Care Home: Acorn House Care Centre

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well People admitted to the home found the information they received about the home useful, and helped them decide if the home was the right place to meet with their needs. They could visit the home to look for themselves at the facilities offered, spend time beforehand and stay for lunch. Special arrangements were made to make people welcome and residents and or their families can help prepare their bedroom as they wanted. Residents living in the home were given a contract that protected their legal rights. Before being admitted people had their needs assessed. This helped to make sure they would receive the right care and support they needed. Important information needed to support them in every day living was recorded. Residents benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. Resident`s also benefited from additional specialist support where needed, such as health care. Relatives visiting and those who provided written comments considered the care provided to be good. They said they were kept up to date with important issues concerning their relatives` care. Residents were happy with the care they received and considered staff to be `helpful` and written comments from relatives included `The staff are always helpful and friendly and willing to put themselves out.` And `Everything I`ve seen whilst visiting my husband has been excellent`. The right of residents to be treated with dignity and respect was included in staff training. Staff in the course of their duties they were observed as respectful to residents. Residents spoke very highly of the staff, and said there was never any question of their privacy being compromised. There were no unnecessary rules imposed on residents and their routines in the home were flexible and special to them. Residents were generally satisfied with the activities and entertainment provided at the home. Birthdays and festive celebrations were catered for. Visiting arrangements were very good and the meals provided met with resident`s tastes choice, and needs. Staff were observed as courteous and made efforts to be discreet when assisting those residents requiring support. The complaints procedure was clear which helped residents/relatives have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues, and safe recruitment practices. This meant residents rights, safety, and welfare was promoted. The home was well maintained, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Information received at the Commission for this inspection showed all essential maintenance had been carried out, for example electrical checks. Written comments from relatives included `The home is always clean and tidy and doesn`t smell `and `I think the majority of the patients have a nice environment`. Recruitment of staff was thorough and met with regulatory requirements. Staff interviewed said they enjoyed their work and felt supported by management. Training was provided and included induction training, and National Vocational Qualification in care level 2 or above. Supervision of staff was good. Written comments from relatives included, `All of the staff are very friendly and pleasant.` And `the staff here, work very hard and are considerate`. There was a warm and friendly atmosphere in the home. Team work among staff and management was good with everyone working together for the benefit if the residents. Residents appeared to be very happy. People living and working in the home were `listened to`. They had regular meetings to have their say on issues that affected them. Systems were in place to approach residents/relatives to give their view on the quality of services and facilities in the home, with Quality Assurance carried out. There were clear lines of management and staff accountability within the home. What has improved since the last inspection? Since the last key inspection the manager has been registered with the Commission. Care plans are reviewed and signed where possible by residents and or relatives to show they were involved in decisions made. Senior staff are identified on the rota which means in the absence of the manager, they know who will take charge to deal with any issue or emergency that may occur. What the care home could do better: Information regarding additional costs that may be incurred such as staff escort must be made known to residents and their representatives. This should include the level of fee charged. Costs should be made known to the placing authority to allow a decision to be made whether additional funding would be available for staff escort relating to resident care, for example hospital appointments. Care planning should be clearer and more person centred. This will help to make sure individual needs are identified properly and support will be provided in a consistent way, and should include detail that identifies who will take responsibility to ensure needs are met, such as carers, ancillary staff, family, and management. Where risk assessments show special measures are needed to reduce an identified risk, it should be clear who will take responsibility to ensure the risk is minimised. A better record should be kept of activities residents are involved in. This will help to identify any shortfalls for all individuals and keep an accurate account of their daily experiences. Residents should have a daily living plan to support them exercise choice and control over their lives. This will help to make sure all staff will support them as they wish and require and their care will be more person centred. Proper arrangements should be in place to ensure food served to the