Inspection on 03/11/06 for Little Acorns

This inspection was carried out on 3rd November 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 20/06/06

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 Key Unannounced Inspection 3rd November 2006 07:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 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.V316421.R01.S.doc Version 5.2 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 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.V316421.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over two days – 3.25 hours on the 3 November and a further 7 hours on 7 November making a total of 10.25 hours. There were eighteen service users in residence on both days. 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, the community nurse and one relative were spoken with. A range of documentation was viewed including service users care plans, personnel files and medication records. Nine service users surveys were returned having been completed by relatives on behalf of the service users. Comments in the surveys were variable but generally they felt that staff were caring and kind. A tour of the premises was carried out. Five comment cards were received from service users whose relatives assisted in their completion. It was disappointing to note that of the twenty-four shortfalls identified at the last inspection only five had been fully met and a further eight shortfalls were identified during this inspection. Prior to the inspection a pre-inspection questionnaire was sent to the home to be completed with information required as part of the inspection process. This was returned and information detailed is in this report. Comments in surveys included: ‘they (staff) are generally kind natured and address my mothers personality appropriately’. ‘we have always found the staff very friendly and helpful’. ‘all the staff are very good, excellent standard of care’. ‘could be better at times (cleanliness)’. Following the inspection a management review meeting was convened from which a decision was taken to issue a warning letter to the registered provider of the need for improvement. What the service does well: What has improved since the last inspection? Some progress has been made since the last inspection as highlighted below. All service users have a plan of care and prescribed creams are used only for the person intended. The recommendations made in the Occupational Therapist report have been implemented, including the fitting of grab rails in communal toilets. Additional Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 6 staff have been recruited to ensure there are sufficient staff to meet service users needs and the managers management hours have also been increased. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 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.V316421.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 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. EVIDENCE: Pre-admission documentation was viewed for recent admissions and these documents are comprehensive and ensure that all needs are identified prior to service users moving into the home. At the time of admission information also is sought from social and healthcare professionals to ensure all needs are clearly identified and can be planned for. Intermediate care is not provided. Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. 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: Four care plans were viewed in conjunction with the daily notes made by day and night staff. Care planning documents included information on meeting service users healthcare needs such as dental, hearing and eyesight checks although there were no records of visits from dentists or opticians. In addition, one returned survey said there has been a delay in obtaining visits from dentists and opticians. Improvements need to be made in respect of ensuring care plans include clear direction to staff as to how care needs are to be met and the daily notes need to be used to inform the monthly reviews of the plans to ensure a clear audit of care is maintained. Information in care plans was not consistent with that in the daily notes, or with information given to the inspector by service users. It was disappointing to note that care plans still include inappropriate language and that service users were heard to be addressed by inappropriate names. There were inconsistencies between the Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 10 pre-admission assessments, care plans and daily notes in that one care plans stated ‘no behaviour problems’ but the assessment and daily notes state they were rude, aggressive and may throw things. Failure to identify and plan for challenging behaviour puts both service users and staff at risk. Care plans did include service users food likes and dislikes but there was no other information in respect of how nutritional needs are to be met and although service users weight was recorded monthly the records did not appear to be accurate. Where service users were noted to have lost weight there was no clear records as to how this was to be rectified. In addition care plans did not include information on how service users need to be assisted with eating and on the first day of the inspection staff were observed to assist in an inappropriate manner. Some service users needed pureed food and the manager said these foods were fortified with milk or butter, but a discussion with the cook found that