Inspection on 20/06/06 for Little Acorns

This inspection was carried out on 20th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 26/01/06

Little Acorns 20/06/05

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 Inspection 20 June 2006 08:00 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 Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000021157.V289647.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Little Acorns Address 43 Silverdale Road Eastbourne East Sussex BN20 7AT 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) 01323 720520 Mr George Wallis Miss Michelle Levett Miss Michelle Levett Care Home 20 Category(ies) of Dementia - over 65 years of age (20) registration, with number of places Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That a maximum number of twenty (20) service users are to be accommodated. That service users with a dementia type illness are to be accommodated. That service users must be aged 65 (sixty-five) years and over on admission. 26th January 2006 Date of last inspection 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 wash 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. The service provides prospective service users and their families with a copy of the Service Users Guide, a contract, terms and conditions, the Statement of Purpose. they are directed to the CSCI website for copies of the latest inspection report. periods offered. Fees charged as from 1 April 2006 range from £362 to £450, which includes toiletries, activities, newspapers and small items such as tights. Additional charges are made for hairdressing, chiropody and the manicurist. Intermediate care is not provided. Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by two inspectors for a total of seven hours. Both inspectors were on site for the first 4.5 hours and the following 2.5 hours one inspector was on site. There were eighteen service users in residence on the day. Service users were spoken with as a group and individually. 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, her deputy, one care staff and the administrator were spoken with. A range of documentation was viewed including service users care plans, personnel files and medication records. A tour of the premises was carried out. One of the Registered Providers is also the Registered Manager. The reader is asked to be aware that where shortfalls are identified the Registered Provider is aware of them in her role as Registered Manager. Five comment cards were received from service users whose relatives assisted in their completion. Comments were in the main positive about the care given with all mentioning that they felt the manager and staff responded promptly to any queries. Other social and healthcare staff were not engaged with on this occasion What the service does well: What has improved since the last inspection? What they could do better: Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 6 There remain shortfalls in care planning, handling of medication and staff training, all of which have significant impact on the delivery of adequate and appropriate care to service users. In addition a number of health and safety issues were identified, including the inappropriate storage of step ladders, comfortable hot water temperatures, that not all parts of the home are well maintained, odour free and kept in good repair, which if not addressed will put service users at risk. 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. Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 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 the following standard(s): 1, 2, 3 and 4. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory pre-admission assessments are carried out prior to service users moving into the home which ensure that their needs can be met and they are provided with detailed information on services provided by the home. EVIDENCE: The Statement of Purpose and Service Users Guide have been recently updated and contain all the information required enabling prospective service users to make an informed choice about where live. Pre-admission documentation was viewed for recent admissions and it is evident that these documents are used effectively to ensure the home is able to meet the needs of prospective service users. At the time of admission information is sought from social and healthcare professionals to ensure all needs are clearly identified and planned for. Intermediate care is not provided. Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All aspects of service users health, social and care must be identified and planned for, in order to clearly direct staff in the delivery of appropriate care. EVIDENCE: Five care plans were viewed, including two who had been recently admitted. Care planning documents now included information on meeting service users healthcare needs such as dental, hearing and eyesight checks. Improvements need to be made in respect of ensure care plans include clear direction to staff as to how care needs are to be met. Risk assessments have been improved in respect of those at risk of falls and tissue breakdown, however improvements need to be made in respect of those service users who present challenging behaviour to provide staff with clear direction on dealing with this. Detailed manual handling risk assessments need to be carried out to ensure the