to reduce any risk and support people to live as independently as possible. A review of mealtimes should be carried out to improve the information available, the facilities and choices and to assist in making mealtimes more of a social event for all those involved. Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Acorn Lodge DS0000048034.V356015.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!