CARE HOMES FOR OLDER PEOPLE
Acorns 29-31 Welholme Road Grimsby North East Lincs DN32 0DR Lead Inspector
Theresa Bryson Unannounced Inspection 2nd December 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 Acorns DS0000063879.V270308.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. Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Acorns Address 29-31 Welholme Road Grimsby North East Lincs DN32 0DR 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) 01472 340129 Pindy Enterprises Limited Position Vacant Care Home 27 Category(ies) of Dementia - over 65 years of age (27), Old age, registration, with number not falling within any other category (27) of places Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th June 2005 Brief Description of the Service: The Acorns is a large Victorian house, which although retains many of its period features has been adapted to meet the needs of service users. The home is in the centre of a large residential area of Grimsby, overlooking Peoples Park, a well-known beauty spot. Local shops and other amenities are close to the home. The home is three-storeys, accessed by stairs and a passenger/chair lift. There are a number of sitting rooms and a large dining room. The house has parking to the front and rear and an adequate sized garden. The staff have their own working areas and there is also a large kitchen and outside laundry room. The home provides for the needs of service users from minimal needs to more complex needs. It is supported by the local district nursing service and local GPs. Staff are encouraged to attend training courses and there appears to be good input from other health professionals. Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day in December 2005. To find out how the home was run and if the people who lived there were pleased with the care they got, the inspector spoke to 8 people who live there, 5 staff members and the Acting manager. Records kept in the home were also seen to make sure the checks to make sure staff are safe to work in the home were done before they started and they are trained to do their job safely. Records were looked at to make sure that the home and the things used in it were safe and checked often. The inspector was accompanied during the visit by the Acting Manager and spoke on the telephone to one of the owners, Mrs.K.Dev. What the service does well:
The home was clean and had a friendly feeling and all staff were welcoming and knew a lot about the people who live there. The people living in the home told the inspector how kind and caring all staff were to them and felt confident the Manager would sort out any problems. Staff were observed assisting the people who live in the home in a dignity way. The people living in the home said how much they liked the meals, there was enough choice for them and the portion sizes were adequate. The paperwork used by the staff to assess each person before they entered the home was comprehensive and gave the staff a good over view of that person’s needs. The activities provided were varied and appeared to meet the people’s expectations and preferences. They all liked the different types of entertainers and reminisce sessions especially. Records were in place to show that the people living in the home were able to exercise their legal and civic rights. Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 6 There were enough staff on each shift to ensure that the needs of the people who live there could be met at all times. What has improved since the last inspection? What they could do better:
The owners of the home still have to ensure they amended the service users guide and statement of purpose to reflect the current management position, as this does not give a true picture of who is in charge of the home. The care plans need to be all up to date and if new records are to be used that the staff be given a tight time scale to complete them, to ensure all the current needs of the people who live there are written down and are being met. The policy for caring for the dying person must be up to date and staff trained to understand the difference when there is an expected and unexpected death, so they can respond in the correct manner. The protection of vulnerable adults training is yet to be completed, this should be accessed as soon as possible to ensure that staff have the latest information to enable them to respond correctly if the need should arise.
Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 7 The owners of the company must ensure that the window restrictors be put in place as soon as possible for the security and safety of the service users. Some improvement had been made in the redecoration programme, but a plan needs to be in place to ensure all areas are monitored to make the home safe and welcoming for the people who live there. A training plan should be in place to ensure that all mandatory and service specific training is given to all staff and also that their individual training needs are taken in to consideration, to ensure they have the latest information on how to look after the people who live in the home. The owners of the home must ensure that supervision records are in place to ensure that the staff employed are safe to work with the people who live there. The owners must ensure that all certificates are in place, the home is audited and the people are asked their opinions of how they like living in the home and if their needs are being meet. This will ensure the environment and equipment is safe and all needs are being met by the staff working in the home. 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. Acorns DS0000063879.V270308.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 Acorns DS0000063879.V270308.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): 1,2,3,4 and 5. The statement of purpose and service users guide did not reflect the current ownership of the home. Staff were well informed of the service users needs on admission, as a comprehensive assessment tool was in place. This assisted the staff in ensuring the service user was feeling secure and welcomed on admission. EVIDENCE: The responsible person has still not amended the statement of purpose and service users guide to reflect the current ownership and organisational position. The main body of the guides appeared to reflect the services provided by the home, so would give a true picture of what any prospective service user could expect of the home. The assessment tool remains unchanged from the last inspection and provides a comprehensive tool from which staff can prepare for the needs of each person admitted to the home.
Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 10 Prospective service users have opportunity to visit the home and any day visit, including meals is free of charge. The staff records showed that some service specific training had taken place, but the management team needs to ensure this encompasses all current needs of service users, so staff have a good knowledge base to attend to any problems which may arise. Acorns DS0000063879.V270308.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 and 11. The company has provided a new comprehsinve document for care plan recording, which was in the process of being changed over, so not all records were up to date. The home has a policy for caring for the dying person, which was not up to date, which could put service users at risk if in correct care was given. EVIDENCE: The understanding of staff of how care plans are vital to ensure correct care is given to all service users to meet their needs, has improved. Staff spoken to appeared to have a good knowledge base of each persons needs and able to inform the inspector how this would be evidenced in the care plans. Of the 4 written care plans seen, this knowledge was not always transposed and recorded in the notes. This could potentially mean that the most recent care needs were not recorded and in correct care was delivered to individuals. The staff were in the process of transferring to a new care plan format, which appeared to be a lot simpler for them to understand and easier to evaluate on
Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 12 a regular basis. The acting manager has moved the storage of the care plans, which ensures they are now in a safe and secure environment and accessed on a need to know basis only. Service users spoken to stated they were always treated with respect and dignity by the staff and their individual needs were being met at all times. The policy for caring for the dying person was last reviewed in July 2004 and does not reflect current legislation and local guidelines. This could result in incorrect care being given at a vital time of a person’s death. The responsible person must also ensure that staff have received up to date training in this area of care and they are aware, as soon as possible about dealing with unexpected deaths. Acorns DS0000063879.V270308.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 14. The home provides a varied choice for recreational and social activities for service users to satisfy their individual needs and staff enable them to exercise choice and control over their lives. EVIDENCE: The social profiles for the service users were to be reviewed, but more details were in the individual care plans seen. The company employs a person for 15 hours each week to facility and help with activities. The records were not up to date, although staff were able to tell the inspector various events, which had taken place. This was reinforced by the service users who could explain how their individual expectations and preferences were being met. One service user said, “I really enjoy when the person comes to talk about the old days and shows us items from the museum”. Another said,” There is always a good choice of singers and other entertainers and I’m looking forward to the Christmas party”. Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 14 Other events documented included; - church services, shopping and pub outings, trip to a local school and craft events. The residents’ fund is controlled by the acting manager and the activities organiser and showed a health balance, with money being spent on appropriate events for service users. The company also provides for activities in the operational budget. This ensures there is money available to provide for social activities to meet peoples needs. Acorns DS0000063879.V270308.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 and 18. Training has not yet been completed for all staff in the protection of vulnerable adults and staff awareness of this topic was poor. All policies were in place to ensure service users can exercise their legal and civic rights. EVIDENCE: The policies on human rights and how service users can exercise their legal and civic rights had been reviewed in June 2005. All permanent service users are on the local electoral role, and the acting manager was putting a new system in place to ensure new people are entered on the list. All policies relating to protection of vulnerable adults had been reviewed between March and June 2005. These included; - handling the aggressive person, consent, whistle blowing and the general abuse policy. Training had still not been provided to staff and their knowledge base on questioning them was very poor. The responsible person needs to ensure that staff are fully up to date in this subject so service users are protected from abuse. Acorns DS0000063879.V270308.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): 19,20,21,22,25 and 26. The home was clean. Some areas did need more attention regarding a redecoration programme and renewal of furniture and fittings to ensure the environment was relaxing and welcoming to live in for the service users. EVIDENCE: The responsible person still has a couple of requirements outstanding from the last inspection, which need to be prioritised to ensure the safety of the service users. The maintenance and renewal programme has not been completed. Although there was evidence that some redecoration had taken place. There were still large areas of the home in need of major refurbishment. This needs to be planned to ensure the service users are living in a well cared for environment. The Acting Manager accompanied the inspector on a tour of the building where all the toilets, bathrooms and communal areas were seen and a selection of service users rooms. The attention to detail by staff was better and some
Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 17 thought had been given in keeping the rooms tidy. Service users spoken to said they had been able to personalise their rooms, which had enabled them to settle into the home a lot quicker. The window restrictors had still not been fitted to the windows and the Acting Manager was asked to make this a priority with the handyman. This is particularly important as some of the service users were suffering from symptoms of dementia and could be at risk from falling out of a window. The garden area and outside of the home was looking a lot cleaner. The Acting Manager had encouraged staff to help her tidy the garden areas making it a more relaxing part of the home to sit and walk in. Acorns DS0000063879.V270308.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): 27,29 and 30. The staffing levels were appropriate for the current dependency of the service users accommodated. The company now has a more robust system for recruitment of staff ensuring they are safe to work with this client group. The training records for staff were poor and could put service users at risk from inadequately trained staff. EVIDENCE: The staffing levels in the home appeared to be adequate for the dependency of service users currently in residence. The Acting Manager was reminded of the staffing matrix for assessing dependency and keeping this up dated to ensure there was sufficient staff on duty at all times to meet the needs of service users. Staff stated that they felt there was sufficient staff, but at weekends this was tight as they had to complete domestic and laundry duties. It was recommended to the Acting Manager that this be reviewed so those on the care staff rota are not taken away from attending to the needs of service users at weekends. 3 staff files were looked at in depth and found to have all the necessary information to ensure that those employed are safe to work with the service
Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 19 users. The Acting Manager has now implemented a much more organised approach to checking criminal records bureau records and those were up to date at the time of the visit. The company had issued contracts for all staff. The only ones missing were the Acting Manager, the activities person and the handyman. The handyman works between the company’s two homes and neither of them have a contract in place for this person. Both managers have stated to the inspector that they would like the Responsible person to make some suggestions of how this person works as they feel areas of work, vital to service user safety are bring neglected. Some training has taken place since the last inspection and the Acting Manager could show the inspector training which is to take place in the next couple of months. She has now identified needs of individuals by using a matrix, which she keeps on her computer. These training needs need to be put together with mandatory and service specific training on a yearly plan. This will ensure staff employed are trained well to look after the needs of service users. Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 20 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): 31,32,33,36,37 and 38. There were no robust systems in the home to ensure that the quality of care delivered to service users was being audited on a regular basis, which could put service users at risk from living in an unsafe environment with poorly trained and supervised staff. EVIDENCE: The responsible person is still overseeing the home, in the absence of a Registered Manager. The staff can also use the Manager of the sister home, should they need advice when the responsible person is not available. The minutes of the last staff meeting were seen for September 2005, which showed a good attendance and a variety of topics discussed, with opportunity for staff to discuss topics they wished to bring up. The Acting Manager had survey forms ready to go out to service users and other parties. She was also putting together a plan to ensure all parties using
Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 21 the home would be surveyed on a regular basis to ensure they were happy with the services the home delivers. The Responsible person still has to ensure that a quality assurance programme is in place and an annual development plan produced to ensure all sections of the home and work carried out is audited to their satisfaction. Most policies have now been reviewed and have dates when completed on each sheet. This ensures staff working in the home they have the most up to date policies to work with to enable them to work safely. The Acting Manager was currently looking at a different system to put in place and showed the inspector the documentation she intends using. The supervision records are poor and do not show that staff have been monitored on a regular basis. This could put service users at risk from poorly trained and monitored staff being employed. Not all the necessary certificates could be found in the home to ensure that all safety checks had` been completed. This included water temperature checks and the fire log being up to date. The Responsible person must ensure that all records associated with health and safety issues in the home, checks completed on all equipment and certificates are in place, to ensure the CSCI that the home is a safe environment to live and work in, and these are open for inspection. Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 22 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 2 2 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 2 2 2 3 3 X X 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X X 1 3 2 Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4,1a-c 2&51a-f 2 Requirement The registered person must ensure that an up to date service users guide and statement of purpose is available at all times. (Precious time scale of 30/11/05 not met). The registered person must ensure that the service users care plan is kept up to date at all times. (Previous time scale of 30/11/05 not met). The registered person must ensure that the care of the dying person policy includes current legislation. The registered person must ensure that all staff have been trained in the protection of vulnerable adults and all guidelines in use are up to date. (Previous timescale of 30/03/05 not met). The registered person must ensure that all windows are safe and meet health and safety regulations. (Previous time scale of 30/08/05 not met).
DS0000063879.V270308.R01.S.doc Timescale for action 30/03/06 2. OP7 15 (1 & 2(a-d) 28/02/06 3. OP11 17.3.a.b. 28/02/06 4. OP18 13 (6) 30/03/06 5. OP19 23 (2b) 30/01/06 Acorns Version 5.0 Page 24 6. OP19 23 (2b) 7 OP30 18.1.c.i and ii. 8 OP33 24 (1a&b), 2 & 3) 9 OP36 18 (2) 10 OP38 23.2.b. The registered person must produce a maintenance and renewal programme. (Previous timescale of 30/04/05 not met). The registered person must ensure that a training programme is in place and all staff have received up dated training in all mandatory and service specific training. The registered person must develop and implement a formal quality assurance system and takes into account the views of service users, in the meeting of the aims and objectives of the home. (Previous timescale of 30/05/0/5 not met). The registered person must ensure that staff receive formal supervision at least 6 times a year and that this is recorded and covers all items in this standard. This is to include the Registered Manager). (Previous timescale of 30/03/05 not met). The registered person must ensure that all certificates are in place to ensure the home is safe to live and work in. 30/03/06 30/03/06 30/03/06 30/11/05 28/02/06 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 OP28 Good Practice Recommendations The registered person needs to be aware of the deadline of 2005 to ensure that she meets the 50 target for NVQ level 2 trained staff working in the home.
DS0000063879.V270308.R01.S.doc Version 5.0 Page 25 Acorns 2 OP27 The registered person needs to be aware of the staffing pressures on care staff at weekends when they have to also complete cleaning and laundry tasks. Acorns DS0000063879.V270308.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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