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Inspection on 31/01/06 for Acorn Residential Home

Also see our care home review for Acorn Residential Home for more information

This inspection was carried out on 31st January 2006.

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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents gave positive comments on the home. They felt that what was good about the home was that "everyone gets on well here, all races", "the food is very good", "you can get up when you want to" and that they "like it here". Residents were also very complimentary about the staff group and their approach. Staff were described as, "kind", "really nice", "understanding" and one resident said that staff had "helped me through a lot of things in my life".

What has improved since the last inspection?

Since the last inspection of the home new flooring has been laid in the lounge area. An additional chair has been added to the lounge which makes sure that sufficient chairs are available for all of the residents to use the lounge should they so wish.

What the care home could do better:

Further work needs to be done to make care plans accessible to individual residents. Staff must be provided with accredited training on medication and first aid. Each staff file needs to contain an up to date photograph of the member of staff. Staff must not decant hand washing liquid into other containers. The manager must make regular checks on the furnishings, fittings and heating in the home to ensure all areas and furnishings are maintained in good order. To fully ensure the health and safety of residents and any visitors a check on the hot water supplied to all accessible baths and sinks must be carried out on a regular basis.

CARE HOME ADULTS 18-65 Acorn Residential Home 47 Mitcham Park Mitcham Surrey CR4 4EP Lead Inspector Liz O`Reilly Unannounced Inspection 31st January 2006 02:30 Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 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.V282144.R01.S.doc Version 5.1 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.V282144.R01.S.doc Version 5.1 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.V282144.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8thSeptember 2005 Brief Description of the Service: Acorn is a registered care home for up to eight younger adults with learning disabilities. The home is also registered to care for one older person with learning disabilities. The home is owned by the registered manager and her husband. The property is a large two storey house situated in a residential area of Mitcham close to shopping and public transport facilities. Communal areas of the home are situated on the ground floor. Residents bedrooms are on the ground and first floor. The property is not identifiable as a care home. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one regulation inspector on 31st January 2006 over four hours. The inspector had the opportunity to meet with all of the residents and talk with four residents about the home. A sample of records were examined and discussions took place with the registered manager. What the service does well: What has improved since the last inspection? What they could do better: Further work needs to be done to make care plans accessible to individual residents. Staff must be provided with accredited training on medication and first aid. Each staff file needs to contain an up to date photograph of the member of staff. Staff must not decant hand washing liquid into other containers. The manager must make regular checks on the furnishings, fittings and heating in the home to ensure all areas and furnishings are maintained in good order. To fully ensure the health and safety of residents and any visitors a check on the hot water supplied to all accessible baths and sinks must be carried out on a regular basis. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 6 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 Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 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.V282144.R01.S.doc Version 5.1 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 the following standard(s): 1&2 Residents are provided with information on what they can expect from the service through the Service User Guide. The needs of residents are assessed prior to moving into the home. EVIDENCE: The home has produced a Service User Guide which sets out what the home aims to provide for residents and what they can expect from the service. Each resident is supplied with a copy of the Service User Guide. Any prospective residents will be provided with a copy to assist them in making an informed choice about moving into the home. The registered manager confirmed that the needs and wishes of any prospective residents would be assessed by social services and the home prior to them moving in. This makes sure that the home can meet the needs and expectations of any new resident and provides staff with information prior to the resident moving in. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 6&7 Each resident is provided with an individual care plan. Further work to be done to making care plans more accessible to individual residents. Staff support residents to make informed decisions about their lives. EVIDENCE: All residents are provided with their own care plan which sets out the needs and preferences of each individual. The care plan seen set out the physical, family support and social needs and wishes of the individual. The likes and dislikes of residents are noted on the care plan. Care plans were seen to be signed by residents. Staff keep daily notes which provide information on the activities of individuals and details of any care provided. Care plans were seen to be reviewed on a regular basis. Further work needs to be carried out to make the care plans more accessible to individual residents. Consideration should be given to introducing person centred planning in the home. Information and guidance on person centred planning can be accessed via the Valuing People web site on the internet. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 10 Residents confirmed that staff assist them in making choices about their lives. Residents are informed of advocacy services which they can access. One resident stated they were very involved with People First and other groups. Residents are supported by staff to manage their finances. Some residents take an agreed allowance on a regular basis from money held in the home. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 12, 13, 14 & 16 Residents are supported to attend day centres and further education colleges. Residents are aware of the facilities and activities available in the local area. EVIDENCE: At the time of this visit arrangements had been made by the placing authority for the majority of residents to be reassessed in relation to education and occupation as the present service they were receiving was to be changed. Staff were supporting the process of seeking out new education or occupation opportunities for individuals. Residents are well informed about local activities and facilities. Discussions with the registered manager and residents indicated that residents did not regularly take up opportunities for activities in the evenings. The manager informed the inspector that none of the residents wished to attend local clubs such as the Gateway Club. Two residents enjoy going to the cinema and residents informed the inspector that they occasionally make visits to a pub and went out for a meal at Christmas. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 12 The home owners have a vehicle which is used for residents for which a mileage charge is made to individuals. One resident said they had been involved in assessing access to transport in stations for an organisation called Transport for All. Residents were seen to be involved in a variety of domestic activities when they returned from their day centres or colleges. All residents are offered a key to their bedroom. None of the residents hold a key to their front door. All residents are registered to vote. Residents can choose when to be alone or to join the group. All residents have unrestricted access to the home. As noted in previous inspection reports residents are not offered as part of the basic contract price a minimum seven day holiday which they help to choose and plan. Residents do go on holiday as a group which they pay for themselves. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 20 & 21 Medication is stored and administered in an appropriate manner. Staff have sought the views of residents and or their representatives on their wishes regarding terminal care and death. EVIDENCE: Residents are supported to administer their own medication should they wish to do so. One resident administers some of their medication. Risk assessments are in place and regular checks are carried out. The records of medication administered, received into the home and returned to the pharmacy were seen to be well maintained. Staff have made sure that the allergy section of the medication administration sheet is completed which ensures the safety of residents. The registered manager informed the inspector that arrangements had been made for all staff who administer medication to be provided with accredited training on the management of medication in the near future. Since the last inspection of the home the manager has sought the views of residents and or their representatives on what their wishes are regarding action to be taken following death. This ensures that the wishes of the individual will be followed by staff in the home. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 14 Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 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 the following standard(s): 22 The home has a clear complaints procedure which is known to residents and available to visitors to the home. EVIDENCE: The complaints procedure for the home is made available to residents. Systems are in place to record any complaint along with actions taken and outcomes. This makes sure that staff can show that complaints are addressed and action is taken if necessary to change practices. Residents spoken to at this visit were aware of the complaints procedure and expressed confidence in the staff to deal with any concerns they had. None of the residents spoken to had any complaints about the home. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 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 the following standard(s): 24 & 30 Residents are provided with adequate furnishings and the home is clean and tidy. The registered persons must carry out regular checks on furnishings and fittings to make sure all areas and furnishings are maintained in good order. EVIDENCE: Since the last inspection of the home repairs have been made to the cupboard under the sink in the ground floor bathroom however these are not adequate. The cupboard under the sink needs to be replaced or repaired to a good standard. The home owners have added an additional chair in the lounge which allows for all residents to use the lounge at one time should they so wish. Certain areas of the home have suffered water damage from overflowing sinks on the first floor, particularly parts of the hallway and the dining room ceiling, these areas need to be redecorated. At the time of the last inspection a requirement was made for the flooring on the first floor corridor to be replaced. This has not as yet been completed. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 17 The majority of residents spoken to buy their own bedroom furniture. This furniture was seen to be of a good quality. It was noted at the last inspection that the chest of drawers supplied by the home in one bedroom were not sufficiently strong to store the residents belongings. The resident has rearranged how items are stored so that heavy items are not stored in these drawers. It was noted that a handle to the white drawers in this room was broken. The registered persons must ensure that the handle is replaced or new drawers provided. Since the last inspection the owners have replaced the flooring in the lounge. At the time of this visit the heating in the home was not in full working order. Certain areas on the first floor had no heating. Following the visit the registered manager confirmed by telephone that the heating had been restored to all areas of the home. All areas of the home were found to be clean, tidy and free from offensive odours. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 The numbers of staff in the home are sufficient to meet the needs of the residents. Staff are provided with opportunities to take part in training courses. Appropriate checks have been carried out on staff prior to working in the home. EVIDENCE: A minimum of two staff are on duty at all times when residents are in the home during the day. At night one member of staff sleeps on the premises. The manager is aware of the need to keep staffing levels under review should the needs of any residents change. Staff meetings are held on a regular basis. Agency staff are not employed in this home. There are low levels of staff sickness and low staff turnover which ensures that residents are familiar with the staff group and staff have a good knowledge of the needs and strengths of individuals in their care. Two staff are in the process of completing NVQ level two training and three staff are on a waiting list to commence this training. The registered manager informed the inspector that progress was being made for all staff to be provided with first aid training. This will make sure that a qualified first aider is on duty at all times. In house training on record keeping, maintaining a Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 19 clean environment and the protection of vulnerable adults has taken place since the last inspection of the home. Pre employment checks are carried out on all staff including Criminal Records Bureau checks which assist in ensuring the protection of residents. The registered manager must ensure that any new staff provide a full record of education and employment history and that any gaps are suitably explained. An up to date photograph of each member of staff must be held on file. Residents are given the opportunity to meet with any prospective staff and their feedback is noted by the management. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 Further work needs to be carried out to complete the quality monitoring and quality assurance of the home. Staff take steps to promote the health and safety of residents. Further checks must be made in relation to hot water temperatures and the provision of hand washing liquid. EVIDENCE: The registered manager has commenced quality monitoring for the home. The registered persons must carry out an annual review of the service taking into account the views of residents and other stakeholders and produce an annual development plan. A copy of the report produced needs to be supplied to the CSCI. The results of residents surveys must be published and made available to residents and any other interested parties. Weekly checks are carried out on the fire alarm system to ensure it is in good working order. Regular maintenance checks are carried out on the fire alarm system and extinguishers. Checks are carried out on the hot water supplied to Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 21 baths to made sure it is supplied at a safe temperature. The checks on the hot water need to include all hot water outlets accessible to residents. It was noted that the hand washing liquid had been decanted into other containers. The registered persons must ensure that hand washing liquid is provided in the original containers. Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 22 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 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 x ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x x x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 x 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 3 3 x x 2 x x 2 X Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 23 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 YA20 Regulation 13(2) 18(1)(c) Requirement The Registered Persons must ensure that all staff who administer medication are provided with accredited training on the management of medication. The Registered Persons must carry out regular checks on furnishings and fittings to ensure that all areas and furnishings are maintained in good order. Broken furniture must be replaced. The Registered Persons must ensure that the cupboard under the sink is repaired or replaced to a good standard. The Registered Persons must ensure that areas of the home affected by water damage are redecorated. Flooring to the first floor corridor must be replaced. The Registered Persons must ensure that an up to date photograph of each member of staff is held on file. DS0000027205.V282144.R01.S.doc Timescale for action 01/04/06 2. YA24 23(2) 23/03/06 3. YA24 23(2)(b) 23/03/06 4. YA24 23(2)(b) 01/04/06 5. YA34 19 Schedule 2(1) 01/04/06 Acorn Residential Home Version 5.1 Page 24 6. YA35 18(1)(c) 7. YA39 24 8. YA42 13(4) 9. YA42 13(4) The registered persons must ensure that training is provided to ensure that at least one member of staff on each shift is a qualified first aider. The registered persons must supply to the Commission a copy of the report compiled following the annual review of the service. The registered persons must ensure that a weekly check is carried out on the temperature of hot water accessible to residents to ensure water is supplied at a safe temperature. The registered persons must ensure that hand washing liquid is not decanted into other containers. 01/04/06 01/06/06 23/03/06 23/03/06 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 The registered persons should make sure that care plans are produced in a format accessible to individual residents. Consideration should be given to introducing person centred planning in the home. The registered persons should ensure residents in long term placements have the option of a minimum seven day holiday as part of the basic contract price. 2 YA14 Acorn Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Residential Home DS0000027205.V282144.R01.S.doc Version 5.1 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. 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