Care Home: Acorn House

What the care home does well Acorn House is proactive in providing a care service. The home makes sure that people that live in the home are able to have input into how Acorn House is run. The acting manager has made sure that significant others and staff who work in the home are able to express their views. Records of residents meetings indicate that individuals are satisfied with the overall service provision. What has improved since the last inspection? All requirements made at the last inspection have been met. See report body for further details. The home has worked with local training providers to make sure that improvements have been made that benefit people directly. The acting manager has been proactive in working with their staff team to make sure that recommendations have been actioned. Care planning is now more person centred and this needs to be continued to enable the home to exceed the standard needed. What the care home could do better: No requirements were made as a result of this inspection. One recommendation has been made in relation to providing detailed information on daily records. Key inspection report Care homes for older people Name: Address: Acorn House 63 Hayes Lane Croydon Surrey CR8 5JR     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: Janet Pitt     Date: 2 0 1 1 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 25 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 25 Information about the care home Name of care home: Address: Acorn House 63 Hayes Lane Croydon Surrey CR8 5JR 02086603363 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Medicrest Ltd care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 31 The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE(E) (of the following age range: 65 years and over) Date of last inspection Brief description of the care home Acorn House is a 31-bed home for older people who are living with dementia. It is linked to Acorn Lodge (a similar care home owned by the same company), and the two share a large rear garden. The home is situated in the pleasant rural area of Kenley, the only drawback being that it is some distance from the nearest public transport links. The stated aims and objectives of the service are to `provide a home from home, a friendly atmosphere where staff are approachable and an open relationship is encouraged between people who use the service, staff and relatives. Care Homes for Older People Page 4 of 25 Over 65 31 0 1 1 1 2 2 0 0 8 Brief description of the care home Fees for this service are from £400.60 to £419.00 per week. Care Homes for Older People Page 5 of 25 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: The quality rating for this service is two star. This means that people experience good quality outcomes. One inspector undertook this unannounced inspection. A site visit was made lasting four hours. During the site visit we examined records relating to care provision, staff files and maintenance records. We were able to speak with individuals that live in the home and members of staff. The home provided us with their Annual Quality Assurance Assessment [AQAA], information from this was used to inform the report. We also took information from notifications we have received and any concerns or complaints. Care Homes for Older People Page 6 of 25 What the care home does well: 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 7 of 25 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 8 of 25 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. Individuals are able to make a positive choice about whether to move into Acorn House. Care is taken to make sure that comprehensive assessments are undertaken to make sure that needs are identified. Evidence: The homes AQAA states that their aim to to assess all potential clients before admission so as to gather as much information as possible to ensure the home can meet individuals needs effectively. The document goes on to state that people are able to visit the home prior to making a decision to move in. One person we spoke to during the site visit said that they would prefer to be in their own home, but they considered they were well cared for at Acorn House and were comfortable. When we looked at assessments of individuals we found preference forms that gave Care Homes for Older People Page 9 of 25 Evidence: information on preferred meal times, when to wake up and same gender care. The assessments covered aspects of a persons mobility,past medical history, activities and hobbies. A dependency section was included in the information. This gave an overview of the individuals abilities. People who live in the home are involved in the process whenever possible. Significant others are also able to input into the assessment. The acting manager confirmed that placing authorities and health professionals provide their own assessments which are Incorporated into the information held by the home. Care Homes for Older People Page 10 of 25 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. People who live in the home can be confident that they will be treated with dignity. Care plans detail how an individuals needs should be met. Improvements have been made in managing challenging behaviour. Medications are kept and administered appropriately within the home. Evidence: In the AQAA it was recorded that: We ensure that all clients have a comprehensive Person Centred Plan to ensure their needs are being met with privacy and dignity. Each care plan is reviewed monthly and retyped six monthly and a copy is sent to their relative with the opportunity to contribute so as to enable them to be involved with the planned care. The home also stated that they have introduced Memory Books to gather information about clients past and preferences. We looked at care plans and found that they led from the assessment of need. There was evidence of input from other health professionals such as opticians, dentists and Care Homes for Older People Page 11 of 25 Evidence: chiropodists. Records of appointments had been made which included plans for future treatment. One person had a risk assessment on moving and handling that linked to information provided by the occupational therapist on how to use the hoist. We noted that were good details on how to meet a persons needs. The plans had phrases such as:[they] prefer to wander around in [their] room or on the ground floor.,[they] need assistance to chose clothing.and [they are] no longer