Care Home: Acorn Hollow General Nursing Home

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What the care home does well The information that tells people how the service works (the service users guide), is clear and detailed to give people the information they would need to help them decide whether Acorn Hollow is the right home for them. People had received checks of their individual needs before they moved into the home. This meant that they and the staff of the home have the information they need to decide if the person`s needs can be met at the home. The home has an established staff team who were keen for high standards to be maintained. Residents` plans of care and individual case notes on the whole were well written and reflected each person`s needs. This helps to make sure that each person living at Acorn Hollow receives the care and support they need in the way they prefer. There is an activities coordinator employed at Acorn Hollow. They provide a wide range of activities and entertainments and people who live in the home confirmed there is always something happening in the home that they can join in with. On the day of our visit there was a church service in the morning and Christmas entertainers during the afternoon. These activities help to keep people busy and give them the chance to join in social occasions. An excellent standard of hygiene was seen throughout the home and the standard of decor and furnishings throughout the home was good. People`s bedrooms are individualised and thought has been given to making sure there is enough light and heating throughout the home. People who live at Acorn Hollow commented, "I usually like the meals. They keep you warm and safe here. The home is always fresh and clean", "I always receive the support and care I need. The home does everything well really. I think I am fortunate to be in this home", "The staff are usually available when I need them. The home always arranges activities I can take part in. I usually like the meals", "I received enough information about the home before I moved in here. They provide what I need. The home is sometimes fresh and clean" and "The staff are usually available when I need them. They look after people who need looking after. I have no complaints". Other comments included, "I think they do good meals but could improve the time over serving them. Usually receive the support and care I need", "Information is widely available. The home is clean and as you enter, its nicely kept", "The cleanliness of the home is good and the toilets are nice and clean as well. I always like the meals", "I usually like the meals. I know how to make a complaint if I need to. The staff are usually available when I need them", "I always receive the care and support I need. They look after you well here. I sometimes like the meals", "The staff are always available when I need them. They look after me very well", "They keep the place clean and the majority of the staff are pleasant and approachable", "We get plenty of entertainment, there is always something going on. Everyone is kind to me" and "I think they manage most things very well. Everything seems satisfactory to me". Relatives commented, "They attend to the needs as required" and "The staff are friendly and helpful. They respond well to my relative`s needs". A visiting professional said, "They are friendly, helpful and reasonably competent staff. No obvious concerns as a GP, the care for my patients had been good with some very good examples". Staff told us, "The home does activities well", "The home does care of the clients well and mandatory training well too. There are usually enough staff to meet the needs of the residents" and "The home is clean. The staff are pleasant and we all put the residents first. Most of the staff will go the extra mile to make sure the residents and relatives are happy and comfortable. Most of the staff have proper conversations with the residents and treating them with respect". What has improved since the last inspection? The home has maintained its hygiene and environmental standards. The staff team continue to strive for high standards to be maintained. What the care home could do better: A requirement was made that the home must employ a manager who must then apply for registration with the Care Quality Commission, so that the home is run by a suitably competent and qualified person. The service users guide should have the previous manager`s details removed and policies and procedures should have the correct address for the commission to ensure that people have up to date information about the home. Care plans and pre-assessment documents should be further developed in personcentred ways and language and risk assessments should be developed for individual needs such as people with diabetes, so that their needs can be well managed. Social profiles and map of life charts should be developed for each person living at Acorn Hollow. The standard, presentation and quality of the meals should be improved so that people have access to a varied and nutritious diet so they remain healthy and well. The baths that are not in use should be repaired as soon as possible so that people have access to a range of bathing facilities. Mandatory training for moving and handling should be undertaken by all the care staff team and specialist training should be developed for peg feeding, dementia and should cover the needs of the people living in the home. National Vocational Qualification level 2 in care or above should be obtained by at least 50% of the care staff team. Key inspection report Care homes for older people Name: Address: Acorn Hollow General Nursing Home Acorn Hollow Manchester Road Lostock Gralam Northwich Cheshire CW9 