dementia unit is timely to avoid residents becoming restless whilst sat waiting. Residents requiring assistance at meal times must be given proper care and supervision. This will ensure residents dependent on staff supervision will get the right support they need. The dining area in the dementia unit should accommodate all residents comfortably. This will allow residents to sit together for meals and allow staff to supervise them better. How staff are deployed should take into account the level of supervision residents require. This will help to ensure sufficient staff are available to provide hospital escort and supervision at meal times. Dementia training should be offered to all staff working on the dementia unit. This will ensure that staff are skilled and confident when dealing with the diverse needs of this specialised client group. Arrangements should be made for residents to access their money during out of office hours. This will ensure cash is readily available should they wish to use it. Individual risk assessments for resident evacuating the building in any emergency for example a gas leak, should be completed. This will help staff to know what to do to help people safely. Key inspection report Care homes for older people Name: Address: Acorn House Care Centre Whalley New Road Roe Lee Blackburn Lancashire BB1 9SP     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: Marie Dickinson     Date: 2 8 0 5 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 31 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 31 Information about the care home Name of care home: Address: Acorn House Care Centre Whalley New Road Roe Lee Blackburn Lancashire BB1 9SP 01254679395 01254677686 acorn.house@ashbourne.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashbourne Homes Ltd Name of registered manager (if applicable) Mrs Carol Waddicor Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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: Old age, not falling within any other category - Code OP (maximum number of places - 22) Dementia - Code DE (maximum number of places - 10) The maximum number of service users who can be accommodated is: 32 Date of last inspection Brief description of the care home Southern Healthcare Ltd own Acorn House Care Centre. Mrs Carol Waddecar is the manager, although she is not yet registered, and is responsible for the day-to-day management of the home. The home is registered to offer accommodation and personal care for twenty-two older people, and ten older people with dementia. The Care Homes for Older People Page 4 of 31 10 0 Over 65 0 22 Brief description of the care home home is located in a busy community on the edge of Blackburn. It is on a main road with access to shops, a church and other community facilities. Bus services are nearby. The front of the home looks onto the shops and road and at the rear there are views of the garden and patio. Car parking facilities are at the rear. The home is a purpose built two-storey building with accommodation in two parts. The dementia unit is on the first floor. There are lounge and dining areas for each unit. There are bathroom and communal toilet facilities on each floor. Every resident in the home has a single bedroom, with an en suite toilet and wash hand basin. Bedroom doors are lockable. There is a passenger lift to the first floor area. The weekly charges at the home vary according to the assessed care and range between £394 to £417 per week. Cost for private care is £517. Additional charges includes staff escort, hairdressing, personal newspapers/periodicals, additional toiletries and Aromatherapy. The home is on the preferred providers list for Blackburn with Darwen Borough Council. Information about Acorn House can be obtained from the home in the form of The Statement of Purpose and Service Users Guide. Care Homes for Older People Page 5 of 31 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 2 Star. This means the people who use this service experience good quality outcomes. A key unannounced inspection was conducted in respect of Acorn House Care Centre on the 27th and 28th May 2009. An annual quality assurance assessment (AQAA), was sent to us by the manager prior to this inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service, such as number of staff trained, and of essential maintenance to keep the home safe being carried out. Written comments were also received prior to the inspection from residents and their relatives. They gave their views as to how well the home performed in meeting needs Care Homes for Older People Page 6 of 31 of residents. Discussion took place with the manager, staff on duty and residents and relatives during inspection. Documents including policies, procedures, and staff and residents records were looked at. The premises were inspected as part of the process. Other information was considered such as the homes annual quality assurance survey, and minutes of meetings held in the home. Areas that needed to improve from the previous key inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Older People. Care Homes for Older People Page 7 of 31 What the care home does well: People admitted to the home found the information they received about the home useful, and helped them decide if the home was the right place to meet with their needs. They could visit the home to look for themselves at the facilities offered, spend time beforehand and stay for lunch. Special arrangements were made to make people welcome and residents and or their families can help prepare their bedroom as they wanted. Residents living in the home were given a contract that protected their legal rights. Before