Inspection on 26/01/06 for Little Acorns

This inspection was carried out on 26th January 2006.

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 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 26th January 2006 07:50 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.V263362.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 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.V263362.R01.S.doc Version 5.0 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. 20th June 2005 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. Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over four hours. There were eighteen service users in residence on the day. Service users were spoken with as a group. 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 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. Due to the staff shortage, staff were not spoken with as this would have further impinged on their time with service users. 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. This is the second inspection of this year and therefore this report should be read in conjunction with the report from the announced inspection carried out on 20 June 2005. What the service does well: What has improved since the last inspection? What they could do better: All documentation relating to service users health, social, and personal care needs to be such that all needs are identified and planned for, including detailed risk assessments. Service users or their representatives need to be consulted in the compilation and reviews to ensure any limitations are agreed upon. The requirements relating to health and safety need to be addressed, including those in respect of including the provision of suitable lifting equipment, washbasins in all communal toilets, ensuring call bells are accessible to service users and that the use of door wedges ceases. Other requirements relating to service users comfort and safety is that guards are fitted to all radiators and that temperatures can be controlled in service users own rooms. All complaints need to be recorded and include outcomes. The introduction of formal quality assurance and quality monitoring systems would Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 6 enable the provider to critically evaluate the service and ensure it is run in service users best interests. Staff training needs to be provided to promote the safety of both service users and staff. All parts of the home need to be maintained to ensure the comfort of service users. Service users bedrooms would be more homely if they were furnished according to the required standard. Staffing levels must be increased to ensure service users assessed needs are met. The Manager needs to increase her management hours to ensure that she effectively manages the home and the requirements in this report are addressed within the timescales. The Manager also needs to enrol on a suitable management course in order to fully meet the qualification required in Standard 31. Immediate requirements were issued in respect of the use of door wedges and an urgent reassessment of one service user who appears to need nursing care. 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.V263362.R01.S.doc Version 5.0 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.V263362.R01.S.doc Version 5.0 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): 3 and 4 Pre-admission and care planning documentation is inadequate therefore the home is unable to demonstrate it can meet service users needs. 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. Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 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, 10 and 11 The care planning system is clear and provides staff with most of the information they need to satisfactorily meet service users’ needs. Some healthcare needs of service users are unmet. Systems for administering medication are unsatisfactory and pose a potentially serious risk to service users. Service users would be better protected if risk assessments including the management of the risk. Service users privacy and dignity is protected. EVIDENCE: A sample of care plans were viewed and were found that although care needs had been identified, there was little information on how needs would be met. There was no evidence to show that service users or their representatives are involved in compiling and reviewing the plans. Risk assessments had been carried out but they do not clearly identify all hazards nor include sufficient detail for the management of risks. Risk assessments for those at risk of tissue breakdown, falls and who present challenging behaviour need to include the management of the risk. Care plans need to include service users personal preferences such as times for getting up and going to bed. When the inspector arrived at the home at 07.50 Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 10 sixteen service users had been washed, dressed and were sitting in the dining room, indicating that they had been wakened very early. These service users were seen to be sleeping in chairs immediately after breakfast. All service users healthcare needs such as dental, optical and chiropody needs to be recorded in care plans and what action is to be taken to meet those needs. When service users are noted to have lost weight dietary advice needs to be sought. Some statements used in care planning documents are judgemental and are therefore not appropriate. The home has policies and procedures on the safe handling of medication but on the day the inspector found a tablet on the lounge floor. The Registered Manager believed she could track who the tablet was for. However, if two or more service users have the same medication one may have a double dose while another may miss a dose. Systems must be created to ensure medication is handled safely. Staff were observed to treat service users with care and respect. Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 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, 14 and 15 Service users would benefit from a planned and varied programme of in-house activities. Service users would benefit from the creation of systems to increase their choice over their daily routines. Meals are good offering both choice and variety and service users individual preferences are catered for. EVIDENCE: Currently the home does not have a planned programme of in-house activities based on service users likes and past hobbies. Service users would benefit from daily activities to ensure they remain stimulated and that their leisure needs are met. Throughout the inspection service users were left to sit in the lounge and dining room without any stimulation, although the Manager did explain that at the time the home was seriously short staffed, with two morning carers calling in sick. The lack of staff also meant that staff had no time to chat or interact with service users. Menus were viewed and it was found that they are nutritious and balanced. Three service users have pureed meals and these are prepared to ensure they are pleasant and attractive. Again, daily notes showed that some service users are not encouraged to exercise choice and control over their daily routines. One service user was Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 12 moved to another shared room because she shouted a lot. Neither she nor her representative were consulted prior to the move. The note stated that the other occupant of the room also shouted so they would be happy together. As previously mentioned under Standard 7 service users preferences in respect of getting up and going to bed are neither recorded nor actioned. Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 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 The home has a complaints procedure, however, not all complaints are recorded. 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 complaints book was inspected and it was seen that not all complaints are recorded. The CSCI has received two complaints since the last inspection and these were not recorded although the Registered Manager responded to these complaints. It is important to record all complaints as they help to inform the quality monitoring systems. A summary of the two complaints is detailed below. A number of concerns were raised with the CSCI in July 2005 regarding lack of attention to service users personal hygiene, personal possessions, lack of supervision of service users, offensive odours, cleanliness of the home, access in/out of the home, call bells and medication. The outcome was as follows: - The lack of attention to service users personal hygiene was unproven. - The issue of the safety of service users personal possessions was partially upheld. - The lack of supervision of service users was upheld. Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 14 - - That the parts of the home were subject to offensive odours was partially upheld. The issue of the cleanliness of the home was upheld. The concerns relating to access in/out of the home required the Registered Manager to make clear that service users accommodated in the home must be sufficiently mobile to manage the outside steps. That call bells were not working was upheld. That staff did not check service users had eaten prior to administering certain medication was upheld. A concern was raised with the CSCI regarding a service user being distressed by comments made by a carer. That a service user was shouted at by a carer when he activated the fire alarm. No evidence was found to either support or refute that a carer caused distress to a service user. A carer agreed that she did mention the cost of unnecessary call outs of the fire services when a male service user activated the fire alarm but refutes that she raised her voice. Therefore this was unproven. The Registered Manager supplied an action plan detailing what action was taken to address these complaints. The home has policies and procedures on adult protection however, the complaint in respect of a service user being shouted at should have been reported under adult protection procedures. The daily notes inspected found that one service user had attacked another service user and this should also have been reported under adult protection procedures. These events were discussed with the Registered Manager who was unaware that these alerts should be been carried out. Service users are at risk if the Manager and staff are unaware of the what constitutes abuse and the correct reporting procedures. Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 15 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, 24, 25 and 26 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 and working practices pose a risk of cross infection. EVIDENCE: A tour of the premises was carried out and the home is generally clean and tidy. However, a number of carpets need replacing as they pose a trip hazard and some areas of the home need to be redecorated. The Registered Manager is aware of these shortfalls and intends to embark on a maintenance and renewal programme in the spring. A strong odour was noticeable in some service users bedrooms. Odours need to be eliminated to ensure the home remains pleasant and comfortable. A suitably qualified person has made an assessment of the premises and grounds to ensure the needs of all service users are met and the subsequent report was viewed. The Registered Manager Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 16 has yet to address the recommendations made in the report. All communal toilets need to have wash hand basins installed to facilitate infection control and all staff need to follow infection control practices. During the inspection staff were noted to be providing personal care without wearing plastic aprons and not changing rubber gloves when move from one bedroom to another. Not all radiators had guards fitted and the guard on the hall radiator had been removed. The Registered Manager said she had removed the guard in order to increase the heat radiated. The thermostat should have been adjusted to provide more heat as unguarded radiators pose a serious risk to service users. Heating cannot be controlled in service users individual rooms and this must be addressed, as some bedrooms were cold. A programme of fitting temperature control valves to hot water outlets in service users bedrooms has begun. However, it was found that some water temperatures exceed 500 which poses a potential risk to service users. Some water temperatures were below 400 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. During the inspection the Registered Manager and staff were noted to be providing personal care without wearing plastic aprons and not changing rubber gloves when moving from one bedroom to another. This practice poses a risk of cross infection. The homes laundry facilities are satisfactory as are the rear gardens which are attractive and well maintained. Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The deployment and number of competent staff available is insufficient to meet the needs of service users. Recruitment practices are poor and are insufficiently robust to protect service users from potential abuse. EVIDENCE: Staff rotas were viewed and there should be three staff on duty during the morning shift. However, on the day two had not turned up for duty and the Registered Manager did not have systems to employ agency or bank staff. Therefore one carer and the Registered Manager covered the shift. This was clearly insufficient to meet the needs of eighteen service users, one of whom appears to need nursing care. Two night waking staff are employed but one service user needs two staff for all transfers and regular turning, when there are only two staff on duty the needs of all service users cannot be met. Staffing levels must be increased based on the needs of all service users. This was a requirement at the last inspection. Of fourteen care staff, only two have achieved NVQ Level 2 in care 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 and as yet the Registered Manager has not created a plan to demonstrate how this Standard will be met. Recruitment records were viewed and although no staff have been employed since the last inspections the requirements in respect of obtaining two Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 18 references and an employment history have not been met for existing staff. Service users are at risk if recruitment practices are not robust. 