Care Home: Acorn House

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What the care home does well Staff working at the home, have a good rapport with individual people who live at Acorn House and demonstrated a good knowledge and understanding of people`s care needs. Staff morale is good and staff feel supported by the management team of the home. People who live at the home are supported and enabled to make choices and decisions about how they spend their day. People who live at the home are encouraged and supported to maintain friendships and relationships. The quality of meals provided at the home is good and people`s comments in relation to meals provided were positive. People can visit the care home before moving in so they can be sure they like it and that it is suitable for their needs. People live in a home which is comfortable, safe and homely for their needs. The home was observed to be clean, tidy and odour free at the time of the site visit. Staffing levels are appropriate for the numbers and needs of people in the home ensuring their safety and wellbeing. In addition recruitment procedures are robust so as to ensure people are protected. People are provided with a range of activities to suit their social care needs and personal preferences. What has improved since the last inspection? Some members of staff have received training relating to dealing with challenging behaviour and health and safety since the last key inspection in April 2007. Areas of the home environment have been redecorated and refurbished. What the care home could do better: Ensure that systems are in place so that newly employed members of staff receive appropriate core and specialist training at the earliest opportunity. Staff supervision needs to be improved as currently this is not undertaken regularly. Ensure that measures are put in place so that care plans and risk assessments for individual people are regularly reviewed and updated. To enhance and improve medication practices and procedures. Key inspection report Care homes for adults (18-65 years) Name: Address: Acorn House 28 Somerset Road Laindon Basildon Essex SS15 6PE     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: Michelle Love     Date: 2 3 0 3 2 0 1 0 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 Adults (18-65 years) Page 2 of 36 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 Adults (18-65 years) 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Acorn House 28 Somerset Road Laindon Basildon Essex SS15 6PE 01268453216 01268455103 kingswood@donna-higby.freeserve.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kingswood Care Services Limited Name of registered manager (if applicable) Mr Graham Edward Sheern Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is 6 The registered person may provide the following categories 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: Learning Disability - Code LD Date of last inspection Brief description of the care home Acorn House provides a high standard of care and accommodation for six adults with a learning disability who also have complex needs such as superimposed mental heath problems, autism and/or present with challenging behaviours. The home is situated in a residential area of Laindon and is in keeping with other houses in the locality. Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 6 Brief description of the care home Each of the six residents has a single room, three of which have en-suite facilities. In addition there is a shared bath and shower room and a ground floor toilet. There is a choice of two lounges and a separate dining room. The rear garden is secure and contains patio furniture and a barbeque area Acorn House is close to the amenities of Laindon town centre. The previous inspection report was readily available for residents or visitors to the home. The homes Statement of Purpose and Service Users Guide were also available in the home. Care Homes for Adults (18-65 years) Page 5 of 36 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 7.5 hours, with all key standards inspected. Additionally progress against previous recommendations from the last key inspection on 23rd April 2007 were also inspected. We also looked at the previous 2 Annual Service Reviews undertaken on 17th April 2008 and 9th April 2009. Prior to this inspection, the manager submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to people who live at the home, support staff and the general running of the home were examined. Additionally a full tour of the premises was undertaken, residents and members of support staff were Care Homes for Adults (18-65 years) Page 6 of 36 spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for people who live at the home, staff and healthcare professionals were requested to be sent to the home for distribution. At the time of writing this report we had received 1 completed staff survey, 1 survey from a healthcare professional and 3 surveys from people who live at Acorn House. Where comments have been recorded these have been incorporated into the main body of the report. The manager and other members of the staff team assisted the inspector on the day of the site visit. Feedback on the inspection findings were given to the manager. The opportunity for discussion and/or clarification was given. Care Homes for Adults (18-65 years) Page 7 of 36 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. Care Homes for Adults (18-65 years) Page 8 of 36 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 Adults (18-65 years) Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Admissions to the home are well planned so as to ensure the service can meet the prospective persons care needs. Evidence: A Statement of Purpose and Service Users Guide was readily available detailing the aims and objectives of the home and the services and facilities provided. On inspection of both documents it was noted that not all information recorded was accurate and up to date. This refers specifically to information about the manager and reference to the Care Quality Commissions previous regional office address. This was discussed with the manager and they confirmed they were aware that both documents required reviewing and updating. We also advised that consideration should also be made to review the Service Users Guide and to provide this in larger print, easy read and/or pictorial