Inspection on 20/06/05 for Little Acorns

This inspection was carried out on 20th June 2005.

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

Little Acorns 19/06/07

Little Acorns 03/11/06

Little Acorns 20/06/06

Little Acorns 26/01/06

Little Acorns 07/12/04

Little Acorns 29/04/04

Little Acorns 13/05/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Little Acorns 43 Silverdale Road Eastbourne East Sussex BN20 7AT Lead Inspector Gwyneth Bryant Unannounced 20 June 2005 07:50 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 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. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Little Acorns Address 43 Silverdale Road Eastbourne East Sussex BN20 7AT 01323 720520 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr George Wallis Miss Michelle Levett Care Home 20 Category(ies) of Dementia over sixty-five years of age (DE(E) registration, with number 20 of places Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 The maximum number of service users to be accommodated is twenty 2 Service users must be older people aged sixty-five (65) years or over on admission. 3. Service users with a dementia type illness only to be accommodated Date of last inspection 7 December 2004 Brief Description of the Service: Little Acorns registered to provide care to up to twenty older people with a dementia type illness. It is a three storey building situated in the Meads area of Eastbourne, with the seafront and town centre within short walking distance Access to the upper floors is via stair lifts. Service user accommodation comprises twelve single and four double bedrooms. None of the bedrooms have en-suite toilet facilities but all have a handbasin. The home provides a dining room and a lounge that looks out onto a patio area. There is a small visitors room that is also used for storage purposes. The rear garden is not accessible or safe for service users as access is via steep steps. There are two bathrooms, both of which are assisted. Toilet riser seats, hand and grab rails have been fitted to meet individual needs. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over seven hours. There were eighteen service users in residence on the day of which three were spoken with. The purpose of the inspection was to check compliance with the requirements made during the last inspection and to inspect other standards. The Registered Manager, two visitors and one member of staff were spoken with. Fifteen key and seven of the other standards were inspected. A range of documentation was viewed including service users care plans, personnel files and medication records. A tour of the premises was carried out. What the service does well: What has improved since the last inspection? All new staff now receive induction training that meets the Care Skills Sector specifications and includes how staff are to offer care to service users. Service users admitted in an emergency are provided with all the admission information within five days. All staff have been trained in manual handling. An up-to-date list of service users possessions bought into the home is maintained. Staff have begun to receive formal supervision. A number of health and safety matters have been addressed including the provision of radiator guards, call bells and repairs to furniture and fittings. Staff are made aware of fire safety procedures during their induction training and fire exits are clear of obstacles. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 7 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 Standards Statutory Requirements Identified During the Inspection Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 8 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 standard(s) 3, 4 and 5 Pre-admission documentation is inadequate therefore the home is unable to demonstrate it can meet service users needs. Service users representatives have the opportunity to assess the suitability of the home prior to admission. EVIDENCE: Pre-admission sheets were viewed and it was found that not all care needs were identified. The pre-admission document needs to contain all the aspects as listed under Standard 3 as the home cannot demonstrate it can meet service users needs unless this document is detailed and accurate. All service users are offered a trial period prior to their stay becoming permanent and this information is included in the Service Users Guide and the home’s terms and conditions. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 9 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 standard(s) 7, 8 and 9 Care plan systems need to be consistent and include all personal and healthcare needs to ensure service users needs are identified and planned for. The systems for administering, storing and recording medication are satisfactory. EVIDENCE: A sample of care plans were viewed and were found to be inconsistent and there was no evidence to show that service users or their representatives are involved in compiling and reviewing the plans. Basic risk assessments had been carried out but they do not clearly identify the hazards nor include sufficient detail for the management of risks. Risk assessment need to be undertaken for those at risk of tissue breakdown, falls and who present challenging behaviour. Care plans need to include service users personal preferences such as times for getting up and going to bed. Service users healthcare needs including dental, optical and chiropody need to be recorded in care plans. When service users are noted to have lost weight dietary advice needs to be sought. All care documentation should be signed and dated. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 10 Medication records were viewed and found to be satisfactory and all staff who administer medication have been appropriately trained. It is recommended that two staff signed for controlled drugs. Staff would benefit from training in dealing with challenging behaviour, to ensure that they and service users are protected from physical harm. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 11 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 standard(s) 13, 14 and 15 Visitors are welcome at all reasonable times. Meals are good offering both choice and variety, however service users individual preferences are not catered for. EVIDENCE: Two visitors were spoken with and they said that they are welcomed to the home and always offered refreshments. Both spoke very highly of the home and the quality of care given. The service users spoken with said that they enjoyed the food. Menus were viewed and it was found that they are nutritious and balanced. The Manager said the home was trying various meats to find out which are most popular and that are easily digestible by service users. Lunch was served during the inspection and it was attractively presented. The night reports found that staff frequently had to ‘persuade’ some service users to go to bed. This was discussed with the Manager who agreed that service users preferred times for going to bed need to be recorded in their care plans and therefore provide guidance for staff. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 12 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 standard(s) 16 and 18 The home has a satisfactory complaints procedure with evidence that complaints are recorded and actions taken to resolve any issues. Although there are systems are in place to protect service users from abuse, staff would benefit from training to improve their understanding of adult protection issues. EVIDENCE: The complaints book was inspected and it was seen that all complaints are recorded and include actions taken and outcomes. No complaints had been received since the last inspection. Relatives said that they would be happy to raise any concerns with the staff or Manager The home has policies and procedures on adult protection, however staff and the Manager were unfamiliar with adult protection procedures. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 13 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 standard(s) 19, 22, 24 and 25 The standard of décor in all parts of the home is good, providing service users with a homely and attractive place in which to live. Improvements are required in respect of the provision of adaptations and equipment to ensure the needs of all service users are met. EVIDENCE: A tour of the premises was carried out and the home is clean tidy and generally well maintained. A suitably qualified person needs to make an assessment of the premises and grounds to ensure the needs of all service users are met. Additional grab and handrails would ensure the needs of all service users are met. All communal toilets need to have wash hand basins installed to facilitate infection control. Service users individual accommodation is furnished according to the required standard unless a risk assessment suggests otherwise. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 14 The heating and ventilation is a satisfactory and service users safety is protected by the fitting of guards to all radiators that required them. Pre-set temperature valves have been fitted to hot water taps in bathrooms and this needs to be extended to taps in service users bedrooms to ensure hot water is delivered at a safe temperature. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The deployment and number of staff is sufficient to meet service users needs, however, the manager also provides direct care and this impinges on her management time. Recruitment practices are not robust and do not provide safeguards to protect service users. Service users would benefit from additional staff training to ensure they have the skills to meet service users assessed needs. EVIDENCE: Staff rotas were viewed and found that three carers are on duty during the morning and afternoon shifts and two waking night staff are employed. Cooks and domestic staff are also employed. However, the Manager frequently provides additional care hours and this impinges upon her management time. This needs to be addressed to ensure she has sufficient time to undertake all management tasks. Recruitment records were viewed and it was found that not all new staff had provided two references and POVA and Criminal Records Bureau checks had not been carried out. One member of staff needs to provide evidence that she has permission to work in the UK. The staff application form needs to be expanded to include a full employment history to ensure any gaps in employment can be identified. The home has a staff induction training programme that meets the Care Skills sector specifications. A similar foundation training programme needs to be developed and implemented. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35, 36 and 38 The Manager needs to exercise her leadership skills to direct and support staff to provide service users with consistent care. The home has yet to develop quality monitoring and quality assurance systems. There are systems in place to safeguard service users financial interests. Service users safety and welfare would be better protected if staff were trained in infection control and first aid. EVIDENCE: The Manager has the required qualifications in care and management and has owned and managed the home for a number of years. Service users families or representatives organize their finances. When the home buys items for service users the cost is included in the monthly invoice and receipts provided. Staff supervision records were examined and from these it is clear that these sessions identify training needs and good practice issues. The staff member spoken with confirmed she receives satisfactory supervision. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 17 The introduction of assurance and quality monitoring systems would enable to the provider to critically evaluate the service and ensure it is run in the service users best interests. Documents relating to Health and Safety were available and found to be satisfactory as were accident records. There were records showing the regular testing of emergency lighting and fire alarms and that fire equipment and systems are regularly serviced. All staff have now been trained in fire safety and food hygiene. Training in infection control and first aid needs to be extended to all staff. Pre-set safety valves have been fitted to hot taps in bathrooms and these also need to be fitted to hot water outlets in service users bedrooms. The Manager was able to demonstrate that an estimate for the cost of the work has been provided. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 x x 1 x 3 3 x STAFFING Standard No Score 27 3 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 x 1 x 3 3 x 2 Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 and 4 Regulation 14 (1) (a) (c) (d) and 12 (a&b Requirement Timescale for action 20.09.05 2. 7 3. 7 4. 8 and 14 5. 9 Pre-admission sheets for all new service users must be completed and be expanded to include all the information as listed under Standard 3. The home needs to demonstrate it can meet service users assessed needs. 15 (2) (b) Care plans must be consistent, (c) and evidence provided to show service users or their representatives are involved in compiling and reviewing the plans. 13 (4) (b) Detailed risk assessments need (c)and 15 to be undertaken for those (2) (b) service users who present challenging behaviour, have falls or at risk of tissue breakdown. Assessments must include the management of the risk and be regularly reviewed. 12 (1) Care plans need to include (a&b) (2) information on dental, hearing, (3) and eyesight and weight checks. 13 (1) (b) Service users preferences and regarding getting up and going Regulation to be need to be recorded. 17 (1) (a) schedule 3 (o) Reg.17 All staff who administer H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc 20.09.05 20.09.05 20.09.05 20.09.05 Page 20 Little Acorns Version 1.20 6. 18 (1) (a) Schedule 3 (k) and 18 (1) (a) 13 (6) (7) (8) 16 (1) (2) (c) and 23 (2) (n) medication need to receive accredited training. Staff need to receive training in adult protection and dealing with challenging behaviour. (timescale of 30.08.04 not met) An assessment of the premises needs to be undertaken by a suitably qualified person to ensure the needs of all service users are met. (timescale of 30.10.04 not met) All staff need to provide the required documentation listed in Schedule 2 of the Regulations prior to appointment, including work permits as necessary. The application form needs to be expanded to include an employment history and that staff records are available in accordance with Schedule 4. (timescale of 29.04.04 not met) That foundation staff training programmes that meet the Care Skills Sector specifications be created and implemented. That the Managers management hours be increased to enable her to fulfil her management duties. That formal quality monitoring and quality assurance systems be created and implemented. That all hot water outlets in service users bedrooms are fitted with safety valves. That all staff be trained in infection control and first aid. 20.09.05 7. 22 20.09.05 8. 29 Regulation 19 (4) (c) (5) and Schedule 2 of the Regulation s and Schedule 4 of the Regulation s 12 (1) (a&b) and 18 (1) (a) (c) (i) (ii) 9 (1) (2) (b) (i) and 12 (1) (b) 24 (1)(a) (b) (2) (3) 13(3) (4) (a) (c) 13 (3) (4) and 16 (2) (J) and 23 (5) 20.07.05 9. 30 20.09.05 10. 11. 12. 13. 31 33 38 38 20.07.05 20.09.05 20.09.05 20.09.05 Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 21 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. 2. Refer to Standard 7 22 Good Practice Recommendations All care planning documentation needs to be signed and dated. That commodes that are rusty are refurbished or replaced. Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Little Acorns H10-H59 s21157 Little Acorns v218976 200605 stage 4.doc Version 1.20 Page 23 - 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. 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