7QA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Maureen Brown     Date: 1 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Acorn Hollow General Nursing Home Acorn Hollow Manchester Road Lostock Gralam Northwich Cheshire CW9 7QA 0160645603 0160645655 Acornhollow@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 48. Date of last inspection Brief description of the care home Acorn Hollow is a purpose built home registered to provide nursing and personal care for 48 elderly service users. It is situated in a residential area close to a range of local facilities. Care Homes for Older People Page 4 of 29 Over 65 48 0 1 3 1 1 2 0 0 8 Brief description of the care home The home is on two floors with access to the first floor by passenger lift or two internal stairways. All of the bedrooms are single rooms with an en-suite WC and wash handbasin. Toilets and bathrooms are located around the home. Registered general nurses are employed in the home 24 hours a day. The current fees for the home are 376.73 pounds to 696.00 pounds per week. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We carried out an unannounced visit to the home on 17 December 2009 and the visit lasted six hours. It was done by two inspectors. The report will say we when referring to what was done and found at the visit, as it is written on behalf of the Care Quality Commission. This visit was just one part of the inspection. Before the visit the manager was asked to complete a questionnaire to provide up to date information about the home. We sent out questionnaires to people who live in the home, relatives, visiting professionals and the staff team to find out their views about Acorn Hollow. Other information about the home was also reviewed. During our visit we looked at various records and the premises. We looked at the care records of four people who live at the home, to see how their needs were being met. We also looked at four staff files to ensure that thorough recruitment processes had Care Homes for Older People Page 6 of 29 taken place and that people who live in the home were safeguarded from harm and supported safely. We spoke with some of the people who live at Acorn Hollow, the project manager, the deputy and other staff who were on duty at the time of this visit and relatives who were visiting the home. They all gave their views about the home. Care Homes for Older People Page 7 of 29 What the care home does well: The information that tells people how the service works (the service users guide), is clear and detailed to give people the information they would need to help them decide whether Acorn Hollow is the right home for them. People had received checks of their individual needs before they moved into the home. This meant that they and the staff of the home have the information they need to decide if the persons needs can be met at the home. The home has an established staff team who were keen for high standards to be maintained. Residents plans of care and individual case notes on the whole were well written and reflected each persons needs. This helps to make sure that each person living at Acorn Hollow receives the care and support they need in the way they prefer. There is an activities coordinator employed at Acorn Hollow. They provide a wide range of activities and entertainments and people who live in the home confirmed there is always something happening in the home that they can join in with. On the day of our visit there was a church service in the morning and Christmas entertainers during the afternoon. These activities help to keep people busy and give them the chance to join in social occasions. An excellent standard of hygiene was seen throughout the home and the standard of decor and furnishings throughout the home was good. Peoples bedrooms are individualised and thought has been given to making sure there is enough light and heating throughout the home. People who live at Acorn Hollow commented, I usually like the meals. They keep you warm and safe here. The home is always fresh and clean, I always receive the support and care I need. The home does everything well really. I think I am fortunate to be in this home, The staff are usually available when I need them. The home always arranges activities I can take part in. I usually like the meals, I received enough information about the home before I moved in here. They provide what I need. The home is sometimes fresh and clean and The staff are usually available when I need them. They look after people who need looking after. I have no complaints. Other comments included, I think they do good meals but could improve the time over serving them. Usually receive the support and care I need, Information is widely available. The home is clean and as you enter, its nicely kept, The cleanliness of the home is good and the toilets are nice and clean as well. I always like the meals, I usually like the meals. I know how to make a complaint if I need to. The staff are usually available when I need them, I always receive the care and support I need. They look after you well here. I sometimes like the meals, The staff are always available when I need them. They look after me very well, They keep the place clean and the majority of the staff are pleasant and approachable, We get plenty of entertainment, there is always something going on. Everyone is kind to me and I think they manage most things very well. Everything seems satisfactory to me. Relatives commented, They attend to the needs as required and The staff are friendly and helpful. They respond well to my relatives needs. A visiting professional said, They are friendly, helpful and reasonably competent staff. Care Homes for Older People Page 8 of 29 No obvious concerns as a GP, the care for my patients had been good with some very good examples. Staff told us, The home does activities well, The home does care of the clients well and mandatory training well too. There are usually enough staff to meet the needs of the residents and The home is clean. The staff are pleasant and we all put the residents first. Most of the staff will go the extra mile to make sure the residents and relatives are happy and comfortable. Most of the staff have proper conversations with the residents and treating them with respect. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good information about the home for them to make an informed decision about moving in and their needs are checked before they move in so they know that these can be met at Acorn Hollow. Evidence: We saw a copy of the information that tells people how the home works, the service users guide, and this had been updated in April 2009. It is produced in standard print and plain English and can also be provided in audio and DVD format. There is enough information about the home contained in the guide for people to decide if they want to live at Acorn Hollow. The information included an introduction, philosophy, accommodation details, service users finances, meals and meal times, a copy of the statement of purpose, complaints procedure and quality assurance processes. It was recommended that the previous managers details be removed from the service users guide to ensure people have up to date information. Care Homes for Older People Page 11 of 29 Evidence: A document was available for staff to use with people before they move into the home to check on what their needs are. This covers personal information, details of next of kin and GP, medication and medical history and all health and personal care needs. This information is mainly gathered in a tick list format and it was recommended that this is developed to become more individualised and include information on likes, dislikes and a social profile. The manager confirmed that intermediate care was not provided at Acorn Hollow. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal care and social needs of the people living in the home are met by the staff team in a way that enables them to maintain their privacy and dignity. Evidence: We looked at the care plans of four people who live at Acorn Hollow, to check the care they receive. On the whole these were well written and the language used was often person-centred; however, this needs to be developed to ensure all plans are written in a person-centred way. It was noted that acknowledgment to privacy and dignity was included in some of the care plans. Each file contained details that had been obtained when the person moved in, relevant personal details, care plans and reviews. There were also details about visits from healthcare professionals to check on peoples healthcare needs, risk assessment and daily records. The daily records were completed for each person and contained information about the well-being of each person and activities that had been undertaken during the day. It was recommended that within the care plans the social profile and map of life should be developed so that a full picture of each individuals past is available. Care Homes for Older People Page 13 of 29 Evidence: All the files had reviews of care plans to make sure that these were up to date and still effective. Some of the people were not able to confirm that they had been involved in planning or reviewing their own care; however, they were able to confirm that staff helped them when they needed it such as with personal care tasks. Some relatives had been involved in the review processes. Risk assessments were included in the care plans. Generally these were up to date and had been carried out for moving and handling, pressure sores, nutrition, bed-rails, dementia, mental health and falls. The risk assessments had staff initials and date with no evaluation. It is suggested that the evaluation should be included; however it is acknowledged that this information was incorporated into the care plans. The use of both waterlow and Barden risk assessment tools for pressure sore prevention is confusing so it is suggested that the home use one or other but not both. A recommendation was made to having a specific risk assessment with regard to hypo/hyperglycemia for people with diabetes. The medication for people living in the home is stored in a first floor medication room. There are three trolleys used in the home. A monitored dosage system is used which is supplied by the local pharmacist. Medication administration record sheets were completed when medication is given to people by staff to confirm they have received their medicines as prescribed by their doctors. It was suggested that medication that should be taken when required should be written as such on the prescription to ensure it is available when the resident needs this. For example, a particular medicine has been prescribed to be given as required but this was not happening for the named resident. Staff had completed medication awareness training to help make sure that those who give out medication know how to do it safely so that errors do not happen. Visits from healthcare professionals were recorded and it was seen that GPs, nurse assessors, dietitians, chiropodists and opticians visited the home regularly to make sure people remain well. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities are well managed so people living at Acorn Hollow have daily variation and interest in their activities. Improvements need to be made to the meals so that people who live in the home have good quality food and variety. Evidence: There is an activities organiser employed at the home. She has kept a record of what activities each person living at the home had taken part in. This helps to show the range of activities each individual has undertaken and to plan for future activities that people will enjoy. Activities included quizzes, entertainers, bingo, massages, aromatherapy, reflexology, individual time with staff, magician, coffee mornings, pianist, film shows and the hairdresser visits. Activities outside the home itself included visiting the local shopping area, Northwich, trip to Tatton Park and bingo at the local church hall. Information about all the activities was well displayed on the notice board and a wide range of activities were available. On the day of this visit there was a church service in the morning and Christmas entertainers in the afternoon. Residents commented, We get plenty of entertainment, there is always something going on, The home does activities well and the home always arranges activities I Care Homes for Older People Page 15 of 29 Evidence: can take part in. The home has a four week menu and a variety of food was available on this menu. There were two main choices for lunch and dinner and other choices available included sandwiches, jacket potato, salad or an omelette. Staff check with residents for their preference for the days meals. On looking at these checklists it was noted that a group of people chose sandwiches for both meals on most occasions. Concern was raised with the manager with regard to these people getting sufficient choice and nutrients in the limited diet. During lunchtime it was noted that the sandwiches served were unappetising as no garnish was provided. Also the cauliflower cheese appeared unappetising and bland. Consideration should be given to making sure meals look appetising and add other colours to bland appearing foods. It was noted that people had appropriate coverings to protect clothes during the mealtimes and that there were enough staff around to support people during mealtimes. Residents views of the meals provided were mixed, standard of cooking in my opinion is not good, repetition all the time, I have to ask for fresh fruit, Choices are poor, Meals could be improved, Should improve the food and catering. Other comments included, Meals and mealtimes could be improved, I usually like the meals and I think they do good meals but could improve the time over serving them. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes procedures for complaints and safeguarding are effective so that the concerns of people who live at Acorn Hollow are listened to and they are protected from abuse or harm. Evidence: We looked at staff files during our visit and these showed that staff had completed training about safeguarding adults. The manager confirmed this and showed that she was aware of the policy, procedure and guidance on safeguarding. There were also policies available in the home on adult protection (and this includes forms of abuse), harassment and bullying, whistle blowing, aggression towards staff, dealing with violence and aggression, physical intervention and restraint and prevention and management of violence. The training and policies helped make sure that staff would know what to do to protect people living at Acorn Hollow from abuse. One referral had been made over the last year under the local safeguarding procedures. One person has been referred to the Independent Safeguarding Authority list from the home and full details about this had been kept within the home. The complaints procedure for Acorn Hollow was satisfactory and contained details of how to contact us. We have not received any complaints about Acorn Hollow over the last year. The home had a complaints file and we looked at this during our visit. There are monthly audit sheets for complaints and also a formal complaints record that shows details of the complaint and action taken. Good records were kept. The home Care Homes for Older People Page 17 of 29 Evidence: had received five complaints during twelve months before our visit and all had been resolved within twenty-eight days. People who live at Acorn Hollow said they would contact the staff or manager if they had any concerns or problems. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Acorn Hollow is well maintained and furnished to a good standard so the people who live there do so in safe, comfortable surroundings. Evidence: During our visit we toured the building and we saw all the shared (communal) areas as well as a number of bedrooms. The standard of decor and furnishings is good. The home was clean and free from unpleasant odours. People who live at Acorn Hollow had made their bedrooms more homely using ornaments, pictures , photographs and some furniture they had brought with them when they moved in. The home was warm and well lit. The garden was secure so that people who oive at Acorn Hollow could walk around it in safety. Access to the garden for people was good. People who live at the home told us, I am happy with the home and my room. It is very clean and tidy, Its very good here really all things considered. Its very clean, thats what I like about it, food varies from time to time they only have so much money, I have been here quite a while. Food is OK and the girls are lovely and Staff are kind. Its very clean here, the cleaners are excellent. The food is terrible in my opinion and the standard of cooking is not good. The activities are good, there is plenty going on and the activities organiser very good. Staff are courteous. During this visit the two baths on the ground floor were out of order. Staff told us that Care Homes for Older People Page 19 of 29 Evidence: there was only access to the shower. It is recommended that the baths are repaired as soon as possible so that people have access to a range of washing facilities. In the two other bathrooms, one bath is low and staff would have to bend to assist people in this and the second bath is high with no space for the use of a hoist. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Acorn Hollow are supported by trained, effective staff who have gone through a thorough recruitment process, so that peoples needs are met and they are safe from possible harm or poor practice. Evidence: The staff rotas showed the number of staff on duty over the week. A nurse was supported by five or six care staff on each shift. The care staff team are supported by the domestic staff, cooks, activities coordinator and maintenance team. People who live at Acorn Hollow confirmed there were enough staff around to help them and during this visit we saw that staff were attentive to peoples needs. We checked four staff files and they all had the necessary pre-employment checks in place including identity checks, Criminal Record bureau checks, Protection Of Vulnerable Adults first checks, references and completed application forms. These checks are carried out to make sure that staff are suitable to work with people who live at Acorn Hollow. The training staff had received included an induction course, moving and handling , safeguarding adults, fire awareness, food hygiene and first aid. Other courses staff had undertaken included safe administration of medicines, infection control, health and safety, nutrition, care plan training, grief and loss, customer care, pressure care, Care Homes for Older People Page 21 of 29 Evidence: dementia awareness and managing pain. Recommendations were made with regard to all staff having moving and handling training and specialist training being developed for peg feeding, dementia and other related needs of the people who live at the home. Progress needs to be made with National Vocational Qualification (NVQ) training. Out of thirty-five staff fourteen have NVQ level 2 or above or have a nursing qualification. This is below the recommended 50 of staff and action should be taken to remedy this. The previous recommendation regarding this had not been met and was reiterated. Staff meetings were held every three months. The last one before our visit was in September 2009 (6 staff attended) and the previous one was held in June 2009 (10 staff attended). General information was discussed including service users and staffing. It appears that the meetings have a poor staff attendance, less than 25 of the staff team, and it is suggested that the reason for low attendance is looked into. The staff handbook is an A5 bound book that contains information on terms and conditions, staff benefits, health, safety and security, time off work, grievances and whistle blowing, attendance - conduct and performance and a range of policies and procedures. Staff members we spoke with during our visit said that it is a nice home. They told us staffing levels are usually good, except when there is sickness, and the management do try to cover. At the time of our visit, the home did not have a manager. The deputy manager usually works on the floor, which leaves little time for management tasks. Staff told us they had received a range of training including moving and handling, medication, first aid, safeguarding awareness. Staff also told us they had seen improvements over the years they had worked at the home. They said the temporary manager was very nice and good and has been around the home for the last couple of months before our visit. They confirmed that they receive regular supervision. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Acorn Hollow had policies and procedures in place to ensure the health and safety of the people living there are promoted and protected and that the home is run in the best interests of the the people who live there. Evidence: At the time of our visit, there was no permanent manager in post at Acorn Hollow. The previous manager had left in August 2009 and attempts to recruit a new manager had been made but had not been successful. At the time of our visit, the post was due to be re-advertised and was being covered by a project manager from the company that runs the home. She had completed the information about the home we ask for each year, the annual quality assurance assessment, that gave us information about the home and what had been happening there during the twelve months before our visit. A requirement was made that the home must employ a manager and that the manager must apply to be registered with the commission. The information we were sent before our visit gave a good overview of what had Care Homes for Older People Page 23 of 29 Evidence: happened at the home. The project manager told us that, Acorn Hollow provides a well maintained and homely environment for all our service users to fulfil their days and promote equality for each. There is opportunity for everyone to have regular involvement to establish choice and preferences to tailor to each individuals needs and wishes. We provide a service to a high standard to maximise physical comfort and social well being and thus enhancing good quality care practice. There is a quality assurance process for the home which includes residents and relatives meetings, managers surgery, surveys to residents, relatives and other professionals, monthly visits from the provider and compliments and thank you cards. The manager held a weekly surgery, during different times over the day where people can come in for a cup of tea and a chat about the way the home was running. Residents and relatives meetings were being held regularly. The last meeting before our visit was on 18 November