format. There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Admissions are not made to the home until a full needs assessment has been Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: undertaken. In addition where appropriate, supplementary information is provided by the persons Placing Authority, Primary Care Trust or previous placement. One staff survey returned to us confirmed that staff are given up to date information about the needs of the people they support. We were advised that since the last key inspection to the service on 23rd April 2007 no new residents have been admitted to the home. We were advised at this site visit that steps are currently underway for a new prospective resident to be admitted to Acorn House. Records showed that an Initial Assessment of Need had been completed by the home and this was observed to be informative and detailed. In addition information had been provided by the prospective residents current placement. Records also showed that a planned period of transition is being undertaken so as to ensure the new placement is appropriate. This has included staff from Acorn House visiting the persons current placement and the prospective resident spending time at Acorn House. We were advised by staff that these visits have proved successful and positive. Of 3 surveys returned to us from people who live at the home, all confirmed they were consulted as to whether or not they wished to live at Acorn House and were given the opportunity to visit the home prior to moving in. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Peoples needs are recorded within an individual plan of care however shortfalls in the management of records means that their current support needs may not be reflected accurately. People who live at the home are involved in making decisions about their daily lives. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these are to be met by staff who work in the home. We were advised by the shift leader that each person has 2 care files which form their plan of care. One folder contains records which require completion on a daily basis e.g. daily care records, behavioural records, daily activity monitoring records and a weight chart. The other folder contains information relating to their personal details, a medication profile detailing all of their prescribed medication, their specific care needs and guidance for support staff as to how these are to be met, identified areas of risk, a copy of their individual activity programme, restrictions and limitations that may be in force, information relating to the individuals healthcare Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: needs and correspondence from external agencies. As part of this inspection the care files for 2 people were examined in full. Records showed that each person had a plan of care that was written in plain language and easy to understand. Included within each care file was a comprehensive and informative client profile detailing their formal medical diagnosis of their condition and personal information about their past, family involvement and likes and dislikes. Records showed the care needs of one person related solely to their personal care and communication with no other elements recorded. Although risk assessments were completed for 9 areas there was little evidence to show these had been updated and reviewed regularly. Records also showed for the other care file examined that although more elements of their care plan were completed depicting their care needs and how these should be met by support staff, in the majority of cases these had not been reviewed since May 2007 or May 2008. In addition risk assessments compiled for the same person showed in some cases that these had not been reviewed or updated since September 2003, June 2005 or 2006. This potentially places people at risk of not having all of their care needs met and support staff having inaccurate and not up to date information and guidance about individual residents. The above was discussed with the manager and they confirmed that all care plans are in the process of being reviewed and updated however they agreed that these were overdue. The manager also advised that an ex-employee of Acorn House had reviewed some of the care plans for one of the residents case tracked. On inspection of these 4 areas were covered and these included contacting their relative regularly, to clean out their fish tank, to clean their personal chair in the lounge and to undertake an afternoon walk. The AQAA provided to us details that care plans are regularly reviewed and updated and risk assessments are reviewed and updated however this did not concur with our findings. Evidence during the site visit showed that people who live in the home are empowered to make decisions and choices about their lives e.g. what time they get up in the morning, what time they retire to bed, choosing their meals, choice of clothing, whether or not they participate in activities or where they choose to sit during the day (bedroom or lounge). There are communication systems in place to enable people to make choices and to understand the structure and routine of their day through pictures and symbols. Interactions between support staff and people who live at Acorn House was observed to be positive. People spoken with confirmed they were happy and liked living at Acorn House and where people were unable to provide a verbal response to our questions as a result of their limited verbal communication, we noted their non verbal cues and these indicated that people were relaxed and happy to be there. Support staff were observed to interact effectively with people who live in the Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: home and understand what their needs are. There is a key worker system in place and two people spoken with who live in the home confirmed they knew who their key worker was. Of 3 surveys returned to us by people who live at the home, all confirmed that staff and members of the management team listen and act on what they say. One survey recorded Yes all the managers and staff listen to us and keep us safe day and night and staff and managers always treat us with respect. One staff survey returned to us recorded All of the service users are supported to their needs Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make choices about their lifestyle and how they spend their day. Evidence: Observations