Inspection on 21/06/05 for Acorn Lodge

This inspection was carried out on 21st June 2005.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Acorn Lodge 01/06/07

Acorn Lodge 09/05/06

Acorn Lodge 25/10/05

Acorn Lodge 07/10/04

Acorn Lodge 20/04/04

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

CARE HOME ADULTS 18-65 Acorn Lodge 361 Ewell Road Surbiton Surrey KT6 7BZ Lead Inspector Michael Stapley Announced 21 June 2005 09:30 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 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 Stationary 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 G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Acorn Lodge Address 361 Ewell Road Surbiton Surrey KT6 7BZ 020 8296 9633 020 8296 9622 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Younoos Jeetoo Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th October 2004 Brief Description of the Service: Acorn Lodge is a privately owned home managed by a private company. The home is registered to provide residential care for up to ten adults with learning disabilities. At the time of the inspection there were eight service users at the home with two vacancies. The current service users have mild to moderate learning disabilities. The premises is a modern purpose built two-storey house set back in a residential road in Surbiton. There are good transport links to Kingston upon Thames and the surrounding area. The home also benefits from having its own people carrier. There is a large communal lounge on the ground floor as well as a spacious kitchen and dining room. The home is homely, bright and clean. The furniture is domestic, flame retardant, and of good quality. The home is fully accessible to all of the service users. The home has parking to the front and a pleasant garden at the rear of the home which the service users spend time in during the summer months. Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This home was inspected under the National Minimum Standards Care Homes for Younger Adults. The inspection took place over one day on 23rd June 2005. There has been a change in management at the home in the last year. Gerald Nadal is the current acting manager supported by a consultant Mike Hale. The home is in the process of advertising for a new permanent manager and this post must be filled without further delay. Records examined included service user plans; care manager needs assessments and risk assessments, medication records, complaints, staffing records, health and safety and fire records. Previous requirements and recommendations were discussed with the acting manager and registered persons. What the service does well: What has improved since the last inspection? The acting manager is now using the staff meetings at the home to improve communication amongst the team and discuss basic care values. Staff members have improved their skills and knowledge by attending a number of Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 6 training courses. The home has a complaints procedure both in written and pictorial form which has now been develop in the form of a video. There have been improvements in the environment with refurbishment and redecoration in the process of taking place. 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 G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 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 standard(s) 2, 3 and 5. The home provides good information and introduction opportunities for prospective service users to make an informed choice about moving to the home. Contracts between the home and the service users do not contain all the information required under standard potentially reducing the rights of the residents of Acorn Lodge. Staff at the home have not had appropriate training for working with service user’s with a learning disability and those service user’s who are non verbal. This could clearly have an impact on the delivery of the service to residents at the home. EVIDENCE: The home has a preadmission procedure including a resident’s charter. Service users are only admitted to the home once a full assessment of their needs; compiled by their care manager or other relevant person has been received. An assessment for the homes most recent service user was seen on the service users file. The assessment was completed by a care manager and included additional assessments from other professionals. While the home has a training programme including NVQ training there is know evidence to suggest that staff have received training for the particular client group they are working with. Staff should receive specialist training for service users who have a learning difficulty such as that provided by LADAF. Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 9 There has been some progress in improving contracts between the home and the service users. Contracts now stated that all residents would have a three month ‘settling in’ period of residence at the home. However they did not contain all the information as required under standard 5.2. The home must accordingly amended service users contracts as at present there is the potential for their rights to be reduced. Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 10 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 standard(s) 6, 7 and 9. Service user care plans do not contain all the information required therefore staff at the home do not have all the information they require to satisfactorily meet the needs of the service users. They had also not been developed with the involvement of the service users, family, friends and advocates which could result in their rights to be eroded. Generally service users have had individual risk assessments and risk management strategies carried out thus enabling them to participate in activities in the home and in the community with appropriate support. EVIDENCE: Service user individual care plans are not at all comprehensive and do not contain all the elements of standard six. Care plans as a minimum should include a pen portrait of the service user, weekly activities, health needs and communication skills. Service users and their respective families are not involved in drawing up such plans as outlined in standard 6.6. In addition although service users have a key worker there was no evidence of one to one key worker meetings. The acting manager advised that he had introduced training as to the roles and responsibilities of a key worker. However there was Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 11 no written evidence to support this. The acting manager explained that the home plans to move towards Person Centred Plans where ownership of the plan is given to the individual service user. While this is to be commended it was noted that only one member of staff had undertaken Person Centred Planning training at the home. A recommendation has therefore been made that each service user has a Person Centred Plan completed every six months. Service users files sampled at random all had individual risk assessments and risk management strategies. As they had not been developed with the involvement of the service users, family, friends and advocates where appropriate there is the potential for their rights to be eroded. Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13, 14 and 17. The daily routines and house rules promote residents’ rights and encourage independence. Service users are given opportunities to engage in age appropriate activities with an emphasis on using community based facilities. Dietary needs are catered for and a balanced diet is provided, to ensure a nutritious diet based on personal preferences. EVIDENCE: The home is supporting service users to access appropriate activities through the activity programme. The service users access local parks, cafes, theatres, local leisure facilities and shops. In addition to swimming, gym and dancing. Since the last inspection the home has acquired its own people carrier which has made accessing activities a great deal easier. The Staff team are available to support service users while accessing community resources. Service users spoken to stated that they enjoyed the activities on offer at the home. Although service users do not at present have access to a computer the registered person explained that this is under consideration at present. Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 13 Weekly menus were constructed with the aid of the service user’s personal choice, advice from service user’s families and the experiences of the staff. One service user said that he enjoyed what he had to eat at the home. Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 18, 19 and 20 Personal care is carried out in a way that residents prefer so that dignity and choice are maintained. Residents’ medication is well managed to ensure good health. EVIDENCE: Health records are maintained for each service user. Service users records examined during this inspection demonstrate that the service user had access to routine health checks and specialist health care. Significant events and accidents are recorded and monitored. All service users are registered with a local General Practitioner. The home employs the Boots blister pack system and the local pharmacist visits the home to offer advice. The staff team at the home now keep an individual record of incidents on service user’s files. Staff members monitor service user’s health and maintain up to date records. All of the staff team have received in house medication training form the acting manager. However this is not ‘accredited’ training. The home must ensure that all staff who give medication undertake such training as a priority. All medication records were complete at the time of the inspection. Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 15 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 standard(s) 22 and 23 There is a complaints policy and procedure, which facilitates good access to the complaints system for the residents, their family or their representatives. The home has the appropriate policies in place to ensure the protection of vulnerable service users. EVIDENCE: The home has a detailed complaints procedure. A pictorial format of this procedure has been developed and provided to service users. In addition this procedure is available in video format. The Acting Manager said that no complaints have been made to the home since the last inspection. There are also policies and procedures in place regarding the protection of vulnerable adults. It is suggested that the home draws up a flow chart in order that all staff are aware of the action to be taken in regard to adult protection. The homes acting manager stated that the staff team are due to complete a refresher course on adult protection issues. The staff team are aware of the action they must take if they need to report an incident. Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 16 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 standard(s) 24, 25, 27, 28, 29 and 30 Service user’s bedrooms provide privacy and reflect individual interests and preferences. The home is homely, bright and clean with the necessary adaptations in place, thus providing the service users with safe, comfortable surroundings that meet their needs. EVIDENCE: The home is a two story building in a residential road. It is situated between Kingston and Tolworth and is close to local shops and amenities. There is a large communal lounge on the ground floor as well as a kitchen/dining room. The furniture is domestic, flame retardant, and of reasonable quality. The home does not have a lift and all service users are ambient. There has been some improvements in the décor of the home since the last inspection and there is an ongoing programme of planned refurbishment. Since the last inspection the carpets have been replaced throughout the home. The home was very clean and hygienic and free from offensive odours through out on the day of the inspection and systems are in place to control infection in accordance with relevant legislation and published professional guidance Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 and 36 The retention of staff has improved the consistency with which service users needs are being met. Staff training has resulted in staff being more confident in their work with the service users and adopting a team work approach. However these improvements may not be maintained unless a permanent manager is appointed to the home who will need to monitor the training needs of the staff group and the frequency of staff supervision is increased. EVIDENCE: The home offers training opportunities to staff at all levels within the home. New members of staff complete an induction programme covering various subjects including health and safety, fire drills, and introductions to service users and other staff. The induction programmes are signed, dated and kept on staff files. Criminal Records Checks are completed before a new member of staff can begin work in a home. Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 18 The home has had a change in management in the last year. Gerald Nadal is the acting manager at Acorn Lodge pending the appointment of a qualified and experienced permanent manager. Mr Nadal is a very experienced and well qualified manager although he has stated that he is not interested in the permanent manager’s post. Mr Nadal has overseen a number of changes within the home including meeting many of the requirements from previous inspections. However there is a need to implement more regular supervision in line with standard 36. The acting manager is currently undertaking all staff supervision. It is suggested that the senior support workers could undertake the supervision of junior staff following appropriate training. The acting home manager has incorporated more information sharing and basic value training to the staff meetings, which he feels has raised awareness of service user’s rights amongst the team and introduced a more service users, led approach. There are at least two staff members on duty during the day plus the manager. Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 Although there has been an appointment of an acting manager there is a need for the appointment of a permanent manager to continue to develop the home. The residents are beginning to see the benefits of a stable staff team and a continuity of approach this generates. However for residents and their advocates these developments need to be consolidated and built on in order for them to be confident that their best interests are safeguarded, their views are taken into account and the home is well managed. EVIDENCE: The home has yet to appointment a permanent manager who has the ability to manage the project and build on the work the acting manager has undertaken. The home has not implemented a quality assurance system that should include service user, relatives, staff and outside professional questionnaires. In addition there was no evidence of an annual audit. The acting manager completes a monthly manager’s report and this is discussed with the Directors of the home and efforts are made to meet any concerns or improve the Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 20 service. The home has an annual development plan and a business plan for 2005-06 which were both seen during this inspection. A senior member of staff said that he was well supported he said that the home is running very well with good management and a positive staff team. Records required for the safety and well being of service users are in place including accidents, water temperatures, complaints, incidents, food records, fire records, staff and service user’s case files, medication records. Fire drills are now up to date and a fire risk assessment is in place. The system for consultation with service users, families, stakeholders and other interested parties is poor. Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 2 x 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 2 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x x 3 Standard No 31 32 33 34 35 36 Score x x x x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Acorn Lodge Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x 3 x G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 22 YES 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 YA3 Regulation 18(1) Requirement Timescale for action 31/10/05 2. YA5 5 3. YA6 15 4. YA6 12(2) The registered person must ensure that all staff receive specialist training in learning disabilities and other training appropriate to the work they undertake in the care home. 31/10/05 The registered person must ensure the service users statement of terms and conditions is revised to include all elements of standard 5.2 and the registered person must ensure that agreements with purchasing authorities make clear responsibility for the funding of day activities, including what is and is not included within existing agreements, including this in contracts with individual service users. The registered person must 31/10/05 ensure that the service users plan contains all elements of standard YA6 The Registered person must 31/10/05 ensure that all restrictions are recorded in the Service User Plan after agreement with the purchasing authority and service user, risk assessments Version 1.30 Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Page 23 5. YA7 12(4) 6. YA20 13(2) 7. YA35 12 8. YA36 18(2) 9. YA37 8 10. YA39 24 completed as appropriate, and further support provided to service users to understand advocacy services available to them in the area. The Registered Provider must ensure that service users choose their key worker, that the key worker is able to develop a relationship with the service user they support, receives training and support to meet individual needs, with attention to gender, age, cultural background and personal interests. The registered person must submit evidence to the CSCI, local office to show that all staff who administer medication have received accredited training. The registered person must ensure that all staff undertake disability equality training, race equality and anti-racism training. The registered person must ensure that all staff at the home have formal supervision in line with standard 36 to include all elements of 36.4 The registered person must appoint a manager to manage the care home and give notice to CSCI of the name of the person so appointed and ensure that the person so appointed comples the appropriate application form for registration purposes. The registered person must ensure the home has an effective quality assurance system in place to ensure the home is meeting is stated aims and objectives. This should include surveys of service users, stakeholders and other interested parties and the registered person must ensure that an annual audit of the home 31/10/05 31/10/05 31/10/05 31/10/05 31/10/05 31/10/05 Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 24 takes place at least once a year. 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 YA6 Good Practice Recommendations It is strongly recommended that all service users have a person centred care plan which is reviewed at least every six months. Acorn Lodge G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor, Grosvenor House 125 High Street, Croydon CR0 9XP National Enquiry Line: 0845 015 0120 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 G53-G53 S13386 AcornLodge V211780 210605 Stage 4.doc Version 1.30 Page 26 - 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. 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