the happy, smiley [person] that we all knew and loved. But we are all trying our best to cope with the change and all staff will do their best to assist [them] to live normally. Preferred communication methods were also noted for example: the person will smile [at staff] or give them a thumbs up to show approval. The home stated in its AQAA that they had made improvements in the past twelve months in record keeping with through working with the Care Home Support Team. Daily records were in place, these could contain more information on how a person spends their day. At the previous inspection a requirement was made concerning managing challenging behaviour. The home now has good processes in place to make sure staff are able to use appropriate interventions and note triggers that may affect an individuals behaviour. Care plans included guidance for staff on what may trigger an outburst and how to manage the situation. Examples of this included:[the person can be] aggressive if too much noise and can at times be physical with the staff when they try to assist [them] with [their] personal care. Appropriate interventions were recorded, such as making sure the individual who was affected by noise had a quiet place to go to away from noise. We saw records of physical and verbal aggression that detailed what actions had been taken. We found that medication were regularly audited and records kept. No issues were identified with the safe storage and administration of medications within the home. We observed staff treating people with respect and protecting their dignity. Staff were polite in their interactions with the people that live in the home. They called individuals by their preferred name and made sure the person was aware of what was going on around them. Care Homes for Older People Page 12 of 25 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. Mealtimes are a social occasion and there is a choice of food available. Contact with friends and family is encouraged and people are able to form new relationships if they chose. Activities offered by the home reflect personal preferences and are varied. Evidence: The home considers in its AQAA that they: We operate a friendly home from home atmosphere and all visitors are made to feel welcome. This was evident during the site visit. we saw that there was a small lounge in which people could receive their visitors in private. Staff made sure that refreshments were offered. Individuals were able to take telephone calls from their friends and relatives. staff were seen taking people to receive telephone calls, which could be taken privately. Individuals preferred hobbies and activities had been recorded in their care plan. The activities offered by the home reflect the persons interests eg days out. Care Homes for Older People Page 13 of 25 Evidence: Residents meetings are held every month. Minutes of meetings indicate that there is always a good attendance and everyone was given an opportunity to have their say. During residents meeting activities was a regular item on the agenda and people were able to discuss what they would like to do. People that live in the home were able to visit the local theatre, children from local schools are invited to the home to sing carols at Christmas time and external entertainers are booked on a regular basis. Other activities offered include:train your brain and band dancing and music appreciation. One person who lives in the home told us that their relatives regularly visit and have tea with them. Relationships with others are encouraged and supported by staff in the home. One persons plan stated that [they] had made very good friends with one of the clients and they will be seen holding hands while they watch TV. There is a safe garden for people to access and staff make sure that opportunities are available for individuals to use it. Plans noted that one person will be seen trying to sweep the garden or tidy the activity cupboard.and likes going for walks in the garden. We looked at the kitchen and found it to be clean and tidy. Food was stored appropriately at the correct temperatures. Records of fridge and freezer temperatures are maintained. At the previous inspection one fridge was operating at too high a temperature, this has now been replaced. On the day of the site visit home made chocolate cake was on the menu for pudding. The menu showed us that there is a choice of meals available. Individuals had personal preferences of who they wished to take their meals with. Signs were above the tables as memory aids for the people that live in the home. As a result of a recommendation from the previous inspection small tables are now available in the lounge for people to put drinks and snacks on. When we observed lunch we saw that the meal was unhurried and a sociable occasion. Staff explained what was on the menu and checked that an individual had had sufficient to eat. Daily food records were maintained and appropriate intervention sought if needed. Care Homes for Older People Page 14 of 25 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. People who live in the home can be confident that they will be protected from harm by the procedures for complaint handling and Safeguarding Adults. Staff make sure that individuals are able to raise any concerns they may have through a variety of avenues, such as residents meetings. Evidence: The home considers in its AQAA that: We work in a transparent manner that leads to a confident approach should a complaint or concern need to be addressed. All clients are encouraged to express any complaints they may have through meetings, quality assurance or during their key working sessions. During the site visit we spoke with one visitor who said they were happy with the care provision and that their relative was in a state before they moved into Acorn House two years ago. The relative said that they did not have any concerns about the service provision. Staff records showed that safeguarding training had been given to staff during the past twelve months. The training had been provided by the local authority. The home makes sure that we are kept informed of any issues they may have. No concerns or complaints have been received by the home or us. There have been no Safeguarding investigations during the past twelve months. Care Homes for Older People Page 15 of 25 Evidence: Minutes of the residents meetings evidenced that no one had any concerns about the care given. Care Homes for Older People