on the day of the site visit and examination of individual peoples records showed that people who live at Acorn House are enabled and supported to maintain and enjoy a full and stimulating varied programme of activities. People have access to activities both in house and within the local community. Each person has their own weekly activity programme to suit their individual needs and in each persons bedroom there is a weekly planner detailing the activities to be undertaken on any given week. The manager confirmed that the activity programme is flexible to meet peoples changing needs. Records showed the views of people who live at the home have been sought and their personal preferences, likes and dislikes have been taken into account. In addition to undertaking activities according to their Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: hobbies and personal interests, several people have the opportunity to participate in adult education classes and one person attends a work placement one day a week. Activities enjoyed by people include yoga, going to the gym, pottery classes, swimming, sports, arts and crafts, bowling, aromatherapy and attending various evening clubs. We were advised that people who live at the home have at least one holiday during the year as a minimum. Discussions are in progress as to the holidays that people wish to have this year. There is an open visiting policy at the home whereby visitors can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at the home are actively encouraged and supported to maintain friendships and relationships. One person who lives at Acorn House confirmed they had recently been supported to visit a friend in hospital and their relative regularly visits the home to see them. Support staff throughout the site visit were observed to treat people in a respectful and dignified manner. People who live at the home are provided with a key to their room and have unrestricted access to all communal areas and the garden to the rear of the property. Where appropriate and according to risk, people are supported to access the homes kitchen and to participate in the daily routines of the home e.g. assisting with laying the dining table, making drinks, going shopping and assisting with household chores. One survey returned to us by a person who lives at the home recorded I help sometimes and when spoken with during this inspection stated It depends on how I feel at the time. There is a 4 week menu and this incorporates both a Summer and Winter menu. We were advised that both support staff and people who live at Acorn House are involved with menu planning. A pictorial menu board is located in the kitchen. Nutritional records were inspected and these showed a varied menu is offered each day with alternatives to the menu readily available. The dining experience for people who live at the home was observed to be positive and people told us that the meals provided are nice. Care Homes for Adults (18-65 years) Page 17 of 36 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 can expect to have their health and personal care needs met. Evidence: Records showed that people have access to a range of healthcare professionals and services as and when required and these include Chiropodist, GP, Dentist, Optician, District Nurse Services, Consultant Psychiatry, Dietician, Community Nurse, Speech and Language Therapy. People who live at the home are supported by staff to attend appointments and other healthcare checks and on the day of the site visit one person was accompanied by staff to attend a GP appointment at the local surgery. One survey was returned to us by a healthcare professional and they recorded I have no qualms about the service. The clients I have always look happy and get on well with all staff. Each person has an individual Health Action Plan which provides an audit trail of visits to and/or by a healthcare professional. Information recorded includes the date and time of visit, rationale for the appointment and outcome. Records were seen to be good however care must be taken to ensure that information recorded is accurate and there is a clear audit trail when cross referenced with other documentation held within the care file to show actions taken by the home. On the day of the site visit the weight Care Homes for Adults (18-65 years) Page 18 of 36 Evidence: record for one person case tracked showed that over a period of approximately one week they had lost 9lbs in weight. We looked at their daily care records, nutritional records and GP records and these showed there were very few occasions where they had refused to eat their meal and no evidence to show that during this period they had been unwell or a rationale as to the sudden weight loss noted. No records were available to show that the above weight loss had been picked up by staff or that a healthcare professional had been contacted for advice. When discussed with the manager she advised that the weight loss was possibly incorrect but agreed that the records should either have been amended to reflect the correct weight of the person or demonstrate steps taken to address the weight loss if this is of concern. We noted that information recorded within the same persons care review record and their GP record did not tally in relation to when they had last seen a GP and there was no evidence of an outcome following a dieticians visit. This was confirmed by the manager. The weight record for the other person case tracked also showed that they too had lost 9lbs in weight over a period of one month. Practices and procedures for the safe storage, handling and recording of medication were examined as part of this inspection. A medication profile for each person was in place providing a photograph of the individual, the name of their GP, known allergies and a list of their prescribed medications. A copy of PRN protocols were in place for people who are prescribed when required medication however for 2 people case tracked, there was no evidence to show these had been updated since they were first written in 2005. We looked at the Medication Administration Records (MAR) for each person. These showed that records for 2 people were of a good standard with no gaps or omissions. Other records showed a small number of gaps and omissions and on one MAR record the rationale forgot to give was recorded for the persons anti-psychotic medications on one day. The MAR