only water or gravy was added to pureed foods. Although basic risk assessments had been carried out for those at risk of tissue breakdown or are at risk of falls, they did not clearly identify the hazards nor include sufficient detail for the management of these risks. Fluid and food charts must be maintained for all service users that require them to ensure there is a record that their needs are being met. All service users need a detailed moving and handling risk assessment to ensure both they and staff are not at risk as poor practice was observed throughout the inspection in respect of moving and handling. Care plans did not include information on the management of continence and although some service users were noted as being continent if prompted to use the toilet, all wore pads and there was no information on how frequently service users need to be prompted. This practice needs to be reviewed and appropriate care provided. The community nurse spoken with said she visited the home regularly and found that she was appropriately consulted and advice sought as necessary. She added that staff will re-apply dressings in line with her directions and at this time there are no service users with tissue breakdown and she was currently treating just one service user who has leg ulcers. Direct observation on the day evidenced very little positive interaction between the staff and the service users. For example, moving and handling procedures were undertaken with no explanation given to the service users of what was happening. The service users personal dignity was not protected during the meal service, for example service users were not assisted to wipe their hands or faces following their meal nor check their clothing. Service users were seen with clothes stained with food remnants. At mid morning the manager accompanied the inspector to the lounge and there was only one carer attempting to seat service users at the table ready Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 11 for morning drinks. This carer was heard to shout at a service user and move another inappropriately whilst they were seated on a dining chair. This was discussed with the manager who said that this was a new member of staff and she should not have been left alone with the service users until she had completed her induction period. One survey returned also said that service users were left alone for long periods and there were concerns that one of them will have a fall. Medication administration charts were viewed and it was found that there were gaps in the charts, signatures had been scribbled out and where code letters were used, they were not followed by an explanation. On the first day of the inspection a carer was observed to administer medication but did not sign the administration chart immediately after. All medications were signed for when all medication had been administered. On the second day of the inspection one service users tablets had been left on her table and although staff signed to indicate it had been administered they did not witness this lady doing so. In addition this lady’s care plan states her medication should be taken with water but on this day she took it with her cup of tea. On day one of the inspection a glass of water was in a service users room with some white granules at the bottom. Despite discussion with the service user, manager and carer administering medication the substance in the water could not be identified but the carer said she did observe the service user taking her medication. Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The lifestyle experience by service users does not always match their expectations, choice or preferences. Meals are satisfactory but improvements could be made in respect of variety or preferences and the breakfast menu. EVIDENCE: Service users’ care plans include some information on their individual preferences in respect of social and leisure interests, however they do not include how they are to be met. The home has a programme of activities including games, manicures and cards but there is no indication that it has been based on service users interests. On the first day of the inspection most service users spent the morning just sitting in the lounge area or wandering around. The staff were seen to observe the service users but did not try to engage with them at all. On the second day one carer took responsibility for providing a game using beanbags which service users appeared to enjoy. There is no evidence of the service users going on trips into the local community and this needs to be explored as some care plans stated that service users liked to go out for walks. Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 13 Surveys returned indicated that activities provided could not be enjoyed by some service users as they could not participate, therefore activities need to be reviewed to ensure all service users have the opportunity to have their leisure needs met. There is an open house policy on visiting although there were no visitors on the day of the inspection. The one relative spoken with confirmed that he visits regularly and is always made welcome by the manager and staff. The first day of the inspection visit commenced at 07.30, and on entering the lounge, twelve service users were already up, dressed and having breakfast and a further two were in the process of being seated at the dining table. It was observed that none of the service users were given a drink until they had their