Inspection on 27/09/07 for Acorn Residential Home

This inspection was carried out on 27th September 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Acorn Residential Home 06/10/06

Acorn Residential Home 31/01/06

Acorn Residential Home 08/09/05

Acorn Residential Home 23/08/04

Acorn Residential Home 16/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Acorn Residential Home 47 Mitcham Park Mitcham Surrey CR4 4EP Lead Inspector Emma Dove Unannounced Inspection 27th September & 2nd October 2007 3:00 Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 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 Residential Home DS0000027205.V348842.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acorn Residential Home Address 47 Mitcham Park Mitcham Surrey CR4 4EP 0208 648 6612 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) Mr Kanagaratnam Nithiyananthan Mrs Yoheswari Nithiyananthan Mrs Yoheswari Nithiyananthan Care Home 8 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2007 Brief Description of the Service: Acorn Residential Home is a registered care home providing care and accommodation for up to eight adults with a learning disability, eight people are living there. The home is owned and managed by two private individuals. The property is a large two-storey house located in a residential area of Mitcham close to shops and public transport. Accommodation is provided over two floors. All bedrooms are single. A lounge, dining room, kitchen, staff office, three bedrooms and a bathroom are on the ground floor. Five bedrooms, a staff room and bathroom are on the first floor. Fees vary, depending on peoples needs and income, information about costs in addition to the fees is included in contracts and the Statement of Purpose. Information about the CSCI is displayed at the home. Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over three hours on the 27th September 2007 and three hours on the 2nd October 2007. The inspection was carried out by one regulation inspector and included looking at records, looking around communal areas and three bedrooms, speaking with people who use the service, the owner, manager and staff. Questionnaires were sent to people who live at the home, two relatives, one health professional and one placing social worker. We have received three questionnaires and comments are included in the relevant section of this report. An Annual Quality Assurance Assessment was returned in good time for the information to be included in this report. No other information has been received about the service. What the service does well: What has improved since the last inspection? What they could do better: Explore the use of meetings for people who use the service to ensure that all people are able to raise issues. The manager and staff should complete training in Person Centred planning. The manager reported that some barriers to improvements have been around staff members availability to attend training courses, people who use the service taking longer to achieve tasks due to their physical or mental disability, Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 6 the time staff have to spend completing paperwork and the lack of certain training courses in the community. The portable electrical appliances must be tested every year to ensure peoples health and safety is protected. 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 Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 People who use this service receive adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The service has developed a Statement of Purpose and Service Users Guide, which set out the aims and objectives and services provided. This information is available in a standard format. Assessments are completed before admission. People who use the service have a contract of residence. EVIDENCE: A Statement of Purpose and Service Users Guide have been developed, which include details of the services provided and what people can expect from the home. These documents are available in written format, which is not fully accessible to people who currently use the service. The manager reported that they welcome prospective people to the home after receiving an assessment from a placing social worker. People are invited to visit the service, look around, meet staff and other people living there before arrangements are made for someone to move in. A settling in period is included in the contract when people can change their mind about moving in. Assessments were seen to be in case files. Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 9 People have a contract of residence with the service, which has been updated to reflect additional charges made for purchasing toiletries, fizzy drinks and car journeys to the shops, bank and hospital. Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The service recognises the rights of individuals to take control of their lives and to make their own decisions and choices. There is evidence that individuals are involved in some decision-making, but this could be improved. Care plans are working documents which are reviewed regularly. EVIDENCE: Care plans were seen to be in individuals case files with a separate Person Centred Plan (PCP). The PCP includes people’s likes, dislikes, details of their life, their weekly timetable and their best day. People have developed goals, including what they want to buy and where they want to go on holiday, which they are supported to achieve. The manager reported that people who use the service manage their lifestyle and finances with help from staff. Three people confirmed that they are involved in decision-making. However the choices people make are quite Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 11 limited to what they are used to, with little changes to their routines and lifestyle over the years. No issues were raised regarding equality and diversity. Information from the local authority about individuals was found to contain incorrect information. When information is received from a third party, it should be checked with any errors noted and returned if necessary. Risk assessments have been completed and reviewed annually. Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16 and 17 People who use this service receive adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Generally staff are aware of the need to support people to develop and maintain their social and independent living skills. People are consulted about the choice of daily activity, although this process could be improved as there is limited choice and knowledge of clubs and groups available. People are supported to maintain contact with relatives and friends. The menu is varied. EVIDENCE: Most people attend day centres and some go to college classes of their choice one day a week. Three people said that the activities available to them were ‘good’. One person said that they spent most of their time watching television and get up and go to bed when told and this was ok with them. A weekly outing list is displayed in the dining room, people can attend the ‘Gateway Club’ one evening, with weekly trips to the bank, shopping and the Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 13 library. An outing can be arranged some Saturdays and people can attend church on Sunday. People were now seen to return from their day centre and have a bath and hair wash and get dressed into casual clothes, rather than their pyjamas, which is more dignified for individuals. The manager reported that she looked into local activities, clubs and groups for people to attend during the evenings and at weekends. She has developed a matrix of events and cost implications for individuals. These outings and activities were discussed with relatives and people who use the service and an agreement made for no changes to the current groups people attend. The manager reported that an area they plan to improve in the next year is to encourage people to make friends in the community. All eight people who use the service, the manager and staff had recently returned from a holiday to Butlins. Some people confirmed that this had been the holiday of their choice and that they had enjoyed it. Meals are varied and meet peoples medical and religious needs and preferences. People were not seen to be involved in meal preparation but confirmed that they carry out household tasks on a regular basis and that this is alright. Three people who use the service said that they like the food. Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs are recorded. People have access to appropriate healthcare professionals with one exception. More attention could be given to the changing needs of people who use the service. The home has an efficient medication policy which staff understand and follow. Medication records are fully completed and signed by staff. EVIDENCE: People’s health care needs are noted in case files. People are registered with a GP and access both community and specialist health professionals as required. The manager reported an issue with getting support from the district nurse services and specialist nurses to get information and advice for individuals. If specialist medical care and advice is not forthcoming, staff must react quickly to ensure peoples health needs are fully met. Three people said that they feel well cared for. The manager reported that they maintain peoples privacy and dignity. Three people confirmed that their privacy is respected. However a list is displayed in the dining room of the Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 15 night each person has a hair wash. This list and the practice of a regular night for hair washing is very institutional and does not demonstrate that people have control over their personal care. Appropriate medication policies, procedures and practices are in place. Staff complete training in the administration of medication. Medication is stored, labelled and recorded correctly. Medication Administration Record Sheets were up to date and signed. Risk assessments are completed and some people who use the service administer their own medication Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use this service receive adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure which is available for people who use the service and their representatives, it is only in a written format and should be more accessible to all people who use the service. Most people are aware of how to make a complaint. Policies for safeguarding people are in place. Staff complete training in the protection of vulnerable adults. EVIDENCE: The complaints procedure is available in written format and is displayed in the dining room. The manager reported that there have not been any complaints or concerns about the quality of care or services provided since the last inspection. Three people knew who to speak to if they had any concerns. One person said that they would speak with the manager, another person said that they would speak to a family member and another person said that they would speak to their social worker if they were worried. One person wasn’t sure who they would speak to, but hadn’t got any complaints. No concerns were raised at this visit. The manager reported that staff have completed training in the protection of vulnerable adults. Two staff confirmed that they have done the training. Three people said that they feel safe living at the home. Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 17 Some money is held for most people who use the service. The records are clear, easily understood and balances were correct. The manager reported that the placing social workers check finances at annual reviews. Records confirmed that this check takes place. Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to meet the needs of the people who live there. Bedrooms are single and people are encouraged to personalise their rooms. All areas were clean and tidy. EVIDENCE: People have access to a kitchen, dining room and lounge. Bedrooms are single. Sufficient bathrooms and toilets are provided. One bathroom did not have curtains at the window and this does not provide full privacy to people who use the service. People who use the service confirmed that they have everything they need in their rooms. One person said that they want a new piece of furniture, the manager is aware and discussed the style required. Two people said that they like their rooms and chose the colour they are painted. All areas of the home were clean and tidy. Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People using the services are happy with the care they receive to met their needs. Staff have access to training. The recruitment process is generally good with appropriate checks completed for most staff. Staff supervision sessions are regular. EVIDENCE: The staff rota noted that two members of staff are on duty during the day with one member of staff asleep but on call at the home at night. The manager reported that she is available at night should more staff be required. These staff levels were seen to be adequate to meet peoples needs. Policies and practices for recruiting staff are in line with legislation. Staff files contain a copy of the individuals application form, two written references for two staff with one staff having just one written reference and a Criminal Records Bureau check. A recent photograph was in place in two staff files and proof of the individuals identity was in one staff file. Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 20 The manager reported two areas which could be improved, to involve people who use the service in staff recruitment in the future and for new staff to complete a three month probationary period before they are confirmed in post. These areas should be developed into an action plan for the service. Three people said ‘staff treat them well’. People who use the service were seen to be comfortable and relaxed at the home, with staff, the manager and owner. The manager reported that they use some of the local authority training, which is good for staff to develop links with other staff groups and to get up to date information on initiatives for working with people with learning disabilities. The manager reported that she supervises staff to carry out their jobs. Staff confirmed that they are supported to do their jobs. Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the necessary experience to run the home. The manager trains and develops staff. Health and safety policies, procedures are in place with most of the checks completed and up to date. EVIDENCE: The home is a small family run business, which has been operating for twelve years. The manager demonstrated knowledge of people who use the services and their needs. The manager completes an annual quality assurance check of the services provided with the help of one person who uses the service. The results of Acorn Residential Home DS0000027205.V348842.R01.S.doc Version 5.2 Page 22 these surveys has been positive with people saying that they are happy living at Acorn and want to remain there. The manager reported that an area to develop in the next year is to consult with people using the service about the décor in the home. Appropriate health and safety procedures are in place. Checks of appliances are completed at the required intervals with the exception of the portable electrical appliances, which must be checked annually. Acorn Residential Home DS0000027205.V348842.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 2 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 2 3 X 3 X X 2 X Acorn Residential Home DS0000027205.V348842.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 YA42 Regulation 13 (4) Timescale for action The portable electrical appliances 30/11/07 must be tested annually to comply with regulations and ensure peoples health and safety is maintained. Requirement 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 recommended that further discussions are had with people who use the service about individuals daily and weekly routines, to ensure they have detailed knowledge of the benefits of taking part in different activities, clubs and groups. The complaints procedure should be accessible to all people who use the service and all people should be made aware of how to make a complaint. The manager and staff should look at accessing training around person centred planning, to keep up to date with current trends and ensure they are working with individuals to meet their needs. The house meetings should be developed to ensure all people who use the service are able to participate in them. DS0000027205.V348842.R01.S.doc Version 5.2 Page 25 2. 3. YA22 YA35 4. YA39 Acorn Residential Home Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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. 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