record for one person showed them as regularly refusing one of their medications. We spoke with them and they confirmed the rationale was as a result of one of their medications making their head feel very itchy. They confirmed that they had previously discussed this with support staff. A risk assessment relating to the persons refusal of medication on occasions was in place however this was dated July 2003 and there was no evidence to demonstrate this had been updated since. On inspection of their GP records these showed their last visit to the GP had been in December 2009 in relation to other illness experienced and their last visit to the Consultant Psychiatrist had been in 2008. Records showed that the latter was in relation to the persons refusal to take medication on occasions. Records of the temperature in the medication storage area were recorded twice daily Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: on most occasions. Records showed that the temperature where medication is stored was within recommended guidelines. On inspection of the staff training matrix records showed that staff had received medication training in 2009. Care Homes for Adults (18-65 years) Page 20 of 36 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 who use the service are able to express their concerns and are protected from abuse. Evidence: Information relating to how people can make a complaint or raise concerns was displayed at Acorn House and this was seen to be compiled in a pictorial/makaton format so as to ensure that people with specialist communication needs know what to do. Information relating to complaints is also recorded within the homes Statement of Purpose and Service Users Guide however as previously stated this requires reviewing and updating to accurately reflect the Care Quality Commissions office address. People who live at the home are aware of how to raise concerns and said they would discuss this with their key worker, a member of support staff or the manager. People spoken with also indicated they were confident to raise issues and felt their concerns and/or worries would be listened to and dealt with. On inspection of the complaint log, records showed that the last complaint at the home was in October 2008. Information relating to the specific nature of the complaint, actions taken and outcome were clearly recorded and there was evidence to show that the complainant was happy with the outcome. During the site visit we also looked at the organisations Regulation 26 reports, as part of our inspection process. One report made reference to a person who lived at the home making a Care Homes for Adults (18-65 years) Page 21 of 36 Evidence: complaint about others who also live at Acorn House. On inspection of the complaint log this was not recorded. We discussed this with the manager following the site visit and they confirmed they had discussed the issues of concern with the complainant on several occasions and completed a record. They confirmed they were not able to find a record of the conversations and actions taken as the documentation could not be located. There are appropriate safeguarding policies and procedures in place. No safeguarding referrals have been made within the last 12 months and this was confirmed within the homes AQAA. On inspection of the staff training matrix this showed that out of 15 members of staff employed at the home, 10 had received safeguarding training in 2007 and 2008. On inspection of 3 staff recruitment files for those people newly employed at Acorn House within the past 12 months, records showed that one person received safeguarding training soon after commencement of employment, one person has only recently completed this training but has been employed at the home for the past 5 months and the newest member of staff has yet to undertake this training. Staff spoken with demonstrated an understanding and awareness of safeguarding procedures and stated that should an issue arise, information would be passed to the person in charge of the shift and/or the manager. We are aware from Regulation 37 notifications received at the Commission that the service accept people who display challenging behaviour. While there is a plan of care in place for people who are challenging and who might exhibit self injurious behaviours, behavioural guidelines and risk assessments for support staff as to how to provide support and interventions were seen to not be reviewed or updated since 2003, 2007 and 2008. The AQAA confirms that all behaviour management guidelines need reviewing. This potentially places people at risk of not having all of their care needs met and support staff having inaccurate and not up to date information and guidance about individual residents. For one person case tracked we have received several Regulation 37 notifications detailing incidents at the care home whereby they have been physically aggressive both towards staff and others who live at the home. In addition on inspection of a random sample of staff supervision records there is evidence to suggest that some members of staff have expressed concern over the individual persons behaviours and how they are managed. The staff training matrix provided to us at the time of the site visit shows that not all staff working at the home have received challenging behaviour training. This was discussed with the manager and we were advised that this training is to be provided to staff at the beginning of April 2010 by the organisations Service Manager who is the in house trainer. We also discussed with the manager the appropriateness of letting a newly employed member of staff accompany and provide support to a person who has challenging behaviour Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: without having undertaken the appropriate training. The manager agreed that in hindsight an additional member of staff should also have been present so as to assist if difficulties had arisen. Care Homes for Adults (18-65 years) Page 23 of 36 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment. Evidence: The AQAA details that in the last 12 months many areas within the home have been redecorated and the kitchen has been newly re-fitted. A full tour of the premises was undertaken on the day of inspection and we were shown around by a member of support staff and a person who lives at Acorn House. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home environment continues to be maintained, decorated and furnished to a very good standard and is both homely, comfortable and modern. Furnishings and fittings were domestic in nature and were of a good quality and in keeping with the environment. There is sufficient communal space and this refers specifically to 1 large lounge, a separate dining area and an activities room. There are sufficient bathing and communal toileting facilities available which enable immediate access. On the day of the site visit the premises were seen to be clean, tidy and odour free and no health and safety issues were noted. People spoken with continue to be happy with their personal space. A random sample of individual peoples bedrooms were inspected and these were seen Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: to be personalised and individualised to suit peoples personalities and individual tastes. We were shown the prospective residents bedroom and from discussion with the member of staff were advised that the prospective person had input into the colour scheme and choice of furnishings. Care Homes for Adults (18-65 years) Page 25 of 36 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff in the home are in sufficient numbers, are trained and robustly recruited to support the people who use the service. Evidence: We were advised by the manager that the staffing levels at the home are 3-4 support staff from 07.00-14.00/15.00, 4 support staff from 14.00-22.00 and 1 waking member of support staff and a sleeping-in person from 22.00-07.00 each day. In addition Monday to Friday there is a further 1 or 2 members of support staff who work 09.00-14.00 or 17.00. The managers hours are supernumerary to the above. The manager confirmed that staffing levels at the home are flexible so as to ensure a proactive rather than reactive approach to staffing the home. This was confirmed from inspection of 4 weeks staff rosters, from discussion with support staff and people who use the service and from peoples daily care records and activity records. Records showed that particular attention is given to busy times of the day and the changing needs of the people who use the service as well as planned events and activities which may require higher levels of staff on duty. The manager confirmed that the majority of people who live at Acorn House are funded with additional 1 to 1 or 2 to 1 staffing hours when accessing the community. We discussed with the manager the benefit of ensuring that the staff roster clearly depicts where the additional staffing hours are utilised on any given day as at the time of the inspection there was no evidence to Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: demonstrate this. We were later advised following the inspection by the manager that the additional hours are recorded on the shift planner however she acknowledges this was not provided at the time of the site visit. Three staff files were viewed for those people newly employed at Acorn House over the past 12 months. The purpose of this was to check the recruitment process in the home. Records showed there is a good recruitment procedure and process in place and that all required documentation is received prior to the employee starting work. Records also showed that staff receive a good induction into the home and this is in line with Skills for Care Common Standards. We were told by the manager that 2 members of support staff have completed LDQ training (Learning Disabilities Qualification Induction Award). The AQAA details that it is hoped in the future to involve people who live at the home to be involved in the staff recruitment process and selection. We requested a copy of the staff training matrix and advised the manager that this would be examined following the site visit. The manager confirmed that the training matrix details were not up to date and verbally provided us with additional information of training undertaken for staff since January 2010 and planned training for April 2010 (the latter being challenging behaviour training). The training matrix shows that the majority of staff employed at Acorn House have undertaken training in both core and specialist subject areas which are pertinent to the needs of the people who live within the service. For 3 members of staff there was no evidence of training attained and this included the newest person employed at the home who had been in post at the time of the inspection for just over 3 weeks. The additional training information provided by the manager indicated they had only completed epilepsy training and were scheduled to undertake challenging behaviour training at the beginning of April 2010. National Vocational Qualification (NVQ) records provided to us by the manager show that 6 people have achieved NVQ Level 2, 5 people have achieved NVQ Level 3, 1 person wants to undertake NVQ Level 2 and 1 person is looking to commence LVQ Level 3. A copy of the staff supervision record for 2009 and 2010 was provided to us by the manager. This showed that the majority of staff have not received regular formal supervision in line with the recommendations as detailed by the National Minimum Standards for Younger Adults. The manager confirmed she was aware of the shortfall and has now implemented a supervision programme for 2010 so as to ensure that these are undertaken regularly. The AQAA details supervisions could have been more regular. On inspection of the 2010 matrix this showed that in addition to 8 members Care Homes for Adults (18-65 years) Page 27 of 36 Evidence: of staff having received a supervision all but the newest member of staff employed at Acorn House have received an appraisal. In general terms the records were seen to be good however as discussed with the manager, consideration should be given to ensuring there is a clear audit trail depicting actions agreed at the supervision, confirmation as to who is responsible for completion of the action and evidence of an outcome. Care Homes for Adults (18-65 years) Page 28 of 36 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 at the home benefit from a well run home so as to ensure positive outcomes. Evidence: The manager has been employed for Kingswood Care Services for approximately 7 years, of which they were the assistant manager at Acorn House for one and a half years and have been the manager since May 2009. The manager told us she is to commence the new Managers Award