Inspection on 29/11/07 for Acorns

This inspection was carried out on 29th November 2007.

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 but made no statutory requirements on the home.

Other inspections for this house

Acorns 06/09/06

Acorns 02/12/05

Acorns 14/06/05

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Acorns 29-31 Welholme Road Grimsby North East Lincs DN32 0DR Lead Inspector Eileen Engelmann Key Unannounced Inspection 29th November 2007 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.V355457.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. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 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 Kavdev@ntlworld.com Pindy Enterprises Limited Mrs Delilah Jane Tilling 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.V355457.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2006 Brief Description of the Service: The Acorns is a large Victorian house, which retains many of its period features, but has been adapted to meet the needs of the people using its service. 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 has three floors, 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 personal care for up to 27 older people, some of whom may have dementia and they receive medical support from the local district nursing service and GPs. Information about the home and its service can be found in the statement of purpose, service user guide and the latest inspection report. These documents are on display in the entrance hall of the home and copies are available from the manager. Information given by the manager on 29/11/07 indicates the home charges a fee of £345.00 to £350.00 per week depending on the source of funding. There are no additional charges other that those for hairdressing, taxis, private chiropody treatment, toiletries and newspapers/magazines. A full list of prices for these additional services is available from the manager. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information has been gathered from a number of different sources over the past 12 months since the last key visit in September 2006, this has been analysed and used with information from this visit to reach the outcomes of this report. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and people’s files, and records relating to the service. Informal chats with a number of people and staff took place during this visit; their comments have been included in this report. Questionnaires were sent out to a selection of relatives, people living in the home, staff and healthcare professionals inputting to people’s care. Their written response to these was good. We received 5 back from relatives (50 ), 6 from staff (75 ), 2 from Care Managers (66 ), 2 from healthcare professionals (66 ) and 9 from people using the service (90 ). One safeguarding of adults allegation has been made since the last inspection in September 2006. The safeguarding of adults team at the local social services investigated and decided there was no evidence of abuse taking place, but recommended that additional documentation, for personal checks of people through the night, be implemented. What the service does well: All of the people living in the home were positive about the home and like living there. The people spoken to said they loved living at the home and the care was very good. People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: People working in the home must make sure the information in the care plans is detailed about the wishes and interests of those people coming into the home. So the activities and the care to be given reflects the needs, interests and likes or dislikes of each person using the service. The people working in the home should be talking to the people using the service, to find out what they like and how they want to be looked after. This helps the people using the service to have choice in how they are cared for and helps them stay as independent as possible. People working in the home must make sure that the way they record and give out medication gets better. At the moment the way they do this is not safe and could put the people who live in the home at risk. People who are working in the home have to be given training around keeping people safe from harm, this helps them understand how to look after individuals and speak up if they think anything is wrong. People who are working in the home have to attend more training around safe working practices to make sure they look after their health and safety and that of the people living in the home. The manager of the home must make sure she completes all the police checks and receives sufficient information and references about new staff before they start work, to protect the people living in the home from harm. The person who owns the home must make sure that the service is looked at on a regular basis to see if it is meeting the needs of the people using it, is working within the guidelines of good practice and is looking after the wellbeing of the people living in the home and the people who work there. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 7 The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this visit. Your comments and input have been a valuable source of information, which has helped create this report. 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. Acorns DS0000063879.V355457.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 Acorns DS0000063879.V355457.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, 4 and 6. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of staff training does not ensure the needs of the people using the service are recognised and met. EVIDENCE: Information from the surveys shows that the majority of people received sufficient information to make an informed choice about the service before accepting the placement offer. They are offered an up to date brochure, statement of purpose and service user guide on enquiry and individuals said the staff are very good at telling them about any changes within the home. People coming into the home have also received a contract/statement of terms and conditions. Those checked on this visit have been signed and dated by the person or their representative. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 10 At the last visit in September 2006 a recommendation was made that ‘The registered person should ensure that an up to date brochure is available to the service users or is ceased to be used’. Checks at this visit show that this is met. At the last visit in September 2006 a recommendation was made that ‘The registered person must ensure that the service users are all provided with an appropriate contracts that include all of the information required by National Minimum Standard 2.2’. Checks at this visit show this has been met. At the last visit in September 2006 a requirement was made that ‘The registered person must ensure that the homes pre-admission assessments are developed to include clearer detail of how service users needs affect them and the support that they require throughout their daily lives’. Checks at this visit show this has been met. The home has improved its own needs assessment for privately paying people since the visit in September 2006. Checks of four care files showed one individual has been admitted in 2007 and this assessment process was used in conjunction with the Social Services assessment of need, to decide if a placement could be offered and information from both assessments has been used to develop the person’s care plan. The home has an equal opportunities policy, which is used when employing staff. The staff group are all White/British although people from overseas are employed if they have acceptable skills and qualifications. People using the service are unable to make a choice of staff gender when deciding whom they would like to deliver their care, as the home has no male care staff due to a lack of suitable applicants. The manager said that she would discuss this with people wanting to use the service during the assessment process. Information from the Annual Quality Assurance Assessment and discussion with the people living in the home indicates that all the people are of white/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Discussion with people and showed that on the whole they were satisfied with the care they receive and have a good relationship with the staff. Comments from the relative surveys said ‘I cannot visit very often as I live some way from the home, however I am happy with the staff and the care that my relative receives’, and ‘the staff are kind and helpful’. One person said ‘the Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 11 staff are meeting my relatives physical needs, but her dementia needs are not met’. Information from the training files and training matrix indicates that not all of the staff are up to date with their basic mandatory safe working practice training, or have accessed a range of more specialised subjects that link to the needs of people using the service. A number of people using the service have dementia needs and 43 of the staff have undergone a short training course in dementia. This may not be sufficient training to give the staff a good, clear understanding of dementia, what the different types of dementia are, how they affect people and how they can help people with dementia’. Discussion with the manager indicated she is aware of the need to develop the training programme further and that individuals are being booked onto courses as they come available; but this is a slow process. The registered person must make sure that staff have the skills and knowledge to deliver the services and care which the home offers to provide. This will help to develop a consistently high standard of care, which maintains and promotes the people’s health, safety and wellbeing. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 12 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff performance around recording within the care plans and medication system is not satisfactory and does not ensure the peoples’ health and welfare are protected. EVIDENCE: Information from the surveys indicates that the majority of people who responded are satisfied that the staff give appropriate support and care to those living in the home. People said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. Comments from the surveys said ‘staff are excellent at informing me of anything to do with my relative’, ‘I have not had any problems with staff and I think they are wonderful’ and ‘staff meet the needs of the people in the home, they provide a good environment and are amenable to peoples wishes’. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 13 At the last visit in September 2006 a requirement was made that ‘The registered person must ensure that individual service users individual care plans identify how their individual needs must be met’. Checks at this visit show this is has not been completed although work is ongoing. The requirement will remain on this report. At the last visit in September 2006 a recommendation was made that ‘The registered person should make sure that the service users or their representative’s sign their care plans to demonstrate that they agree with them’. Checks at this visit found this was met. The care of four people was looked at in depth during this visit and included checking of their personal care plans. The content of the plans is very task orientated, and does not explore fully the personal wishes or needs of the people living in the home. The plans would benefit from additional information about the individuals abilities, strengths, weaknesses, personal preferences, likes and dislikes. The staff have not completed