Inspection on 19/03/07 for Acrefield House

This inspection was carried out on 19th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Acrefield House 15/02/06

Acrefield House 02/11/04

Acrefield House 28/07/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Acrefield House 2 Acrefield Road Prenton Birkenhead Wirral CH42 8LD Lead Inspector Peter Cresswell Unannounced Inspection 19 March 2007 09:10 th Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acrefield House Address 2 Acrefield Road Prenton Birkenhead Wirral CH42 8LD 0151 608 0664 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) Diane.Meacock@mentalhealthcare-uk.com Mental Health Care (Wirral) Limited Mrs Diane Beryl Meacock Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The number of persons for whom residential accommodation (with personal care) is provided at any one time shall not exceed twelve Only adults (aged 18 - 64 years) whose primary disability is learning disability maybe accommodated. 15th February 2006 Date of last inspection Brief Description of the Service: Acrefield House provides accommodation and care for twelve people with learning difficulties. The home is close to a main bus route and about a mile from shops and other community facilities in Prenton, Wirral. Acrefield is a three storey Victorian house with twelve bedrooms and it blends in with neighbouring properties. It is not externally identified as a care home. All of the residents have large single bedrooms. There is one main lounge, an activities room and a small ‘quiet room’. A spacious conservatory overlooks the large, well maintained back garden and also serves as the dining room. There is no lift in the home. There is a small car park at the front of the house and cars can also park on the road. Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit. The inspector spoke to a number of staff, including the Registered Manager, and several of the residents who were in the home at the time. He toured the building, including most bedrooms, the kitchen and lounges and looked at records, in particular care plans, pre admission assessments and recruitment files for all new staff. Other records examined included medication, fire safety, accidents, and staff training. The manager completed a pre inspection questionnaire which she gave to the inspector when he visited the home. A number of residents and relatives returned survey forms to the Commission before the site visit. The site visit lasted six and a half hours. What the service does well: What has improved since the last inspection? What they could do better: Slightly fewer than 50 of care staff are qualified to NVQ2 level but a number of staff are studying for the qualification and several of them are due to complete the course soon. The gas safety certificate was a few days out of date but it was renewed before the first draft of this report was prepared, a few days after the site visit. Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 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. Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5. Quality in this outcome area is good. Detailed assessment before admission helps to ensure that Acrefield can meet the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the admission plans for the resident who had been admitted since the last inspection. The owners have detailed pre admission procedures involving staff from their headquarters in North Wales. There were assessments of file from professional staff and the Registered Manager had also assessed the resident before admission. The care plan was detailed and included a brief pen picture that gave a useful, accessible description of the resident and her needs. In a survey form one resident commented that he and his family had been able to visit Acrefield before he moved in. One outside professional commented on a survey form that s/he was ‘very impressed at how quickly a rapport had been developed’. Each resident has an individual contract and copies were seen on file. Acrefield provides a specialised service with high staffing levels and fees are negotiated individually with commissioning authorities, starting at £1274 a week. Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 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, 8, 9. Quality in this outcome area is excellent. Detailed care planning enables staff to focus on the needs of service users. Residents’ involvement in the affairs of the home helps to develop their independence as far as is possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Acrefield has extensive and detailed care plans for all of its residents. A summary of the plans and relevant risk assessments is printed on daily report sheets for each individual and staff complete at least three reports each day. This system makes sure that staff are constantly aware of the agreed care plans and provides a detailed record that forms a sound basis for care planning and reviews. Key workers review the plans every month and a full review is held every year. The annual review is attended by all relevant people, including the resident, key workers, other professionals and (where appropriate) family members. If changes are agreed the plan is rewritten and the old version kept on file for reference. Residents make their own decisions as far as they can though this varies depending on their individual capacity. A senior member of staff supports regular residents’ meetings and keeps a record of the points raised by those Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 10 who attend. Some residents help with tasks around the home – one said he likes to help to keep the dining room and patio area clean and tidy and he did so during the site visit. Appropriate risk assessments are completed for individual activities; at the moment only one resident goes out of the home unaccompanied. The manager said that this resident is known by people in the local community. This issue was dealt with in some detail in the care plan and risk assessments. Confidential documents are securely stored in the home in locked cabinets in offices. Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 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): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. Acrefield supports and provides appropriate activities to meet the needs and likes of its residents. The balanced, varied menu meets the residents’ dietary needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Acrefield develops an individual activity programme for each resident and they also take part in group activities such as trips out and visits by the music therapist. There is a new music therapist who uses a different approach and the manager said that the residents had appreciated the variety this introduced. There was a lot of evidence around the home – including individual bedrooms - of the residents’ individual tastes and pastimes. Some play golf, others enjoy music, ‘soft play’ (at a sports centre), ten-pin bowling, shopping and other everyday activities. Some residents also attend day centres, which they attended before coming to Acrefield, helping to provide some continuity in their lives. One visiting professional said on a comment form that the resident she helped ‘seems to have done different activities on every visit to the home.’ Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 12 Every resident who wants to go on holiday is supported to do so. Residents go wherever they want on holiday as long as they can afford it. One resident feels that a holiday has to include an aeroplane flight, so some ingenuity is sometimes called for. The home has two vehicles so residents can go on trips in groups or individually. Families are encouraged to visit their relatives in the home and play a role in the development of care plans (in accordance with the care plan and the wishes of the residents themselves) though none visited during the site visit. One relative said in a survey form sent to the inspector before the site visit: ‘The staff …….. have the ability of creating a family atmosphere. It is a happy place to visit.’ The menu is based on meals that the residents are known to enjoy from past experience. There is an illustrated menu on the main corridor near the kitchen with pictures of many of the meals to help all of the residents to understand what they are going to have. The main meal of the day is served in the early evening (tea time) and usually includes a genuine choice. If a resident does not like the choices available then an individual meal will be prepared for them. During the site visit one resident was eating lunch in his own room and another was being helped in a respectful way in the main lounge. Each individual is supported to eat in their own way and at their own pace. The chef works five days a week and when she is not there care staff do the cooking. Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 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): 18, 19, 20, 21. Quality in this outcome area is excellent. Acrefield keeps detailed records of the residents’ personal support needs, enabling staff to provide support accordingly. This meets residents’ personal needs effectively and sensitively. Medication is administered accurately and is reviewed regularly, thereby meeting the residents’ medical needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans set out how personal care is to be given and staff ensure that the residents’ dignity is respected. Three lifting devices with electric ceiling tracks have been fitted, two in individual bedrooms and one in a ground floor bathroom to assist in lifting and the provision of personal care. The home also has a mobile electric hoist and has separate, customised sling seats for each resident who uses it. The built in lifting seat in the ground floor bathroom has been removed as it kept breaking down. Residents now use the mobile hoist and staff showed the inspector how this operated. The manager said that only two residents had used the built in seat and everyone found the new system comfortable. Two residents have specialist beds (paid for by themselves) that can be adjusted by a built in electric motor. All of the residents receive appropriate community and specialist health care services to meet their often highly complex needs. One resident uses a PEG feed and staff have been Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 14 appropriately trained to use it. The resident’s medication is also administered via the PEG feed. Medication is kept securely in a small room used solely for that purpose. Acrefield uses a monitored dosage system for medication. This means that medication is provided by the pharmacist in specially prepared blister packs. The samples checked were accurately recorded and securely stored. Medicines requiring refrigeration are kept in a secure, dedicated fridge, the temperature of which is checked and recorded twice a day. General Practitioners attend annual individual medication reviews for each resident. Medication records include details of any allergies that might affect the administration of any medicines and details are on file of the circumstances in which medication to be taken ‘as required’ (PRN) is to be given. A long standing much loved resident had recently died and this had been dealt with sensitively, in close co-operation with the resident’s family. Staff had spent time explaining the situation to the other residents, and a framed photograph of the resident was in the main lounge. No residents attended the funeral but many staff did. Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 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, 23. Quality in this outcome area is good. The home’s complaints and abuse procedures protect the interests of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owners have well-established complaints and adult abuse policies. No complaints have been received since the last inspection. In a survey form one of the residents said that he knows he can go to ‘Diane’s (the manager) office’ if he was not happy about something. All staff are trained in the prevention of adult abuse and the manager has access to all of the relevant protocols. Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 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, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. The home provides a comfortable, well-maintained, individualised and spacious environment for the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Acrefield was clean, well decorated and odour-free on the day of this unannounced site visit. Minor repair items are dealt with as they arise by the handyman. Acrefield does not have a shaft lift and there are no plans to fit one, given the nature of the (Victorian) building. The manager ensures that wherever possible residents with any mobility problems have rooms on the ground floor. However, occasionally this is not possible and in those circumstances residents who can no longer cope with the stairs would need to move. Fortunately this has been rare and in those circumstances the resident may in any event need nursing care beyond that which can be provided by a visiting district nurse at Acrefield. Residents’ bedrooms are spacious, well equipped and in most cases highly individual, showing evidence of the occupier’s tastes and background. Some residents have used their own money to pay for improvements in their rooms – one has a large plasma screen television and two have special beds. Acrefield has a large main lounge, a Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 17 small ‘quiet room’ and an activities room. There is a spacious conservatory/dining room that overlooks the large, attractive back garden. Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 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, 36. Quality in this outcome area is good. Staff recruitment and training procedures help to ensure that well trained, suitable staff are available to meet the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Acrefield’s staff team is stable and experienced. When staff are first employed they go to the owner’s headquarters in North Wales for an extensive induction training programme. The owners have a wide ranging staff training programme and a detailed training matrix illustrates both mandatory and additional training. Recent training has included ‘philosophy of care’, ‘Downs syndrome and dementia’ and epilepsy. All senior staff have NVQ3 and seven care staff have NVQ2. This is just under 50 so the home does not yet quite meet the target of 50 of care staff with NVQ2 as set out in Standard 32.6. A further six staff are working towards NVQ2 and three of them are due to qualify shortly, when the target will be exceeded. Some overseas staff work at Acrefield and their qualifications may be equivalent to NVQ if checked by NARIC, the appropriate government agency (www.naric.org.uk). The home usually has four or five care staff (including a senior) on duty in the daytime, in addition to the manager and ancillary staff. Additional staff may be provided as part of individual care packages and to accompany residents on holidays. Acrefield employs a full time administrator, which ensures that the Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 19 home’s records are efficiently maintained. Support staff are organised in teams, which are deployed flexibly where necessary. Six new staff had been recruited since the last inspection. The owners have a well-established recruitment procedure and files for newly employed staff showed that appropriate checks are taken up before employment, including Criminal Records Bureau checks and POVA clearance (i.e. their names are not on the Protection Of Vulnerable Adults register). Some staff have been recruited from overseas, in particular Poland. During the site visit the inspector spoke to the owner’s Human Resources Officer who said that Polish staff are recruited using a specialist agency which carries out police checks and obtains references in Poland. Staff of the Mental Health Care Group (the owners) visited Poland to conduct interviews personally. Job descriptions are on file; staff receive regular supervision and there are regular staff meetings. Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 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): 37, 38, 39, 42. Quality in this outcome area is excellent. The home is well managed, which helps to ensure that the home meets the often complex needs of the residents. Health and safety procedures are up to date, ensuring a safe environment for the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager is highly experienced, competent and well qualified. The atmosphere in the home is relaxed, friendly and open with good relationships between staff and residents. Acrefield’s quality assurance is based on surveys given to residents, family members and visiting professionals. In recent survey one relative said that ‘I could not fault in any way the care my {relative} receives at Acrefield and from my own point of view it is a pleasure to visit her there.’ Another said that her relative ‘is always happy and well looked after’. The questionnaires are analysed annually but the manager takes action immediately on any issues raised in them. The most recent results showed a very high level of satisfaction with the home. A representative of the Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 21 Registered Person visits the home each month and submits a report of the visit to the Commission for Social Care Inspection. The manager makes occasional unannounced night visits to check on the quality of care at night. Fire safety records were checked and all were up to date apart from the gas safety check which was a few days out of date. This certificate had been renewed before this report was written and a copy was sent to the inspector. The kitchen was clean and well organised; food is properly stored and fridge temperatures are regularly checked. Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 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 x 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 4 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 4 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 4 3 3 4 4 x x 3 x Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Acrefield House DS0000018853.V306717.R01.S.doc Version 5.2 Page 25 - 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!