breakfast although many would have been woken at least an hour earlier. Service users breakfasts were on a food trolley and a plate of toast was left on a plate for up to twenty minutes before being given to service users. Service users cereals and porridge was just placed in front of them and allowed to become almost cold before staff assisted them to eat. Generally the breakfast foods were not presented in a way that would encourage service users to eat. One service user only ate two spoonfuls of porridge and one bite of her marmalade sandwich, but staff did not offer her anything else. Service users were not offered a choice for breakfast nor were they offered additional spreads on their toast such as jam or honey. The manager and one carer spoken with said that service users are offered fruit but during the two days of the inspection none of the service users were seen to be offered this snack. None of the service users were offered a second cup of tea with their breakfast. One the second day of the inspection service users were offered fruit juice with their breakfast and the manager was unable to explain why it had not been provided on the first day. Some service users needed pureed food and the manager said these foods were fortified with milk or butter, but a discussion with the cook found that only water or gravy was added to pureed foods. Menus provided as part of the pre-inspection documentation showed that a choice of meal is not routinely offered and on the day of the inspection the cook decided to change the midday dessert as she felt they should not have a hot meal and a hot dessert. This approach does not demonstrate a good understanding of the need to provide balanced meals based on nutrition rather than temperature. As a number of service users are noted to have lost weight a concerted effort needs to be made to ensure all service users receive a nutritious and wholesome diet to ensure they remain well and maintain their weight. Again, from direct observation on the day of inspection, many service users slept the morning away either seated at the breakfast tables or in the lounge Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 14 chairs or wandering around with little interaction or input from the staff on duty. Throughout the morning staff worked in a task orientated way and this was demonstrated by one carer agreeing that a service user likes a jug of water in her room but ‘she had to do the laundry’. Another carer said ‘she would get a service users breakfast, after she had got up another service users so she could do them both together’. This practice fails to show that service users needs are a priority and this needs to be addressed in order to provide a service that is in the service users best interests. The shortfalls identified on day one of the inspection were discussed with the manager and improvements in some aspects had been made on the second visit. Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 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 detailed policies and procedures on complaints and the complaints book showed that complaints are recorded and acted upon in line with those procedures. All of the surveys returned confirmed that relatives knew how to make a complaint or who to speak to if there was a problem. Not all staff have been trained in adult protection procedures and although the one carer spoken with had an understanding of what constitutes abuse and action to be taken in the event of an allegation, it remains of concern that another carer was heard to shout at a service user. This situation needs to be rectified to ensure service users are not put at risk and that all staff are aware of the importance of behaving appropriately towards service users. Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 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 an area outside a service users door. The manager explained that the odour in the area outside the service users door was due to the homes cat and not one of the service users. Odours need to be eliminated to ensure the home remains pleasant and comfortable. Surveys returned indicated that there was usually some odour in the home but early Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 17 morning and weekends it tends to be worse therefore the manager needs to identify working practices that would account for these variables .A suitably qualified person has made an assessment of the premises and the recommendations in the subsequent report have now been addressed, including the provision of grab rails in communal toilets and bathrooms. In one room, a mattress had been put against an open window to dry. Not only is this an inappropriate way to deal with incontinence it was noted that the mattress was badly stained on both sides, indicating that incontinence needs to be managed more effectively. Not all service users bedrooms include bedside tables and bedside or overhead lamps. In two rooms wall mounted lamps were not working and one was loose which may allow service users access to the wiring. 