all the information required by the care plans, especially for people who have been admitted in the past month. These must be brought up to date as soon as possible to ensure people living in the home receive the care and attention they require. Staff must also make sure that, when a person’s care needs have changed, the plan of care on the problem/ability sheet is amended to reflect this. One very positive practice is that when care plans are being evaluated monthly, the staff are including the relatives and people living in the home in the process and are recording their comments and views about the care being given and received. These issues were discussed with the manager who assured us that action would be taken to improve the care plans. People said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people and relatives indicate they are satisfied with the level of medical support given to the people living at the home. One individual said ‘the staff are very caring and alert to peoples needs; they contact the District Nurses and GP’s when necessary’. At the last visit in September 2006 two requirements were made that: ‘The registered person must ensure that all prescribed medication is appropriately administered and monitored at the home’. Checks at this visit showed this has not been met. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 14 ‘The registered person must make sure that all service users that are selfmedicating have appropriate records maintained of the medication that they have received in case of medical emergencies’. Checks at this visit showed this is met. We looked at the medication stock and the administration records kept by the staff. These showed that a number of practice areas needed improvement and included • There are a number of missing signatures where staff have given out medication, but have not signed on the record sheet. • Where staff are hand writing medication onto the sheets (transcribing), they are not following best practise. Staff should include the amounts of medication received or brought forward, put the strength of the medication and what type it is (tablet, liquid etc), include how often it is to be taken and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct (this is a good practice measure). • The medication system does not include a photograph of each person receiving medication. This is a good practice measure to ensure the staff give the right medication to the right person. Checks of the controlled drugs register found that: • Staff are not recording the correct name of the drugs onto the register. One pain relief patch was recorded as ‘duragesic’ but this was not the name on the packet. It was the same drug, but manufactured under another name. Staff must record what is on the packet as to do otherwise could lead to mistakes being made. • The strength of the pain relief patch (see above comment) was not recorded on the register, which is not acceptable practice • As new supplies of a person’s controlled medication were received the staff recorded each one onto the same sheet. Best practice is that a new sheet in the register is started each time new medication is received, even if it is the same medication and strength as the medication in use. Discussion with the manager indicated that she would be taking measures to ensure staff practises around medication recording and administration improved. It is recommended that she does a weekly audit to ensure best practice is being implemented by the staff. People and relative comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 15 At the last visit in September 2006 a recommendation was made that ‘The registered person should make sure that all service users that share a bedroom at the home have written consent agreeing to this. Checks at this visit show that information in the contract/statement of terms and conditions shows if a room is for double or single occupancy, and as the person signs this (or their representative) it indicates they agree with this. The recommendation is met. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 16 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. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are provided with choice and diversity in the activities and meals provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. EVIDENCE: At the last visit in September 2006 a recommendation was made that ‘The registered person should make sure that the activity programme for the home is developed further to include the interests of all of the service users living at the home’. Discussion with those living in the home indicates that this has been met. The home employs an activities co-ordinator who works three days a week from 10am to 3pm, and who organises a range of in-house activities including bingo, sing-a-longs, film afternoons, craftwork and baking. Time Care is an organisation, which specialises in reminiscence work with the older person and they are booked to come into the home about every two months. Discussion with people living in the home and feedback from the surveys sent out Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 17 indicates that individuals are satisfied with the activities on offer and have enough to do to keep them occupied. Some relatives would like to see more done for those with dementia as surveys and comments said that ‘there is a need for more entertainment and stimulating activities within the home’ and ‘my relatives dementia needs are not met as there is a lack of suitable activities for them’. Information from peoples’ files indicates that there are a number of individuals who follow different spiritual faiths, including Catholic and Church of England. The manager said that there are regular church visitors within the home and people could go to the local church services and religious celebrations as requested. The home provides special meals and cakes for birthdays and helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the community. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. Relatives and visitors to the home are very positive about the service and the staff. Written and verbal comments given to us showed a high level of satisfaction. Individuals commented that ‘staff are friendly when we visit’, ‘I am kept up to date by the staff and they are wonderful people’ and ‘staff are all very patient and friendly to the people who live in the home’. At the last visit in September 2006 a requirement was made that: ‘The registered person must make sure that all restrictions identified as part of a multi-disciplinary review are recorded within the care plan and are supported through clear risk assessments’. Checks at this visit found that it has been met. People spoken with were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. Staff have not received formal training around current legislation in equality, diversity and disability matters other than a brief outline in their induction and National Vocational Qualification’s. It is recommended that the manager should enable staff to access this training to improve the staffs knowledge and understanding of a person’s individual rights within the care home and out in the community. People told us that the home encourages them to bring in small items of furniture and personal possessions to decorate their bedrooms. There are meetings where the viewpoints and opinions of those living in the home can be expressed and the management team will listen and take action Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 18 were needed. Visitors said they are kept informed of any important issues affecting their friend/relative and felt that staff did a good job of supporting people to live the lives they choose. Comments from the people living in the home and their relatives are on the whole very positive about the meals and kitchen service provided. Individuals commented that ‘the food is very good’, and ‘my relative enjoys the meals in the home’. The lunchtime meal was well presented and offered a good choice of food, menus were available and staff were organised when serving the meal. Staff were seen to offer assistance to people who needed help with eating and drinking. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 19 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a good complaints system with some evidence that peoples’ views are listened to and acted upon. Visitors and people using the service are confident about reporting any concerns and the manager acts quickly on any issues raised. The uptake of staff training in safe guarding of adults is unsatisfactory and does not ensure people using the service are protected and kept safe at all times. EVIDENCE: Checks of the records in the home showed that there have been no formal complaints made to the service since the last inspection. Discussion with the manager indicates that she resolves niggles and grumbles on a daily basis, but does not keep a record of these or the action she takes to resolve the issues. It is recommended that a written record of niggles and grumbles is developed. The complaints policy and procedure is on display, but is only available in a standard small print format. The registered person should consider how they could produce the complaints policy in more person-friendly formats. People’s survey responses showed the majority of individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said ‘the manager comes round every day to see us and will discuss any problems at this time’. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 20 Relatives are aware of the complaints procedure and are confident of using it if needed. Those who responded to the surveys said that the manager was efficient and effective in answering queries and they were satisfied with her actions. One safeguarding of adults (abuse) allegation has been made since the last visit in September 2006 and this was around poor staff practises. The local social service team, who found no evidence of neglect, investigated the allegation. It was recommended that staff keep records of their nightly checks on individuals and this has been actioned by the home. At the last visit in September 2006 a recommendation was made that ‘The registered person should continue with the homes programme of protection of vulnerable adults training to make sure that all staff are aware of abuse issues and how to appropriately report suspected abuse’. Checks of the training plan showed that just over 50 of the staff have received this training since the last inspection, however this needs to continue so everyone is up to date. The registered person should also consider the need to offer staff-training in management of challenging behaviour and dementia care to ensure the needs of all people using the service are recognised and met. The recommendation will remain on this report. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 21 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, 21, 25 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing people with a comfortable and homely place to live. EVIDENCE: Observation of the premises showed that the home is clean, warm and tidy, with no odours. There is a maintenance programme in place to ensure that the environment is refurbished and redecorated on an ongoing basis. Comments from the surveys say ‘the home provides people with a secure and caring environment’, ‘the rooms are clean’ and ‘the fabric of the home has improved’. The last environmental health report for the kitchen was October 2007, and this showed the home is improving its standards and is providing better quality Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 22 outcomes for the service. The environmental health officer is coming into the home again to help staff