being admitted people had their needs assessed. This helped to make sure they would receive the right care and support they needed. Important information needed to support them in every day living was recorded. Residents benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. Residents also benefited from additional specialist support where needed, such as health care. Relatives visiting and those who provided written comments considered the care provided to be good. They said they were kept up to date with important issues concerning their relatives care. Residents were happy with the care they received and considered staff to be helpful and written comments from relatives included The staff are always helpful and friendly and willing to put themselves out. And Everything Ive seen whilst visiting my husband has been excellent. The right of residents to be treated with dignity and respect was included in staff training. Staff in the course of their duties they were observed as respectful to residents. Residents spoke very highly of the staff, and said there was never any question of their privacy being compromised. There were no unnecessary rules imposed on residents and their routines in the home were flexible and special to them. Residents were generally satisfied with the activities and entertainment provided at the home. Birthdays and festive celebrations were catered for. Visiting arrangements were very good and the meals provided met with residents tastes choice, and needs. Staff were observed as courteous and made efforts to be discreet when assisting those residents requiring support. The complaints procedure was clear which helped residents/relatives have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues, and safe recruitment practices. This meant residents rights, safety, and welfare was promoted. The home was well maintained, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Information received at the Commission for this inspection showed all essential maintenance had been carried out, for example electrical checks. Written comments from relatives included The home is always clean and tidy and doesnt smell and I think the majority of the patients have a nice Care Homes for Older People Page 8 of 31 environment. Recruitment of staff was thorough and met with regulatory requirements. Staff interviewed said they enjoyed their work and felt supported by management. Training was provided and included induction training, and National Vocational Qualification in care level 2 or above. Supervision of staff was good. Written comments from relatives included, All of the staff are very friendly and pleasant. And the staff here, work very hard and are considerate. There was a warm and friendly atmosphere in the home. Team work among staff and management was good with everyone working together for the benefit if the residents. Residents appeared to be very happy. People living and working in the home were listened to. They had regular meetings to have their say on issues that affected them. Systems were in place to approach residents/relatives to give their view on the quality of services and facilities in the home, with Quality Assurance carried out. There were clear lines of management and staff accountability within the home. What has improved since the last inspection? What they could do better: Information regarding additional costs that may be incurred such as staff escort must be made known to residents and their representatives. This should include the level of fee charged. Costs should be made known to the placing authority to allow a decision to be made whether additional funding would be available for staff escort relating to resident care, for example hospital appointments. Care planning should be clearer and more person centred. This will help to make sure individual needs are identified properly and support will be provided in a consistent way, and should include detail that identifies who will take responsibility to ensure needs are met, such as carers, ancillary staff, family, and management. Where risk assessments show special measures are needed to reduce an identified risk, it should be clear who will take responsibility to ensure the risk is minimised. A better record should be kept of activities residents are involved in. This will help to identify any shortfalls for all individuals and keep an accurate account of their daily experiences. Residents should have a daily living plan to support them exercise choice and control over their lives. This will help to make sure all staff will support them as they wish and require and their care will be more person centred. Care Homes for Older People Page 9 of 31 Proper arrangements should be in place to ensure food served to the dementia unit is timely to avoid residents becoming restless whilst sat waiting. Residents requiring assistance at meal times must be given proper care and supervision. This will ensure residents dependent on staff supervision will get the right support they need. The dining area in the dementia unit should accommodate all residents comfortably. This will allow residents to sit together for meals and allow staff to supervise them better. How staff are deployed should take into account the level of supervision residents require. This will help to ensure sufficient staff are available to provide hospital escort and supervision at meal times. Dementia training should be offered to all staff working on the dementia unit. This will ensure that staff are skilled and confident when dealing with the diverse needs of this specialised client group. Arrangements should be made for residents to access their money during out of office hours. This will ensure cash is readily available should they wish to use it. Individual risk assessments for resident evacuating the building in any emergency for example a gas leak, should be completed. This will help staff to know what to do to help people safely. 