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 the following is necessary: - bed heads - refurbishment of paintwork - broken toilet seats - leaking water heater in communal toilet - provision of a light shade in the shower room - maintaining hot water temperatures - cleaning stains from carpets - fitting covers to hot water pipes as required. On the first day of the inspection a number of hat water temperatures in service users bedrooms were below the recommended temperature and the plumbing system made very loud noises when certain taps were turned on. In addition two taps in service users bedrooms did not work at all. These shortfalls were addressed on the second day of the inspection. Staff were observed to be working in ways that minimised the risk of infection, with staff wearing gloves and aprons when required. The pre-inspection documentation showed that additional training in infection control has been booked for November 2006 although it is not clear how many staff will attend. Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The deployment and competency of staff available is insufficient to meet the needs of service users. Recruitment practices are insufficiently robust to protect service users. EVIDENCE: The staff rota provided as part of the pre-inspection documentation showed that there are four staff during the morning shift and two during the other shifts including the night shift. Cooks and domestics are also employed. Staff appeared to have sufficient time to meet care needs but they did not engage with service users on a more social level nor to provide satisfactory supervision as mentioned under Standard 7. One survey returned said ‘weekday staff are extremely good and vigilant. Weekend staff, apart from two wonderful girls, tend to be less ‘kind’ and supporting. One, especially seems to have a negative outlook and this definitely affects the residents’. From this it appears that the manager needs to use supervision sessions to examine staff attitudes and identify training shortfalls. Recruitment files for the four most recently recruited staff were viewed and all had completed an application form and Protection of Vulnerable Adults First Checks had been carried out at the time of the Criminal Record Bureau checks being applied for. However, one application forma had not been completed and another did not provide a reference from their most recent employer. The Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 19 staff application form needs to be expanded to include a full employment history to enable the manager to explore and explain any gaps in employment. All staff undergo an induction period but it was disconcerting to note that one member of staff had been given a certificate for a completed induction but the induction workbook had not been completed. There is no consistent training programme for all staff that ensures they have the skills to provide consistent and high quality care for service users. Staff training records found that not all staff had been trained in manual handling, dealing with challenging behaviour, infection control, adult protection and dementia care. This ad hoc approach to staff training puts service users at risk as staff do not have the skills to meet their identified needs. Foundation training programmes that meet the Care Skills Sector specifications need to be devised and implemented to ensure staff have the skills and knowledge to meet service users care needs. Pre-inspection documentation showed that of fifteen care staff, five have achieved NVQ Level 2 in care. Therefore the required level of 50 of care staff with an NVQ qualification remains unmet. The Manager has applied to enrol one other carer on this course but has yet to create a written a plan to demonstrate how this Standard will be met by April 2007. One survey returned stated ‘the staff are caring, friendly and always there if you want to talk to them’. Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Comprehensive quality assurance systems need to be developed and implemented to enable the provider to objectively evaluate the service. Systems are in place to protect service users financial interests and staff are appropriately consulted. 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. She needs to develop her management skills to enable her to provide clear leadership to staff and ensure they work in ways that are in line with good practice guidance. Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 21 Staff meetings have not been provided for several months although there is a handover period at the start of each shift. Convening staff meetings would ensure they are consulted on how the home is run and provide further opportunity to discuss good practice issues. Staff were observed to approach the manager with any concerns and it was evident they were comfortable doing so. The one relative spoken with confirmed that he would be happy to talk to the manager if he had any concerns or complaints. All of the surveys returned said that they were notified if there were any concerns or changes to the care given indicating that relatives are consulted on the service provided. The manager has sent out questionnaires to relatives but only a few have been returned to date. Responses to the questionnaire were variable with some being very positive and other querying certain issues. This needs to be further developed into a detailed quality assurance system to enable 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 finances are safe. On both inspection days staff were seen to move and handle service users in ways that were not in line with safe handling techniques and this puts both service users and staff at risk. This was discussed with the manager who explained that some staff who were seen to handle service users inappropriately had been trained in moving and handling, therefore regular refresher courses should also be provided. On the first day of the inspection one carer was seen to use a dining chair to push a service user closer to the table, again this practice puts both staff and service users at risk. This was discussed with the manager who agreed to address the issue with staff during one-to-one supervision. One member of night staff has been employed for over ten months but has yet to receive training in fire safety and manual handling and this needs to be addressed to ensure service users are not at risk. 