protection of both service users and staff. One service user admitted three weeks prior to the inspection did not have a care plan. The manager explained that she uses the trial period to assess service users and does not write a plan until the month trial period has elapsed, however this practices does not ensure all staff are clearly directed in how care need are to be met and must Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 10 be rectified. Clear guidelines on the management of incontinence need to be developed and implemented. There was evidence to show that some relatives have been consulted on the provision of service users care and this needs to be extended to all service users relatives or representatives. When the inspectors arrived at the home at 08.00 fifteen service users had been washed, dressed and were sitting in the dining room, indicating that they had been wakened very early. This was discussed with the manager who said that staff were required to only get service users up and dressed if they wished to do so. Therefore all care plans need to include service users personal preferences in respect of times for getting up and going to bed to ensure staff are clearly directed in this matter. One service user was found sitting in another service users’ bedroom. While it is good practice to allow service users to access all communal areas of the home, there needs to be sufficient supervision to ensure service users privacy is not compromised. Some statements used in care planning documents remain judgemental and are therefore not appropriate. Care plans include service users leisure preferences but not how they will be met and this needs to be clarified. Staff were observed to treat service users with care and respect and it was evident that they had built comfortable working relationships with them. Staff spoken with were knowledgeable about service users individual needs, however this information was not always recorded in the care plans, in particular that relating to dietary needs and taking service users out for walks. The home has policies and procedures on the safe handling of medication, however some service users rooms contained creams that could not be matched to the occupant as the name on the labels were illegible. This needs to be addressed as it poses a risk of cross contamination. In addition correction fluid had been used on part of a medication administration chart and this is not good practice and must be addressed. Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lifestyle experience by service users matches their expectations, choice and preferences. Meals are satisfactory but improvements could be made in respect of variety and choice in order that service users are informed of the alternatives available so that they can make an informed decision about what they would like to eat. EVIDENCE: The home has introduced a planned programme of activities for both the morning and afternoon periods. One inspector observed the morning activity of basketball and it was evident this was enjoyed by all those who participated and gave staff the opportunity to relate to service users in a less formal, care related setting. Menus were viewed and it was found that they are nutritious and balanced, however a choice of lunchtime meal is not routinely offered and only provided if a service user does not like the planned meal. Care plans included service users food preferences. Weight charts were viewed and it appeared that some service users are underweight although the daily records showed that service users generally ate well. This was discussed with the manager and it was agreed that service users should be offered a second helping at each meal. In addition the process for weighing service users may be at fault as many cannot stand on the scales for long so readings may be Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 12 inaccurate. The manager said she will make enquiries with a view to the purchase of ‘sit on’ scales. One service user who was able to express a preference said she had enjoyed her breakfast but wanted to go to the lounge with the others. Staff escorted her to the lounge area. Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a satisfactory complaints system with evidence that service users, via their relatives felt confident their views would be listened to. Although there are systems in place to protect service users from abuse, staff would benefit from training to improve their understanding of adult protection issues. EVIDENCE: The home has comprehensive complaints policies and procedures and all complaints are now recorded and include actions taken and outcomes. There have been no complaints received since the last inspection. The home has detailed policies and procedures on adult protection and there is a staff training programme in place. Some staff have been trained in adult protection and the rest are due to receive this training in September 2006. Discussion with the manager found she is familiar with adult protection procedures. Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home is clean and tidy improvements need to be made to the furniture, fittings and general maintenance to create a pleasing, safe and comfortable environment for service users to live in. Laundry facilities are satisfactory, but some parts of the home were malodorous. EVIDENCE: A tour of the premises was carried out and the home is generally clean and tidy. The lounge and dining room have been improved by redecoration and the fitting of new carpets. Most service users bedrooms were attractively decorated but some were malodorous as was the main hallway. Odours need to be eliminated to ensure the home remains pleasant and comfortable. All communal bathrooms and toilets now have hand washbasins fitted but it is necessary to have liquid dispensed soap, paper towels and toilet paper on holders as required to reduce the risk of infection. A suitably qualified person has made an assessment of the premises and the recommendations in the Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 15 subsequent report need to be addressed, including the provision of grab rails in communal toilets and bathrooms. Heating cannot be controlled in service users individual rooms and this must be addressed to ensure bedrooms are comfortable for the individual. Water delivery temperatures in service users bedrooms were mostly below the recommended 430C and this results in service users having to wash in tepid water. Not all service users bedrooms include bedside tables and bedside or overhead lamps. Service users individual accommodation must be furnished according to the required standard unless a risk assessment suggests otherwise. In addition a number of minor repairs to bed heads and refurbishment of paintwork and the plumbing system is required to ensure all parts of the home remain in good repair. Three radiators still need to be fitted with guards, as does some pipe work to reduce risk to service users. The manager is aware of the shortfalls and is currently working with fitters to find radiator covers that are suitable. The laundry was clean with equipment that can wash soiled laundry at high temperatures. Staff training in basic infection control continues to be provided in-house, with more detailed training provided by outside trainers. Staff were observed to be working in ways that minimised the risk of infection, with staff wearing gloves and aprons when required. Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The deployment and number of competent staff available is insufficient to meet the needs of service users. Recruitment practices are insufficiently robust to protect service users. EVIDENCE: The staff rota was viewed and there are three staff during each shift with one extra member of staff to cover the middle period of 09.00 to 15.00. Cooks and domestics are employed and two night waking care staff. Staff appeared to have sufficient time to meet care needs but the do not have time to engage with service users on a more social level nor to provide satisfactory supervision as mentioned under Standard 7. All aspects of recruitment were discussed with the manager and she agreed that more staff need to be employed to ensure all aspects of service users needs are met. In the meantime the Manager frequently fills in during staff shortages and this impinges on her management time. She is aware of this and has interviewed to new staff with the intention of appointing them when the Criminal Records Bureau checks and references are obtained. One member of staff has been employed and while she provided identity papers, she did not provide a work permit. The manager will make enquiries with the Home Office in this matter. Of fifteen care staff, five have achieved NVQ Level 2 in care, one is in the process of gaining this qualification and one is in the process of gaining NVQ Level 4. Therefore the required level of 50 of care staff with an NVQ qualification remains unmet. The Manager has applied to enrol one other carer Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 17 on this course but has yet to create a written a plan to demonstrate how this Standard will be met by April 2007. Recruitment practice has improved in that all new staff have provided two references and do not work unsupervised until a satisfactory Criminal Records Bureau check has been received. All staff have a POVA check prior to appointment. The staff application form needs to be expanded to include a full employment history to enable any gaps to be explored at the time of interview. The home has an induction training programme that meets the Care Skills Sector specifications and corresponding foundation training needs to be devised and implemented to ensure staff have the skills to meet service users needs. In addition all staff receive training in first aid, manual handling and fire safety. Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from an appropriately supported staff team who are consulted on how the home is run. Quality assurance systems need to be expanded to enable the provider to objectively evaluate the service. Systems are in place to protect service users financial interests. All aspects of service users health, welfare and safety need to be protected and promoted. EVIDENCE: The Registered Manager has managed the home for a number of years and is knowledgeable about older people and their needs. She has satisfactory training in care and is in the process of gaining NVQ Level 4 training in management as is her deputy. As mentioned under Standard 27 the Registered Manager covers for staff shortages therefore she does not have Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 19 sufficient time to