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 10 of 31 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 11 of 31 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. The admission process ensured peoples needs were properly assessed. Contracts issued protected residents legal rights of residency. Evidence: Information received at the Commission for this inspection informed us, Assessments are carried out on potential residents in their own home or hospital before admission. This is comprehensive and incorporates a full range of personal and health care needs. People admitted were made to feel welcome and were looked after by a named carer. Residents who provided written comments for this inspection said they received enough information about the home before they moved in. This helped them decide if the home was the right place for them. They had received a contract. Those funded by a local authority were issued with a financial contract. This was to agree to the funding arrangements made on their behalf, and people knew how much they would have to Care Homes for Older People Page 12 of 31 Evidence: pay. However information as seen in the service user guide stated charges will be made for staff escort service. The cost of this service was not given although the manager said they had never charged residents for this. However, Information regarding additional costs that may be incurred such as staff escort must be made known to residents and their representatives. This should include the level of fee charged. Costs should be made known to the placing authority to allow a decision to be made whether additional funding would be available for staff escort relating to resident care, for example hospital appointments. Residents funded in this way receive a set weekly allowance for their personal needs. All contracts as seen on resident files were signed by the resident agreeing to the terms and conditions of residency. Records kept of the most recent admissions showed how planned admissions were managed. Where people had been referred to the home by social services, information supporting the persons needs and reason for referral was made available. The manager had also completed an independent assessment. This had considered for example, health and personal care, mobility, nutrition and other essential information. Potential risks had been identified providing staff with information to care for people safely. One resident had a draft care plan written in preparation for the planned admission to ensure all areas of identified need was considered. This helped to make sure they would receive the right care and support they needed. Care Homes for Older People Page 13 of 31 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. Residents had care plans, risk assessments, and a named key worker, which supported them to ensure their health and personal care needs being met in a consistent way. Medication was managed safely. Evidence: The majority of residents who provided written comments and those spoken to during inspection, indicated that they always or usually receive the care and support they needed at Acorn House. Positive comments about the care and attention they receive were made. For example they said, Staff are very good and help me. And They are always available when I call them. Staff were also described as helpful and written comments from relatives included, The staff are always helpful and friendly and willing to put themselves out. And Everything Ive seen whilst visiting my husband has been excellent. Other relatives however said they thought overall this is a very caring home, however the service could do better with staffs understanding of basic care needs and medical care. Care Homes for Older People Page 14 of 31 Evidence: Information received at the Commission indicated Individual care plans are formulated within the first 48 hours after admission. This is based on assessments to ensure that residents personal and health care needs are fully considered. Potential risks were looked at and included for example, risk of developing pressure sores, nutrition, moving and handling, continence, and risk of falling. Staff worked to a key worker system, having responsibility to make sure care needs were personalised for residents. This meant residents benefited a continuation of their care support by people they knew and trusted, and was particularly beneficial for residents with dementia care needs. Three care plans were looked at in detail. Information recorded included reference to peoples past history and lifestyle, such as where they had worked, their family networks and what they liked and disliked. Needs identified for personal care, mobility, communication, personal safety, medication, medical, and social were also listed. How identified needs were to be supported was generally clear, for example, the support they required with getting dressed and when having a bath. Whilst care planning was generally good, more detail of actual needs and personal wishes of residents for staff to know about, when providing their care is required. This will help to make the care plan more person centred, and should include detail that identifies who will take responsibility to ensure needs are met, such as carers, ancillary staff, family, and management. Care plans had been reviewed and updated regularly. The right of residents to be treated with