where 7 staff, 8 residents and 7 relatives attended. Discussions included general information, changes at the home and staff. The next meeting was due in February 2010. A relative who was visiting the home said they had been to a couple of the meetings and had found them useful and informative. The most recent satisfaction surveys before our visit were completed in November 2009. They are given to people who live at Acorn Hollow, their relatives and healthcare professionals who visit people who live at the home. Service users and relatives stated they were 100 satisfied with the service provided. Professionals stated they were 66 satisfied with the service. People said in the surveys that areas that were good included attitude of the staff, activities, laundry and food. A bound booklet giving an analysis for each group of people (residents, relatives and professionals) was seen. There was also space for extra comments at the end of the document. Peoples comments included, I would like air conditioning, Needs to be more staff, Activities are very good, Poor quality of food and variety, Excellent care given and Top marks for cleanliness. A thank you file was available at the home and contained a range of cards and letters. Comments included, You are a wonderful, caring team, Staff make me feel welcome, Thank you for the love, care and attention shown to us and Thank you for the care given. A representative of Southern Cross visits the home each month to check on how it is running. The most recent visit before our visit was in October 2009 and the report of the visit covers meetings with people who live in the home and staff, inspection of premises and of records. The audit includes an action plan to cover the findings of the visit. Good records were kept of these visits. Care Homes for Older People Page 24 of 29 Evidence: Day to day supervision of staff was good and regular formal supervision is undertaken with records kept. This ensures that staff have a chance to discuss their work with their manager, so they can continue to provide good quality care of the people who live at Acorn Hollow. Safe working practices were in place in the home. There were up to date safety checks on the homes electrical wiring system and gas installation. All checks with regard to the fire safety were up to date and checks were also completed on the emergency lights, hot water system, call system, window restrictors and wheelchair visual checks. There were four policies in the home about safe working practices, and these were not easy to access and had been reviewed in 2003. However, staff have access to up to date policies via the homes intranet. Policies included ones on accident prevention, medication, first aid, smoking, risk assessments, prevention of falls, moving and handling, control of infection, MRSA, cleaning methods, health and safety and fire prevention. The home had a policy on smoking. Staff can smoke only in break times and in designated area, outside in the shelter. Acorn Hollow is a no smoking home. Residents can only smoke in the designated area which is outside. The policy on gratuities and gifts states that staff are not permitted to accept gifts or payments from people who live at the home by will or otherwise without the prior consent of a director of the company. Any gift of money should be handed over to manager. People who live at the home whose money is looked after have an account whereby any interest accumulated is paid to them. No personal money is stored at the home. A residents float is available for cash for service users and there are suitable arrangements for people to have access to this when they want. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 31 8 A manager must be appointed to manage the care home. That person must apply to the Care Quality Commission for registration as the manager of Acorn Hollow. The home must have a manager, as it is run by an organisation, and that person must be registered with the Care Quality Commission in accordance with the Care Standards Act 2000. 19/02/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The previous managers details should be removed from the service users guide to ensure people have up to date information. The document used to collect information about peoples 2 2 Care Homes for Older People Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations needs before they move to the home should be developed to become more individualised and include information on likes, dislikes and a social profile. This will provide staff with valuable information to help them make sure that peoples needs can be met in the way they prefer. 3 7 A specific risk assessment should be developed with regard to hypo/hyperglycemia for people with diabetes so that their needs can be fully met. Within the care plans the social profile and map of life should be developed so that a full picture of each individuals past is available. Systems should be in place to ensure people get sufficient choice and nutrients when they choose a limited diet. Efforts should be made to ensure meals look appetising and add other colours to bland appearing foods. The baths that are out of use should be repaired as soon as possible so that people have access to a range of bathing facilities. 50 of the care staff team should have NVQ level 2 in care or above so that the people who live at Acorn Hollow are supported by well trained staff. All staff should have moving and handling training and specialist training should be developed for peg feeding, dementia and other related needs of the people who live at the home. 4 7 5 6 7 15 15 19 8 28 9 30 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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