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. On touring the premises it was found that a number of fire doors did not fully close and this puts both staff and service users at risk in the event of fire. Two bedroom doors were also wedged open with furniture on both days of the inspection and this also needs to be addressed. A fire risk assessment has been carried out but it needs to include an evacuation plan, with emphasis on those whose mobility is impaired. Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 3 X X 1 Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 23 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 include information on how needs are to be met. (timescale of 20/09/05, 31/3/06 and 20/07/06 not met) 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, 31/3/06 and 20/07/06 not met) That manual handling risk assessments are carried out as required. (timescale of 20/07/06 not met). That care plans include information on how service users leisure preferences are to be met and their dietary needs, including any assistance required. (timescale of 20/07/06 not met). That a continence management plan is developed and implemented for all service users. That care plans include action to be taken when service users are noted to have lost weight as DS0000021157.V316421.R01.S.doc Timescale for action 07/12/06 2 OP7 13(4bc) (15) (2b) 07/12/06 3 OP7 13 (5) 07/12/06 4 OP7 16 (2)(i) (mn) 07/12/06 5 OP8 13 (1)(b) 07/12/06 6 OP8 Schedule 3(o) 07/12/06 Little Acorns Version 5.2 Page 24 7 8 OP8 OP9 13 13 9 10 OP9 OP10 13 12 under Regulation 17 (1) (a). (timescale16/03/06 not met). (1) (b) That service users have regular eyesight and dental checks when necessary. (2) That all medication administered is recorded and that medicine administration records are clear and accurate. (2) That staff ensure medication is taken by the service users prior to signing as administered. (4)(ab) That sufficient supervision is provided to ensure service users privacy is not compromised. That a planned programme of activities based on service users interests be devised and implemented. That service users preferred rising times are recorded accurately and staff adhere to them at all times. That meal choices are offered routinely and fresh fruit routinely offered as a snack. (timescale of 20/07/06 not met). All staff need to receive training in adult protection and dealing with challenging behaviour. (timescale of 30.08.04, 20/09/05, 31/03/06 and 20/07/06 not met) That all parts of the home, are properly maintained and refurbishment undertaken as necessary. (timescale of 31/03/06 and 20/07/06 not met). That furniture listed under the standard be provided in service users bedrooms. (timescale of 31/03/06 and 20/07/06 not met). That hot water delivery temperatures in service users DS0000021157.V316421.R01.S.doc 07/12/06 07/12/06 07/12/06 07/12/06 11 OP12 16 (2mn) 07/12/06 12 OP14 12 (2)(3) 07/12/06 13 OP15 16 (2)(i) 07/12/06 14 OP18 13(6)(7) (8) 07/12/06 15 OP19 23(1a)(2b ) 07/12/06 16 OP24 16(1)(2c 07/12/06 17 OP25 13(4)(a) (c) 07/12/06 Little Acorns Version 5.2 Page 25 18 19 OP25 OP26 20 OP28 21 OP29 22 OP30 23 24 OP31 OP33 bedrooms are near to 430. (timescale of 31/03/06 and 20/07/06 not met). 13(4)(a) That guards are fitted to all pipe (c) work that require them. (timescale of 20/07/06 not met). 16 (2) (k) That all parts of the home are kept free from offensive odours. (timescale of 31/03/06 and (07/07/06 not met). 18(1)(a-c) That a plan is developed to (i) ensure 50 of staff achieves NVQ level 2. (timescale of 20/07/06 not met). 19(4c)(5) All staff need to provide the required documentation listed in Schedule 2 (as amended) of the Regulations prior to appointment. 12(1ab That induction and foundation 18(1a staff training programmes that ci)(ii) meet the Care Skills Sector specifications be created and implemented. (timescale of 20/09/05, 31/03/06 and 20/07/06 not met 9(1)(2b)(i That the Registered Manager ) acquires an appropriate management qualification. 24 (1ab) That formal quality monitoring (2)(3) and quality assurance systems be created and implemented. (timescale of 20/09/05, 31/03/06 and 20/07/06 not met) 16(2j) That all staff be trained in infection control. (time scale of 31/03/06 and 20/07/06 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 and 20/07/06 not met All fire doors need to close properly. (timescale of 20/07/06 not met). DS0000021157.V316421.R01.S.doc 07/12/06 07/12/06 07/12/06 07/12/06 07/12/06 07/12/06 07/12/06 25 OP38 07/12/06 26 OP38 12(1)13 (1-8) 07/12/06 27 OP38 23 (4) (c) (i) 07/12/06 Little Acorns Version 5.2 Page 26 28 29 OP38 OP38 13(5) 23(4)(ae) That all staff be trained in manual handling. That all staff receives regular fire safety training. 07/12/06 07/12/06 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.V316421.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Little Acorns DS0000021157.V316421.R01.S.doc Version 5.2 Page 28 - 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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