dignity and respect was included in staff training. Residents spoke highly of the staff, and said there was never any question of their privacy being compromised. Observations showed staff respectful, and personal care provided in privacy such as toilet doors shut and residents spoken to discreetly re these needs. Complimentary remarks about the staff were made, such as all very good, and helpful. Care plans showed how staff were instructed to maintain privacy, dignity, and independence. For example, Provide dignity at all times. This is clearly good practice. Relatives and people visiting were generally happy with the standard of care given. They said they were kept up to date with important issues regarding their relatives care. Written comments from relatives also suggested improvements could be made by staff having a better understanding of physical health needs, and more attention given to hair and nails. Where risk assessments show special measures are needed to reduce an identified risk, it should be clear who will take responsibility to ensure the risk is minimised. This could be for example managing diet to ensure the risk of malnutrition is reduced. Instructions to offer snacks between meals to prevent this should indicate the type of snack needed, who would take responsibility to prepare the snack and when this Care Homes for Older People Page 15 of 31 Evidence: would be given. Residents had access to health care services both within the home and in the local community. All residents were registered with a GP and accessed local services either in the community, or were supported by visits to the home by health care professionals. This included visits from the district nursing team for nursing intervention required such as applying dressings. Continence care was managed well. Pressure care was promoted and pressure-relieving aids were used where need was identified. Risk assessments had been completed for moving and handling and were used as guidance for staff to help care for residents safely. Observations were made of the hoist and wheelchairs being used safely. The home operated a monitored dosage system for the administration of medication, which was dispensed into blister packs by the supplying pharmacist. An appropriate recording system was in place to record the receipt, administration and disposal of medication. Consent for medication should be recorded better, and demonstrate peoples wishes and capabilities to self medicate, as not all options had been considered. Medication given as when necessary was sufficient in detail as to when this would be given. A clear audit of medication received was kept. The record of medication administration was signed and storage of medication was secure. Staff responsible for administering medication had been trained. Care Homes for Older People Page 16 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social, recreational activities, and lifestyle, generally met residents needs and expectations. Catering arrangements were satisfactory in providing for individual taste, and choice, although resident support at meal times needs to improve. Evidence: The residents preferences in respect of social activities had been recorded as part of their assessment. Activities for residents were organised and offered a good variety. For example records showed residents had enjoyed baking, reading, and entertainment. Birthdays and festive celebrations catered for. Comments from residents and relatives returned to the Commission as part of the inspection show everyone thought there were activities arranged by the home they could usually join in. They said, The activities organised are well done and topical, Chinese new year theme, Easter etc. which keeps the residents in touch with the outside world. And, I think the majority of the patients have a nice environment with lots of stimulation in the form of crafts, concerts, music, TV, bingo etc. Although care plans did not include a daily living plan with preferred routines recorded to support residents personalise their day, observations showed residents appeared to have freedom of choice over their lives within their capability. For example several Care Homes for Older People Page 17 of 31 Evidence: residents said they got up when they wanted and went to bed when it suited them. An activity coordinator was currently being recruited. Personal preferences in respect of daily social activities had been recorded as part of residents initial assessment. How this is included in a person centred way needs to be developed so that residents are involved in meaningful daytime activities of their own choice and according to their individual interests and capability. For example basic comfort needs for getting up and going to bed, when they preferred to bathe, what they would like staff to consider such as, to be woken, not woken, have a cup of tea etc. As all residents are individual with differing needs, how these are managed could be documented with an easy to read daily living plan for support. This would also help to identify staff support required at particular times and provide staff at a glance important detail to be followed such as food requiring cutting up, and level of supervision during meals required. Records were kept of the activities provided on each residents Recreational Activities Record, by an A-Z system. This method of recording was difficult to follow, for example one resident in the dementia unit had YU recorded which basically meant wandering and one to one. This was discussed with the manager as there was no accurate record of what one to one involved or why wandering was considered a social activity. Residents