improve their paperwork. At the last visit in September 2006 a requirement was made that: ‘The registered person must ensure that all toilets and bathrooms meet infection control standards and appropriate infection policies and procedures must be developed for the home’. Checks at this visit found this has been met. The staff-training matrix shows that 71 of staff have received infection control training since the last visit and adequate personal protection equipment is available. The home has three floors and offers accommodation on all of these. The top floor has a shower room, which currently is not in use. Plans are in place to refurbish this area to offer people a better selection of bathing facilities. There is an assisted bath on the first floor with a fixed hoist to help people get into and out of the bath. On the ground floor there is a rise and fall bath, and this bathroom is the most popular in the home. At the last visit in September 2006 a recommendation was made that ‘The registered person should make sure that all of the window locks that have been purchased are appropriately fitted to ensure the health and safety of the service users’. Checks at this visit showed this has been met. The laundry for the home is located in an outside building. There are two washers and one dryer provided and people said they were satisfied with the service. It was seen that the floor of the laundry has a carpet in place. This is not acceptable for hygiene and infection control purposes and must be removed. The concrete floor of the laundry must be made impermeable and readily cleanable. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 23 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Practices around staff training and recruitment are not robust and do not ensure the wellbeing of the people in the home is adequately protected. EVIDENCE: Comments from the people using the service, relatives and staff are on the whole very positive about the staffing levels within the home, and individuals feel that there is a good standard of care being given to the people living in the home. At the time of this visit there were 21 people living in the home and the staffing rotas showed that the following staffing levels were in place 7am – 3pm 3pm – 10pm 9.45 pm –7am One senior care staff and two care staff One senior care staff and two care staff One senior care staff and one care staff Information from the annual quality assurance assessment and staff rotas about the number of staffing hours provided, and information gathered during this visit about the dependency levels of the people living in the home, was used with the Residential Staffing Forum Guidance and showed that the home Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 24 is meeting the recommended guidelines. These figures do not include the manager’s hours or those for domestic and cleaning activities. At the last visit in September 2006 a recommendation was made that ‘The registered person needs to be aware of the homes responsibilities towards the 50 target for NVQ level 2 trained staff working in the home’. Checks at this visit showed the training is ongoing and the recommendation will remain in this report. The staff training matrix shows that 33 of the care staff have completed their NVQ 2 training and six others are currently going through the process. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. At the last visit in September 2006 a requirement was made that: ‘The registered person must ensure that appropriate recruitment procedures are carried out by the home and staff personnel files include all of the information required by schedules 2 and 4. This includes an improvement required to the homes reference forms to identify who supplied the reference’. Checks at this visit showed the requirement is not met and so it will remain on this report. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that the one of the newest employees (2007) has only one valid reference, the second is not dated and is addressed to ‘whom it may concern’. Two of the newest staff (2007) were started in post before their Protection of Vulnerable Adult checks were received. These concerns were discussed with the manager and she assured us that this is not normal practice and she would audit all the files and ensure the correct checks and information is in place before anyone started work in the future. The home provides a mandatory staff-training programme that links to training provided by the company and other outside agencies. Information from the staff training files and training matrix indicates that there are some updates needed in the mandatory training with the following percentages showing the uptake by staff in the past twelve months: Fire safety training (78 ), health and safety (64 ), food hygiene (55 ), infection control (83 ), medication (83 ), moving and handling (28 ), first aid (21 ). There is evidence that the home has thought about introducing more specialist training looking at conditions linked to old age and dementia, but uptake of these courses is slow due to the fact that Training Facilities places on the Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 25 courses are limited and date specific. The manager is aware of the need to improve the training and has booked staff on a number of courses over the next six months, but they depend on places being available. The registered person must ensure the staff receive basic mandatory training, especially around moving and handling, and more specialised training that reflects the different care needs of the people living in Acorns. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 26 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, 32, 33, 35, 36, 37 and 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems for quality assurance and risk assessment within the home are not robust and must be improved to ensure the health, safety and welfare of the people who live in the home and staff are maintained and protected. EVIDENCE: At the last visit in September 2006 two requirements were made that ‘The registered person must ensure that the manager of the home is competent and has completed a fit person interview with the Commission to be accepted as the Registered Manager’. This has now been met. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 27 ‘The registered person must provide the manager of the home with a contract detailing the manager’s roles and responsibilities’. This has now been met. The manager of the home is Mrs Delilah Jane Tilling and she was registered with the Commission in September 2007. She has started her Registered Managers Award training and hopes to have this completed by the end of December 2008. Mrs Tilling told us that she keeps her skills and knowledge up to date by attending the training session provided by the home, and is currently booked to attend Safe Guarding of Adults and First Aid. Discussion with the manager indicated she has a job description and contract detailing her roles and responsibilities. She recognises that there is a need to improve the management of staff training and recruitment issues and told us that she would make these a priority in the next few months. At the last visit in September 2006 a recommendation was made that ‘The registered person should show consistency in the recording of information in the home’. This has now been met. The registered person visits the home at least once a month and completes a regulation 26 report detailing issues looked and discussed with people, staff, relatives and the manager. A copy of these reports is kept in the home for us to review at our visits. At the last visit in September 2006 a recommendation was made that ‘The registered person should continue with the development of the homes quality assurance and monitoring programme to develop an effective system’. This is an ongoing process and further work is needed. A requirement around this will be put into this report (see comments below) There is no formally recognised quality assurance system within the home, but the home has developed a calendar type checklist looking at some areas of practice within the home. However, given that we have picked up a number of issues around care planning, medication, staff training, staff recruitment and maintenance (see comments below) during our visit, there is a need for more robust auditing of the service looking at all aspects of care and management Staff and resident meetings are taking place and offer individuals an opportunity to voice their opinions and ideas about the service. Satisfaction surveys are going out to people using the service and their representatives, and the feedback and action taken is recorded by the service on an Annual Development Plan. Checks of the financial records showed that people are able to have personal allowance accounts in the home. These records are hand written and detail the transactions undertaken and the money held for each person, the manager updates these each week. Information from the manager indicates that the majority of people have a family member or representative who looks after Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 28 their monies and these individuals make sure the personal allowances are sent/brought into the home. Two accounts were checked and one was found to be up to date and accurate at this visit, but the other had £27.00 unaccounted for and missing from the person’s wallet. An immediate requirement was left at this visit giving the manager 24 hours to provide the Commission with evidence of what had happened to the money. The immediate requirement was met within the given timescales and a full explanation was provided. At the last visit in September 2006 a recommendation was made that ‘The registered person should make sure that the staff supervision continues to improve to meet the recommended minimum of six formal supervision periods a year’. Checks of the staff records show that this has been met. At the last visit in September 2006 two requirements were made that: ‘The registered person must ensure that all confidential materials are appropriately stored in the home. The content and detail of some of the records also needs to be improved this includes the service users assessments and care plans’. Since the last visit the registered person has supplied the home with lockable filing cabinets to keep the care plans in. Improvements to the content and detail of the care plans, has already been addressed earlier in the report. This requirement is met. ‘The registered person must audit all policies and procedures in the home and make sure that they are complied with’. Since the last visit the registered person has supplied the home with new and up to date policies and procedures. This requirement is now met. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. However, there was no evidence of an up to date fire risk assessment within the building. An immediate requirement was left at this visit giving the manager 24 hours to provide us with evidence that one has been carried out. The immediate requirement was complied with in the given timescales. No evidence was seen of generic risk assessments for the home, however the manager said she is about to start doing these as she has attended risk assessment training in preparation for the task. Accident books are filled in and regulation 37 reports completed and sent on to the Commission where appropriate. Staff are able to access safe working practice training although uptake has not always been as good as it should be over the past year. The registered person must make sure all staff attend this training. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 29 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 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X 3 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 2 3 3 2 Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 30 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 OP4 Regulation 12(1) Requirement The registered person must make sure that staff, individually and collectively, have the skills and experience to deliver the services and care which the home offers to provide. Timescale for action 01/04/08 2. OP7 15 So people can be confident that their needs relating to old age and dementia are recognised and managed appropriately. The registered person must 01/01/08 make sure that the care plans are detailed and individual to the person they are about, putting the person at the centre of it, and giving a picture of who they are as well as what their needs are and how to met them. The plans should meet relevant clinical guidelines produced by professional bodies concerned with the care of older people and those with dementia. This will make sure that staff have access to information that will help them to provide person Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 31 3. OP9 17 centred care and support. (Given timescale of 06/12/06 was not met). Accurate records must be kept of all medications, received, administered, leaving the home or disposed of to ensure there is no mishandling. The registered person must make sure that medications in the custody of the home are handled according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society, the requirements of the Misuse of Drugs Act 1971. To make sure people receive their medication correctly and their health and safety is not put at risk. (Given timescale of 07/09/06 was not met) The registered person must make sure the floor of the laundry is impermeable and readily cleanable. 01/01/08 4. OP26 13(3) 01/03/08 5. OP29 19 (1a,b, and c, 5a,b, c and d) To control the spread of infection and protect the health and wellbeing of the people using the service. The registered person must 01/01/08 ensure that appropriate recruitment procedures are carried out by the home and staff personnel files include all of the information required by schedules 2 and 4. This includes an improvement required to the homes reference forms to identify who supplied the reference. This is so people living in the home are not put at risk of harm. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 32 6. OP30 OP38 18(1)(a) (c) (Given timescale of 30/09/06 was not met) The registered person must ensure that there is a training programme in place that ensures staff fulfil the aims of the home and meet the changing needs of the people using the service. Specialist training on the elderly and diseases relating to old age and dementia must be included in the training programme. So the health, safety and welfare of the people in the home is protected and promoted, and staff have the skills and knowledge to provide a high standard of care. 01/04/08 7. OP33 24 (1)(a)(b), (2)(3) (Given timescale of 30/09/06 was not met) 01/04/08 The registered person must make sure that effective quality assurance and quality monitoring systems are in place, which seek the views of people and measure the success in meeting the aims and objectives and statement of purpose of the home. So the home can demonstrate that it is offering a quality service and value for money to the people using the service, and is listening to their views and opinions and taking action to meet its aims and objectives and produce favourable outcomes for people. The registered manager must be 01/01/08 proactive in developing, updating and monitoring health and safety issues within the home such as fire risk assessments and generic risk assessments. This will ensure the health, safety and wellbeing of people DS0000063879.V355457.R01.S.doc Version 5.2 Page 33 8. OP38 13 Acorns living or working within the home is protected and maintained. 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 OP9 Good Practice Recommendations Staff should include the amounts of medication received or brought forward, put the strength of the medication and what type it is (tablet, liquid etc), include how often it is to be taken and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. The medication system should include a photograph of each person receiving medication, to ensure the staff give the right medication to the right person. The manager should make sure that as new supplies of a person’s controlled medication are received the staff record each one onto a new sheet. The manager should audit the medication records on a weekly basis to ensure that accurate records are kept and staff practice is improved. The manager should enable staff to access training around current legislation in equality, diversity and disability matters, to improve the staffs knowledge and understanding of a person’s individual rights within the care home and out in the community. The manager should develop a record of any niggles and grumbles that she receives and the action taken to resolve them. The registered person should consider how they could produce the complaints policy in more person-friendly formats. The registered person should ensure that all staff receive safeguarding of adults training by July 2008, and also consider the need to offer staff training in management of challenging behaviour and dementia care to ensure the DS0000063879.V355457.R01.S.doc Version 5.2 Page 34 2. 3. 4. 5. OP9 OP9 OP9 OP14 6. 7. 8. OP16 OP16 OP18 Acorns 9. OP28 needs of all people using the service are recognised and met. The registered person should ensure 50 of care staff achieves NVQ level 2 by the end of 2008. Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. Extracts may not be used or reproduced without the express permission of CSCI Acorns DS0000063879.V355457.R01.S.doc Version 5.2 Page 36 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!