CARE HOMES FOR OLDER PEOPLE
Acorn Lodge Turners Hill Road East Grinstead West Sussex RH19 4LX Lead Inspector
Mrs M McCourt Unannounced Inspection 29th November 2006 11:00 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 DS0000024100.V321202.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 DS0000024100.V321202.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Acorn Lodge Address Turners Hill Road East Grinstead West Sussex RH19 4LX 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) 01342 323207 Acorn Health Care Limited Mrs Mary Ann Wattam Care Home 33 Category(ies) of Dementia (33) registration, with number of places Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Up to 33 male and female service users in the category of Dementia to be admitted / accommodated. No service users under the age of 65 years to be admitted. Date of last inspection 23rd November 2005 Brief Description of the Service: Acorn Lodge is a care home providing personal care and nursing for thirtythree residents in the category of elderly dementia care DE(E). The registered provider is Acorn Healthcare Ltd. The Responsible Individual is Mr V Ghugroo and the Registered Manager is Mrs Mary Wattam. The home is a large detached property located just outside the town of East Grinstead, West Sussex. The accommodation is provided in seventeen single rooms and eight double rooms, arranged over three floors. A vertical lift provides access to all floors. Communal facilities include four lounges and a dining area located on the ground floor. There are extensive grounds with private car parking to the rear of the property. Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection was undertaken by one Inspector on Wednesday 29th November 2006, lasting a total of eight and a half hours. Preinspection planning took approximately two days. Preparation for the inspection included review of information, the request and examination of a Pre-Inspection Questionnaire, the reading of various policies and procedures, including; admissions/referral procedures, staffing rotas, menus, complaints policy and any complaints received by the Commission for Social Care Inspection. A full tour of the building took place and included the observation of health and safety matters, hygiene issues, decorative order and a general overview of the atmosphere created within the home. Four staff members, three visitors and the Registered Manager were all spoken with at the time of inspection. Case tracking was carried out by examination of relevant records and information held on the staff and residents. The Inspector also spoke briefly with four Service Users accommodated at the home. Policies and procedures were examined during the site visit. What the service does well:
Acorn Lodge is a large detached property set in beautiful surroundings with Service Users benefiting from extensive grounds. The interior of the home is spacious and is well decorated and maintained throughout. There is plenty of communal space, including four lounges and a dining room. Staff are aware of the need to treat residents with respect and dignity at all times. Observation of staff interaction was positive and appropriate. The Inspector spoke with some relatives and was told that the home provides a good level of care. One visitor said that the care provided by the home is wonderful and she cannot fault anything. The visitor said that she believes that her relative is being well cared for. “Staff are always polite and caring.” Another relative told the Inspector that their family member’s health had significantly improved since being admitted to the home. The visitor said that Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 6 “residents are looked after with dignity and respect and the relatives are really looked after well too.” Staff have attended POVA training and discussion with several staff members demonstrated that they have a good level of understanding regarding Adult Protection. A high percentage of staff have obtained NVQ level 2 or above. What has improved since the last inspection? What they could do better:
There were no contracts found to be in place for social services placed Service Users. They do have the placing authority’s agreement, but nothing between the home and the provider. Service Users do not have copies of the agreement from the placing authority. They are kept in a filing cabinet in the office. Not all private residents have contracts either. The Inspector looked at a sample of records and found that at least three private paying residents did not have a contract in place. The registered provider must ensure that appropriate steps are taken to remedy this situation and a requirement has been made in respect of this. Medication is stored in a designated room. Stock is stored in cupboards whilst current medication is stored in a moveable medicine cabinet. On examination of stock control the Inspector found many discrepancies in both the storage and administration of medicines and a referral has been made to the Pharmacy Inspector for further advice. The complaints procedure was returned with Pre-Inspection Questionnaire material. It was seen on display at the entrance hall within the home. A log
Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 7 book and forms are available as part of the complaints procedure. There have been no complaints logged. On discussion with the Registered Manager, the Inspector was told that complaints or concerns raised by either Service Users or relatives are dealt with “at the time.” The Inspector advised that all complaints, regardless of how minor should be recorded There is little in the way of quality assurance. The Registered Manager said that she has tried obtaining relatives views but it did not work. She will apply to attend quality assurance training for insight and advice on seeking the views of people who use the service and their relatives. There is a formal system of supervision for staff, but it is currently not being held as regularly as the standard recommends. 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 DS0000024100.V321202.R01.S.doc Version 5.2 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 DS0000024100.V321202.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service Users must be in possession of a written contract/statement of terms and conditions with the home. The Registered Manager must ensure that assessed needs are transferred into care plans and individual requirements fully met by the home. Service Users assessed and referred solely for intermediate care are helped to maximise their independence and return home. EVIDENCE: A Statement of Purpose is available at the home, and in addition there is a notice in the hallway reminding visitors to ask for it. It is comprehensive and explanatory.
Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 10 There were no contracts found to be in place for social services placed Service Users. They do have the placing authority’s agreement, but nothing between the home and the provider. Service Users do not have copies of the agreement from the placing authority. They are kept in a filing cabinet in the office. Not all private residents have contracts either. The Inspector looked at a sample of records and found that at least three private paying residents did not have a contract in place. The registered provider must ensure that appropriate steps are taken to remedy this situation and a requirement has been made in respect of this. The Registered Manager carries out assessment prior to admission. Assessments looked at for three residents were all in place. Those looked at also had care plans in place, although it was not clear on what information plans were based as specified needs are not always transferred across to the plans. Although the home tries to avoid providing intermediate care, there have been admissions on that basis. Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 11 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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are in place detailing personal care needs, although they must closely reflect assessed needs. There are discrepancies with the medication system and the Inspector has made a referral to the Pharmacy Inspector for further advice. Staff were observed to treat Service Users with respect. EVIDENCE: Care plans are in place with review sheets. Those looked at had been reviewed regularly, usually monthly in the first few months following admission, then every three months, unless more frequent monitoring is required. As previously highlighted, care plans do not always reflect information documented in assessments prior to admission.
Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 12 Health care is provided as necessary and records were seen for various health professionals, including dental, ophthalmology, occupational therapy and so on. Visits are made to the home regularly following referral. Resident’s health is monitored on a regular basis with daily records written up. Medication is stored in a designated room. Stock is stored in cupboards whilst current medication is stored in a moveable medicine cabinet. On examination of stock control the Inspector found many discrepancies in both the storage and administration of medicines and a referral has been made to the Pharmacy Inspector for further advice. Staff are aware of the need to treat residents with respect and dignity when delivering personal care. Observations of staff interaction was positive and appropriate. The Inspector spoke with some relatives and was told that the home provides a good level of care. One visitor said that the care provided by the home is wonderful and she cannot fault anything. The visitor said that she believes that her relative is being well cared for. “Staff are always polite and caring.” Another relative told the Inspector that their family member’s health had significantly improved since being admitted to the home. The visitor said that “residents are looked after with dignity and respect and the relatives are really looked after well too.” Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 13 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users do maintain contact with family and friends, with visitors welcomed into the home. Menus show that the home provides nutritional and varied meals. EVIDENCE: The home provides some recreational activities, such as; Music for Health, with the use of instruments and reminiscence work. The Registered Manager said that due to the residents level of mobility and other health issues, there is very little that they can access. The Inspector observed visitors coming and throughout the day. Three visitors were spoken with and all were very complimentary about the running of the Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 14 home, particularly the staff, the surroundings and the care offered to their relatives. The home has a set menu, and alternative meals are made as and when required. Service Users spoken with generally said that the food was nice. Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 15 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although a complaints procedure is in place, there have been no logged complaints and the Registered Manager must ensure all complaints are logged, regardless of how minor. Staff are trained in Adult Protection and there are good awareness levels among the team. EVIDENCE: The complaints procedure was returned with Pre-Inspection Questionnaire material. It was seen on display at the entrance hall within the home. A log book and forms are available as part of the complaints procedure. There have been no complaints logged. On discussion with the Registered Manager, the Inspector was told that complaints or concerns raised by either Service Users or relatives are dealt with “at the time.” The Inspector advised that all complaints, regardless of how minor should be recorded. Abuse policies and procedures are in place. The West Sussex County Council Adult Protection procedures were available in the office. Staff have attended Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 16 POVA training and discussion with several staff members demonstrated that they have a good level of understanding regarding Adult Protection. Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 17 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, 20, 21, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users live in a safe and well maintained environment. Where Service Users share a room, confirmation of their agreement should be recorded on personal files. EVIDENCE: Acorn Lodge is a large detached property set in its own grounds. It is a lovely setting with extensive gardens. A tour of the premises found the entrance hall to be well organised with details on how to access various documents, including the Statement of Purpose. The home has a spacious layout and is well decorated and maintained throughout.
Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 18 There is plenty of communal space, including four lounges and a dining room. The Inspector could not detect any odour from the interior of the home. The kitchen is a good size with fridges and freezers kept in good order. However, under the milk dispensing machine there were cleaning products being stored, such as; washing powder and bleach. The Inspector advised that these were too close and should be moved, which the manager arranged immediately. The Inspector noted that although some rooms are shared, Service Users are not always fully aware that they are sharing a room. The Registered Manager said that Service Users don’t know that they are sharing, although it is discussed with the family prior to admission. The Inspector was of the opinion that the manager should ensure that were possible Service Users are made aware of the fact that they are sharing a room and that confirmation is sought from either them or relatives, and is recorded. Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 19 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 and 30. Quality in this outcome area is good. . This judgement has been made using available evidence including a visit to this service. Service Users’ needs are met by the numbers and skill mix of staff. Service Users are protected by the home’s recruitment policy and practices. Staff do receive training in specific and mandatory subjects. EVIDENCE: The home employs twenty-nine staff, including; ten nurses, thirteen carers, two cooks, one laundry assistant and two cleaners. The rota shows that six staff work 7am to 2pm and five staff work 2pm to 8pm. The Registered Manager said that there is always one registered nurse on shift. Nine staff hold NVQ level 2 or above. Ten are qualified nurses. The Registered Manager is also a qualified nurse. Staff spoken with confirmed that they do receive mandatory training and the manager said that all staff received dementia training last year. Recruitment records were seen and found to be in place for those sampled.
Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 20 Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 21 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, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users benefit from a well run home with clear lines of accountability. The Registered Manager should ensure that quality assurance systems are in place for seeking the views of Service Users, relatives and other professionals. Staff should receive supervision on a regular basis to ensure continuity of care is provided. The general health, safety and welfare of Service Users and staff are promoted. EVIDENCE: Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 22 Mrs Mary Wattam is the Registered Manager and has managed Acorn Lodge for approximately eleven years. She is a qualified RMN and has just completed her RMA. There is little in the way of quality assurance. The Registered Manager said that she has tried obtaining relatives views but it did not work. She will apply to attend quality assurance training for insight and advice on seeking the views of people who use the service and their relatives. There is a formal system of supervision for staff, but it is currently not being held as regularly as the standard recommends. The Registered Manager agreed to look into improving the frequency of supervision. Team meetings are held, although again, not regularly. There were only two sets of minutes seen for 2006. Mandatory health and safety matters are monitored by the home. Environmental risk assessments and fire risk assessments are in place and were reviewed in May 2006. Equipment checks are carried out weekly and records were seen. Fire drills are carried out every six months with the Fire Training Officer who does a full fire frill with all staff present. These were recorded as being done on 6/7/06 and 9/2/06. All policies and procedures were reviewed in June 2006. Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 23 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 1 2 x 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 3 3 x 3 3 3 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 2 3 3 Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 24 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 OP2 Regulation 5(c) & 3 Requirement Timescale for action 31/03/07 2 OP9 13(2) The registered person shall produce a written guide to the care home which shall include; a standard form of contract for the provision of services and facilities by the registered provider to Service Users. The registered person shall make 31/03/07 suitable arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. 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 OP7 Good Practice Recommendations 7.2 – The Service User’s plan sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the Service User (see standard 3) are met.
DS0000024100.V321202.R01.S.doc Version 5.2 Page 25 Acorn Lodge 2 3 4 OP8 OP16 OP36 8.7 – The Service User’s psychological health is monitored regularly and preventive and restorative care provided. 16. 3 – A record is kept of all complaints made and includes details of investigation and any action taken. 36.2 – Care staff receive formal supervision at least six times a year. Acorn Lodge DS0000024100.V321202.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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
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