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. Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 19 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, 36 and 38 Service users benefit from an appropriately supported staff team who are consulted on how the home is run. There are no quality monitoring or quality assurance systems in place 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 needs to undertake NVQ Level 4 training in management to fully meet the required standard. As the Registered Manager covers for staff shortages she does not have sufficient time to effectively manage all aspects of the service. Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 20 She has begun to provide formal supervision for staff but needs to develop a programme to ensure all staff receive this bi-monthly. Supervision records were viewed and showed that these sessions are used to identify training and good practices issues. Regular staff meetings are carried out and the minutes were viewed. It was evident that staff use this time to comment on all aspects of how the home is run. There is also a ‘hand over’ session at the end of each shift to ensure staff coming on duty are aware of what needs to be monitored. The introduction of formal quality assurance and quality monitoring systems would enable the Registered Provider to critically evaluate the service 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. All staff have need to be trained in infection control and first aid. Door wedges were still being used and this practice must cease as this poses a risk to both staff and service users in the event of a fire. An immediate requirement was issued in respect of this. A wheelchair impeded a fire exit outside a service users bedroom and this needs to be rectified. A written risk assessment of the grounds and premises in respect of safe working practices needs to be carried out and identified shortfalls acted upon. Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 21 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 X X 2 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X 2 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 1 X 3 3 X 2 Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 22 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 Manager(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)(a) (c)(d) Requirement Pre-admission sheets for all new service users must be completed and be expanded to include all the information as listed under Standard 3. (timescale of 20/09/05 not met) The home needs to demonstrate it can meet service users assessed needs. (timescale of 20/09/05 not met) That an urgent reassessment is undertaken for the identified service user. Care plans must be include information on how needs are to be met and evidence provided to show service users or their representatives are involved in compiling and reviewing the plans. (timescale of 20/09/05 not met) Risk assessments for those service users who present challenging behaviour, have falls or at risk of tissue breakdown must include the management of the risk and be regularly reviewed. (timescale of 20/09/05 not met) DS0000021157.V263362.R01.S.doc Timescale for action 31/03/06 2 OP4 12 (a&b) 31/03/06 3 4 OP4 OP7 12 (a&b) 15 (2) (b) (c) 05/02/06 31/03/06 5 OP7 13(4bc) (15) (2b) 31/03/06 Little Acorns Version 5.0 Page 23 6 OP8 12 (1ab (2)(3)13 (1b 13 (2) 7 OP9 8 9 10 OP12 OP14 OP14 16 (2mn) 12 (2)(3) 12 (2)(3) 11 OP16 22(1) 12 OP18 13(6)(7) (8) 13 14 OP18 OP19 13 (6) 23(1a) (2b) 16(1)(2c) 14(1a) 16(1)(2c) 13(4)(a) (c) 13(4)(a) (c) 15 16 17 18 OP22 OP24 OP25 OP25 Care plans need to include information on dental, hearing, eyesight and how they will be actioned. (timescale of 20/09/05 not met) Advice must be sought from a GP if medication is not given to a service user due to tablets being dropped. That a planned programme of activities be devised and implemented. That evidence is provided to demonstrate rooms are shared by choice. That service users are consulted in respect of their daily routines and their wishes taken into account. That all complaints are recorded and include action taken and outcomes as required under Reg 17 (2) Schedule 4 (11) Staff need to receive training in adult protection and dealing with challenging behaviour. (timescale of 30.08.04 and 20/09/05 not met) That adult protection procedures are followed when an incident occurs. That all parts of the home, are properly maintained and refurbishment undertaken as necessary That the recommendations made in the Occupational Therapist report be implemented. That furniture listed under the standard be provided in service users bedrooms. That hot water delivery temperatures in service users bedrooms are near to 430. That guards are fitted to all radiators and pipe work that require them. DS0000021157.V263362.R01.S.doc 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 Little Acorns Version 5.0 Page 24 19 20 21 22 23 OP26 OP26 OP27 OP28 OP29 24 OP30 25 OP31 26 OP31 27 OP33 28 29 OP38 OP38 30 OP38 That all parts of the home are kept free from offensive odours. 16 ((j) That hand basins are fitted in all communal toilets that require them. 18(1)(a) That sufficient numbers of suitably qualified staff be deployed. 18(1)(a-c) That a plan is developed to (i) ensure 50 of staff achieves NVQ level 2. Reg.19 All staff need to provide the (4c)(5) 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 as required under Schedules 2 and 4. (timescale of 29/04/04 and 20/09/05 not met) 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 not met) 9(1)(2b) That the Registered Manager (i) develops a plan to acquires an appropriate management qualification. 9(1)(2bi) That the Managers management 12(1b) hours be increased to enable her to fulfil her management duties. (timescale of 20/09/05 not met) 24 (1ab) That formal quality monitoring (2)(3) and quality assurance systems be created and implemented. (timescale of 20/09/05 not met) 13(4) That all staff be trained in 16(2j) infection control and first aid. 12(1)13 That a risk assessment of the (1-8) grounds and premises in respect of all safe working practices be undertaken. 23(4a)(c) That the practice of wedging (i)(v) open fire doors ceases. DS0000021157.V263362.R01.S.doc 16 (2) (k) 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 Little Acorns Version 5.0 Page 25 31 OP38 23(c)(iii) That exits are kept free from obstacles. 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Manager/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Little Acorns DS0000021157.V263362.R01.S.doc Version 5.0 Page 26 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.V263362.R01.S.doc Version 5.0 Page 27 - 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!