Page 16 of 25 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. People live in a homely environment that provides personal space if needed. The home makes sure that any maintenance or cleaning issues are dealt with effectively. Individuals are able to bring their own possessions to personalise their bedroom. Evidence: Acorn House consider that they We provide a clean and pleasant environment with a homely and cheerful atmosphere. They state in their AQAA: An independent member of staff undertakes audits of all rooms within the home on a quarterly basis. These are checked by manager and then put in priority order. Minutes of residents meetings evidenced that they considered the home to be clean and tidy. When we looked around the home we were able to confirm this. There are sufficient communal and private spaces for people to receive visitors, or have some time alone if they want. Bedrooms had been personalised and many people had brought in their own possessions. The acting manager told us that a lounge on the ground floor was to be developed to enable more independent individuals to maintain their skills. The area includes a Care Homes for Older People Page 17 of 25 Evidence: kitchenette and dining facilities. We noted that the refurbishment of the bathrooms had been completed to a high standard. We did not find any hazards in the home that could affect the safety of the people that live there. The duty rota showed that there are adequate numbers of maintenance and domestic hours available to keep the home safe. Care Homes for Older People Page 18 of 25 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. Individuals can be confident that they are supported by a staff team who are trained and competent. Recruitment processes within the home make sure that people are protected from harm. Evidence: At the previous inspection a requirement was made for staff to receive training on dementia care.During the site visit we spoke with a member of staff who said that they were undertaking a distance learning course on dementia that has made them think about how their practice could be improved in the future. Staff files showed that other members of staff had either started or completed study on dementia awareness. Other training provided included Safeguarding, bereavement, fire, First Aid, nutrition, moving and handling, medication and challenging behaviours. Some training had been given by the Care Home Support Team. This included person centred planning and record keeping. We found that this training had been put into practice, as the quality of recording had improved. Recruitment practices in the home make sure people are protected from harm. We examined staff files and found that appropriate checks had been carried out on potential employees. Each file examined had an application form, job description and Care Homes for Older People Page 19 of 25 Evidence: contract. A persons previous employment history had been requested and there was evidence of Criminal Records bureau checks being undertaken. Permission to work were in placed and proof of the staff members identity. Interview notes evidence good recruitment practices. At the previous inspection a requirement was made for the home to make sure that references taken up were valid, this had been met. The staff rota evidenced that there were sufficient numbers of care and ancillary staff on duty. Care Homes for Older People Page 20 of 25 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. People live in a home that is well run. Care is taken to make sure individuals have an opportunity to comment on how the service is run. Health and safety of Acorn House is maintained and there are good audit procedures in place. Evidence: Acorn House continues to have an acting manager in place who is in the process of registering with us. They have made sure that the home runs in the best interests of the people that live there. The AQAA we received gave us a clear indication of how the service is performing. The service has a quality assurance system in place which enables individuals to have their say. The acting manager considers that: Management work with an open door approach and is qualified at leadership and management and NVQ 4 in health and social care. Care Homes for Older People Page 21 of 25 Evidence: Staff receive supervision every two months and a staff appraisal once a year. In addition there are staff meetings every two months, to make sure that all staff are briefed on any issues and can be involved in developing the home further. Staff were spoke with confirmed that they had received supervision and were able to input into the service provided. We did not identify any health and safety issues. The AQAA tells us that: Regular checks are carried out and recorded to make sure the home and the equipment is safe for people who use the service, staff and visitors. When we looked at fire records we found that the fire alarms systems are checked weekly and fire drills are regularly carried out and recorded. As previously mentioned food is stored safely and equipment such as fridges are checked to make sure they are operating at the correct temperature. Records of hot water checks were available and we saw that the temperature of the bath water was checked prior to individuals taking a bath. We consider that much improvement has been made in the management of the home with all requirements from the previous inspection being met. The home has also taken note of recommendations made relating to challenging behaviour, daily record keeping, social and cultural needs of people, choice at meal time and making mealtimes a pleasant experience. In addition to providing small tables in the lounge and making sure that recent publications on dementia care are available to staff. The home does not manage any finances for the people that live there. Relatives or appointed people assist individuals with their monies. Care Homes for Older People Page 22 of 25 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 23 of 25 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 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 7 It is recommended that daily records could contain more detail on how a person spends their day. Care Homes for Older People Page 24 of 25 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. 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. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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