in September 2010 and was scheduled to undertake this earlier this year however due to a lack of applicants the course was cancelled. The manager was able to demonstrate a clear understanding of the ethos, aims and objectives of the service. The manager confirmed this as to give people in the home a good quality of life and ensuring people are supported and enabled to maximise their full potential but recognising for some people there are limitations and risks which may determine whether or not their goals and aspirations can be fully achieved. The manager advised that the management team of the service are all fairly new Care Homes for Adults (18-65 years) Page 29 of 36 Evidence: however she feels they are committed to ensuring positive outcomes for people who live at Acorn House. With regards to the staff team in general, the manager feels they are working cohesively, that they are supported to have a voice and some members of staff are now more confident in their work. Both staff and people who live at the home were very complimentary about the manager stating they found her to be approachable and understanding. It was evident at the site visit that she has a good rapport and relationship with people who live at the home. Evidence showed that on a day-to-day basis the home is generally well run and provides positive outcomes for the people who live at Acorn House. It is evident from this inspection that while there are many positives and outcomes for people are generally good, further development is required in relation to records management and ensuring individual care records for people who live at Acorn House are up to date and the information recorded is accurate and reflective of the persons current care needs. Where risks are identified these too need to be reviewed and updated in line with the persons care needs. Additional work is required by the management team to ensure that improvements are made in relation to the medication issues highlighted within the main text of the report and systems are developed and maintained in relation to staff training and staff supervision. All sections of the AQAA were completed and the document returned to us when requested however some of the information recorded does not fully concur with our findings and is detailed within the main text of the report. Kingswood Care Services have strategies in place for monitoring the quality of the service provided at Acorn House. This includes a member of the organisation visiting Acorn House once monthly as part of its obligation to undertake Regulation 26 visits and to compile a written report. We requested records of these visits and noted that there is evidence to indicate these have not been undertaken as regularly as they should. Following the site visit this was discussed with the manager and she was able to confirm there were no records to support these being undertaken each month. We were advised by the manager that in November 2009 objectives for the home were agreed during a Management Development Day. Objectives set include meeting and exceeding regulations as identified under the Care Standards Act 2000 and Care Homes Regulations for Adults, creating new menus, ensuring that all people who live at the home have an individualised plan of care and all members of the staff team have an individual learning and development plan. We were advised that the above objectives were formalised from the outcomes of consulting with people who live at the home, from their relatives and other stakeholders. There was also evidence to show that regular staff and resident meetings are held at the home. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: Corporate health and safety policies and procedures were observed to be in place within the home and staff training records showed that staff have received health and safety training. Care Homes for Adults (18-65 years) Page 31 of 36 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 Adults (18-65 years) Page 32 of 36 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 6 15 Ensure that the individual plan of care for each person is kept under review and accurately reflects their current care needs. So as to ensure that staff have the most up to date information. 10/05/2010 2 9 13 Where risks are identified for 10/05/2010 each person ensure these are kept under review. So as to ensure that staff have the most up to date information. 3 22 13 Ensure that all staff working at the care home receive training relating to safeguarding and challenging behaviour This will ensure that staff are competent and feel confident to deal effectively with any issues that arise 01/06/2010 Care Homes for Adults (18-65 years) Page 33 of 36 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 and people who live at the home are safeguarded. 4 35 18 Ensure that all staff receive training in both core and specialist subjects areas within a reasonable timeframe. So that staff feel confident to provide appropriate care to people in the home. 5 36 18 Ensure that staff receive regular supervision and there is evidence to demonstrate this. So that staff feel supported. 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 01/08/2010 01/05/2010 1 1 Information recorded within the Statement of Purpose and Service Users Guide is reviewed and up to date and in an appropriate format for the people it is intended for. Ensure that information recorded is accurate. Ensure that PRN protocols are reviewed so as to ensure that the information recorded remains appropriate. Ensure that people receive their prescribed medication when they should. So as to ensure their health and wellbeing. Where a complaint is made ensure there is a clear audit trail detailing the specific nature of the complaint and the actions taken. The complaints procedure must be amended to ensure that 2 3 4 18 20 20 5 22 6 22 Care Homes for Adults (18-65 years) Page 34 of 36 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 it has the correct information recorded regarding the Care Quality Commissions contact details. 7 8 35 39 Ensure the staff training matrix is up to date and accurate to reflect training achieved. Ensure that Regulation 26 visits are conducted each month and a report compiled and available for inspection. Care Homes for Adults (18-65 years) Page 35 of 36 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. 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