CARE HOMES FOR OLDER PEOPLE
Acorn Lodge 14 Abbotts Lane Kenley Surrey CR8 5JH Lead Inspector
Michael Stapley Unannounced Inspection 21st October 2005 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 DS0000048034.V251309.R01.S.doc Version 5.0 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.V251309.R01.S.doc Version 5.0 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 - over 65 years of age (39) registration, with number of places Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A variation has been granted to allow one specified service user under the age of 65 to be admitted. 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’. Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes second statutory inspection during the year 2005/2006. The inspection was unannounced and involved consultation with the registered manager and staff on duty. The inspection took place over one day and during that time a tour of the premises was undertaken, several service users and key members of staff were spoken to. Care plans of service users were examined as well as various records required for the health and safety and wellbeing of both the service users and staff. Comment cards that are routinely sent out by the Commission for Social Care Inspection during the inspection cycle for 2005-06 were received from ten service users and nine of their relatives and were all very positive about the care and services provided. Comments were also received from a number of care managers, one described the home as having a “warm and conductive atmosphere” while another commented that the appointment of a permanent manager “is a welcome development and should give stability to the home” Most of the service users suffer from dementia however several were spoken to during the course of the visit and two members of staff were spoken to on an individual basis. No complaints have been made about the service since the last inspection either to the home or directly to the Commission for Social Care Inspection. What the service does well:
This home provides a safe and comfortable environment for service users, the majority who have some form of dementia. Although communication can be difficult with them one commented that he “felt very happy here “and another that the”food was very good”. Relative’s comments reflect that they are always made welcome and they are appreciative of the care and service that is provided. They all perceived that staff always had time to spend with the service users and respected their individuality. The daughter of one service user commented on how much her mothers’ quality of life had improved since she moved into the home. This home provides a safe and comfortable environment for service users, the majority who have some form of dementia. Although communication can be difficult with them one commented that he “felt very happy here “and another that the”food was very good”. Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 6 Staff come from a wide range of nationalities however their language skills are good and pose no problems. On the day of this inspection they were seen interacting in a positive manner with service users. What has improved since the last inspection? What they could do better: All of the previous requirements have now been met. The only requirement made during the course of this inspection was that the home makes suitable arrangements for an assessment by an occupational therapist for adaptations and equipment. Although the home has had such an assessment this occurred three years ago. Given the age of the service user’s at the home the registered manager and inspector both agreed there was a need to update the assessment to ensure further adaptations were not needed. In addition although the home offers service users a wide range of activities it was noted that a number of staff were still reluctant to become involved with such
Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 7 activities. The home has appointed an activities coordinator; while this is to be commended the inspector noted that this is only for one day each week. The home should consider increasing these hours to ensure that service users have a wider range of activities. It is to be hoped that with this appointment the activities coordinator will be able to use her knowledge and expertise to encourage the staff to become more involved in activities with service users. The inspector spoke to two relatives at some length who raised a number of concerns regarding the home. Comments regarding these concerns are detailed under standards 16-18 “Complaints and Protection” 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 DS0000048034.V251309.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 All service users admitted to the home have a full and comprehensive pre admission assessment usually undertaken by the homes deputy manager. This ensures that the home is fully able to meet the needs of anyone who moves into the service. Standard 6 does not apply, as the home does not offer intermediate care. EVIDENCE: The care plans of the last three service users who had been admitted were examined. These were comprehensive and showed that risk assessments and manual handling assessments had been duly completed. Activities of daily living had been assessed and physical and psychosocial needs examined. The home’s management team undertakes these assessments and they form the basis for subsequent care planning. Where possible the relatives of service users are involved in this process. Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 All health care needs of potential residents are assessed prior to admission and the care plans illustrated that these needs are reviewed regularly. In this way the home ensures that it remains able to meet these needs. EVIDENCE: A sample of service users care plans were inspected and showed evidence of regular review and in some cases the involvement of relatives. The advanced stages of dementia many of the service users preclude their involvement. Since the last inspection there had been several minor falls, while none have required admission to hospital all have been clearly and accurately recorded in the accident book. There were no service users with pressure sores at the time of the inspection. Staff were seen interacting with service users in a positive manner and were treating them with dignity and respect. Despite care staff coming from a wide range of nationalities they were able to communicate well and effectively with the service users. The last inspection by the pharmacist for the home was on 24th February 2005 and all requirements from the visit have been complied with. During the
Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 11 course of the inspection it was noted that on one service users MAR chart it had indicated that seventeen tablets had been given whereas only seven had been used. The manager advised that this had occurred has a service user who had recently been admitted to the home brought medication with her. Inspection of MAR sheets at this inspection were all found to be correct and in the case of service user having medication upon admission a clear note is made on the MAR sheets. The requirement made at the last inspection has therefore now been met. All staff that administers medication has received appropriate training. Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. It can be difficult to communicate with some of the service users in this home, and many of them appear to appreciate a quiet and peaceful life and the pleasant surroundings, which the home provides to enable them to do so. Care staff are encouraged to assist service users to maintain a degree of independence and participate in social activities if they choose. Visitors are encouraged and always made welcome. EVIDENCE: The inspector had the opportunity to meet with two relatives of service users who expressed a number of concerns about the home. These are in the process of being addressed by the manager and comment is made under “Complaints and Protection”. Evidence from comment cards received during the course of the inspection cycle 2005/06 showed that visitors are always made most welcome. The ethos of the home is to develop an open transparent culture in which families and relatives can feel that service users are being well cared for. On the day of the inspection, various activities were the order of the day and care staff at the home was actively encouraging service users to participate. However some of the staff still appeared reluctant to take part in activities and
Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 13 it is to be hoped that with the appointment of an activities coordinator this issue can be addressed. The manager said the activities programme was seen as pivotal in the development of service users at the home. The advanced stages of dementia of the service user’s means that they appreciate a degree of routine in their daily lives however staff were seen encouraging them to exercise as much choice as they are able. Lunch was not taken at this visit although comments from service users and their respective families are extremely positive, save for comments from two relatives – see “Complaints and Protection” There is a reasonable choice for service users and the menus are reviewed on a regular basis in consultation with service users, relatives and friends. The amount of food actually eaten is duly recorded if there are concerns regarding appetite. In addition the weight of service users is monitored and any adverse concerns are referred to relatives and/or GP. It is suggested that advice be sought from a dietician when service users have lost weight since admission. Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Residents in the home and their relatives are confident that complaints would always be treated seriously and acted upon promptly. The staff within the home is aware of and work within the Local Authority guidelines for the protection of vulnerable adults and refer any allegations of abuse under the London Borough of Croydon’s Vulnerable Adults Procedure. EVIDENCE: The complaints record was checked and there had been no entries since the last inspection. The complaints book and associated procedure is available on request and it is included in the homes statement of purpose. Service user’s Families and Relatives are aware of the procedure to be followed should they wish to make a complaint. Given that the home has regular meetings with service users that both Families and Relatives are able to attend it is not surprising that there have been no complaints since the last inspection. The culture of the home and the transparent manner in which all the staff work lead to a confident approach when managing concerns or complaints. All of the staff members that were spoken to displayed knowledge of adult abuse procedures and all felt confident that they could approach the homes management team with any concerns. All of the staff has now completed Adult Abuse Awareness training. The manager has drawn up a flow for ease of reference for all staff to ensure the correct procedures are followed when reporting any allegation of adult abuse. The inspector spoke to two relatives
Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 15 during the course of this inspection regarding a number of concerns they had regarding their parents. They both advised the inspector they thought that service users did not have enough food to eat and that their Father’s food was not cut up. In addition they had concerns regarding their parents clothing and the loss of property. An impromptu meeting was held between the relatives of the service users, the registered manager and the inspector to discuss these and other issues. The manager agreed to investigate all these concerns and advise all parties in writing accordingly. Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 16 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, 22, 24 and 26. The home is well maintained with due regard to the health and safety of both staff and service users. It is clean and provides a pleasant place to live with a homely and cheerful atmosphere. EVIDENCE: The home is in a pleasant residential area and is in keeping with surrounding properties. During the course of the past twelve months much of the home has been redecorated and looks much brighter. There is a delightful rear garden that has been well maintained and it accessible to all service users who enjoy it in the summer months. The home had an inspection from the local authority’s food safety officer in December 2004 and the two requirements from that inspection have been complied with. In addition the home had an inspection from the fire officer on 12th October 2005. There was one requirement from that inspection that has to be completed by 17th January 2006. The requirement relates to the serving hatch between the kitchen and the dinning room. In the event of a fire the said hatch must close automatically due to
Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 17 spread of fire and smoke. The registered manager advised that work to meet this requirement would shortly be carried out. Service user bedrooms are pleasant and they have been personalised by their occupants. Most of the bedrooms contain all of the furniture and fittings as per standard 24. Where a service user has made a decision not to have a particular item of furniture or if the space is inadequate this is duly recorded. All radiators are covered and windows have been fitted with restrictors. Laundry facilities are small but adequate and the home is generally odour free. Alternative floor covering has been provided in five bedrooms for those service users who are incontinent. There are two sluices in the home, which are kept locked. Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 18 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 and 30. There are sufficient staff on duty that collectively have the skills and experience to provide a good level of care for the service users in this home. Robust recruitment procedures and staff training ensure that service users are well cared for. EVIDENCE: Staff turnover in the home is relatively low; many of the staff has been with the home for some years. There is now a good balance of staff. Three experienced senior staff support the manager while there are an enthusiastic team of carers. Many of them have gained an NVQ level 2/3 qualification and some are planning further studies. A number of staff files were inspected at random and all those inspected complied with the standard. Copies of their induction programme were seen. No new member of staff is employed until POVA and CRB checks are complete. There is now a through training programme in place and staff spoken to confirmed that they had been able to access training. Records of Supervision and appraisal were both available for inspection and take place in line with the standard. Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. The home benefits from a strong staff team with good leadership, which ensures a high standard of care. Attention to health and safety procedures means that the wellbeing of service users is maintained. EVIDENCE: The registered manager is well qualified and experienced to manage the home. She is an effective leader who supports her team for the benefit of the service users at the home. She has excellent interpersonal skills and operates in an open and transparent manner. Meetings are held for service users on a monthly basis and relatives/friends are always welcome to attend. Staff meetings are held every month and minutes of the last three meetings were evidenced. It is suggested that staff some them to ensure they have read them. The results of a quality assurance audit were seen and this will be repeated at least yearly.
Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 20 The home does not take responsibility for the financial affairs of any of the current service users. Maintenance records were seen and were all in good order. Fire safety requirements had all been complied with; save for one requirement, which the manager advised, will be completed shortly. The home has the appropriate insurance policies in place. Kitchen practices were good and all staff have received appropriate health and safety training. Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 17 X 18 3 3 X X 2 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 22 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 The registered person must make suitable arrangements for an assessment of the home by an occupational therapist to ensure suitable aids and adaptations are provided for service users. Timescale for action 1 OP22 12 31/12/05 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 Acorn Lodge DS0000048034.V251309.R01.S.doc Version 5.0 Page 23 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
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