effectively manage all aspects of the service. Staff spoken with said she is approachable and it was evident throughout the inspection that staff are comfortable approaching her with any concerns. The minutes from the last staff meeting were viewed and it is clear that these sessions give staff the opportunity to comment on how the home is run. The manager has begun to gather evidence for the quality monitoring process and has devised questionnaires for both service users and their relatives. These systems need to be expanded to allow her to objectively evaluate all aspects of the service provided and ensure it is run in service users best interests.. The home does not hold or manage monies on behalf of service users. Receipts are obtained for items bought on behalf of service users and the cost is included in the monthly fee invoice. Therefore service users are finances are safe. 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. Some staff have been trained in infection control and the plan to train the rest in September needs to be met. A fire risk assessment has been carried out and a corresponding written risk assessment of the grounds and premises in respect of safe working practices needs to be carried out and identified shortfalls acted upon. All fire doors need to be maintained to ensure they close fully. Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 20 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 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 X 2 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 2 Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 21 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 OP7 Regulation 15 (1)(2) Requirement Care plans must be include information on how needs are to be met. (timescale of 20/09/05 and 31/3/06 not met) All service users need to have a plan of care. Risk assessments for those service users who present challenging behaviour must include the management of the risk and be regularly reviewed. (timescale of 20/09/05 and 31/03/06 not met) That manual handling risk assessments are carried out as required. That care plans include information on how service users leisure preferences are to be met and their dietary needs. That prescribed creams are used only for the person intended. Timescale for action 20/07/06 2 3 OP7 OP7 15 (1) 13(4bc) (15) (2b) 20/07/06 20/07/06 4 5 OP7 OP7 13 (5) 16 (2)(i) (mn) 13 (2) 20/07/06 20/07/06 6 7 8 OP9 OP10 OP15 20/07/06 20/07/06 20/07/06 12 (4)(ab) That sufficient supervision is provided to ensure service users privacy is not compromised. 16 (2)(i) That meal choice are offered routinely and fresh fruit available each day. DS0000021157.V289647.R01.S.doc Little Acorns Version 5.1 Page 22 9 OP18 13(6)(7) (8) All staff need to receive training 20/07/06 in adult protection and dealing with challenging behaviour. (timescale of 30.08.04, 20/09/05 and 31/03/06 not met) 20/07/06 10 OP19 23(1a) (2b) 11 OP22 12 OP24 13 OP25 14 15 16 17 OP25 OP25 OP26 OP27 18 19 OP28 OP30 20 OP31 That all parts of the home, are properly maintained and refurbishment undertaken as necessary. (timescale of 31/03/06 not met). 16(1)(2c) That the recommendations made 14(1a) in the Occupational Therapist report be implemented, including the fitting of grab rails in communal toilets. 16(1)(2c That furniture listed under the standard be provided in service users bedrooms. (timescale of 31/03/06 not met). 13(4)(a) That hot water delivery (c) temperatures in service users bedrooms are near to 430. (timescale of 31/03/06 not met). 13(4)(a) That guards are fitted to all (c) radiators and pipe work that require them. 23(1)(2p) Individual controls need to be fitted to service users bedroom radiators 16 (2) (k) That all parts of the home are kept free from offensive odours. (timescale of 31/03/06 not met). 18(1)(a) That sufficient numbers of suitably qualified staff be deployed. (timescale of 31/03/06 not met). 18(1)(a-c) That a plan is developed to (i) ensure 50 of staff achieves NVQ level 2. 12(1ab That foundation staff training 18(1a programmes that meet the Care ci)(ii) Skills Sector specifications be created and implemented. (timescale of 20/09/05 and 31/03/06 not met 9(1)(2bi) That the Managers management 12(1b) hours be increased to enable her DS0000021157.V289647.R01.S.doc 20/07/06 20/07/06 20/07/06 20/07/06 20/07/06 20/07/06 20/07/06 20/07/06 20/07/06 20/07/06 Little Acorns Version 5.1 Page 23 21 OP33 24 (1ab) (2)(3) 22 23 OP38 OP38 16(2j) 12(1)13 (1-8) 24 OP38 23 (4) (c) (i) to fulfil her management duties. (timescale of 20/09/05 and 31/03/06 not met) That formal quality monitoring and quality assurance systems be created and implemented. (timescale of 20/09/05 and 31/03/06 not met) That all staff be trained in infection control. (time scale of 31/03/06 not met). That a risk assessment of the grounds and premises in respect of all safe working practices be undertaken. (timescale of 31/03/06 not met). All fire doors need to close properly. 20/07/06 20/07/06 20/07/06 20/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations That appropriate language be used in care plans. Little Acorns DS0000021157.V289647.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East Sussex Area Office 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 DS0000021157.V289647.R01.S.doc Version 5.1 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!