were able to receive visitors at any time and were able to entertain their guests in private. There was evidence seen in care records that relatives regularly visited the home. Comment cards supported this, and observations of relatives visiting showed how staff were considerate to their needs and made them feel very welcome. Residents were also supported to continue with their chosen religion. This was recorded in residents assessment. Residents bedrooms were personalised. They were able to bring in personal belongings and arrange their rooms how they wished. Those who could managed their own finances. Residents could choose where to eat their meals. Those residents spoken to during inspection said the food was good. They said they had choices. Menus seen were planned over several weeks to alternate meals provided, and ensure variety, choice and good nutrition. Portions served were generous and residents could have more if they wished. Observations at lunchtime showed the way meals were organised and served. The Care Homes for Older People Page 18 of 31 Evidence: arrangements for meals delivered to the dementia unit could improve as staff were required to collect the pudding from the kitchen and this task took two journeys. Staffing numbers at meal times should be increased as the level of supervision required for residents was lacking in both units. Very dependent residents requiring assistance with eating was given sensitive one to one support when staff could provide it. One staff was observed discreetly feeding two people at the same time. People on the dementia unit who made little attempt to eat let their meals go cold. Tea was served from a communal teapot. Care Homes for Older People Page 19 of 31 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 complaints procedure was available and used properly, which helped residents and other people have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted Evidence: The complaints procedure was given to residents when they were admitted to the home. A complaints recording system was in place. The procedure gave clear directions on whom to make a complaint to and the timescales for the process. Any issue raised was quickly dealt with by the manager who said people are very open and would say if they had any concern. Records showed two complaints received at the home in relation to staffing levels had been taken seriously. These were in relation to staffing levels in the dementia unit and as a result the levels of staffing was reviewed and additional staff were made available for morning and evening shifts when the unit is at its busiest. There had been no complaints received at the Commission. Residents and relatives, who were consulted, knew who to talk to if they were not happy, and were confident to use the complaints procedure. Staff working at the home said they were trained in adult protection and were aware of the written abuse policies and procedures, which included whistle blowing. They knew their responsibility in this area and were confident they would report bad practice if ever the need arose. In addition to this staff training was provided to Care Homes for Older People Page 20 of 31 Evidence: ensure new staff understands procedures. Staff contracts precluded them from financial reward or assisting in or benefiting from the residents wills. Care Homes for Older People Page 21 of 31 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. Residents live in a clean, safe and comfortable environment. Evidence: The home is a purpose built property in Blackburn. It is close to shops and other local amenities and is on a bus route. Car parking is to the rear of the home. Accommodation is in single en suite bedrooms on two floors with access to the upper floor via a passenger lift. The home is divided into two units, residential and dementia. Entrance to the home and dementia unit is by security keypad access. The first floor of the building was occupied by the residents who suffered from varying forms of dementia. The lounge area was open plan and reasonably decorated and furnished with comfortable chairs. There was a separate dining room; however there was not sufficient room to seat all residents at the same time. The manager said plans were being made to create more space. Bedrooms were clean and reasonably decorated. Furniture was modern and all rooms had nurse call points fitted. Residents were provided with a lockable piece of furniture and personal possessions such as pictures and ornaments were accommodated and arranged as residents wished. There was an enclosed garden area for residents use; however residents in the Care Homes for Older People Page 22 of 31 Evidence: dementia unit could not independently go into this area. Residents on the ground floor said they sat out in the warm weather and enjoyed this. The home was generally well maintained and requirements made by the fire department and environmental health had been complied with. Water temperatures monitoring and fire alarm testing were regularly done. The laundry personnel are commended for keeping the facilities exceptionally clean and organised. Residents clothes were on hangers and each resident had a laundry basket. All residents clothes were ironed. Relatives who provided written comments were satisfied with the environment. Comments such as The home is always clean and tidy and doesnt smell, and I think the majority of the patients have a nice environment. Care Homes for Older People Page 23 of 31 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. Recruitment practices were thorough in ensuring the right staff were employed. Evidence: Information received at the Commission for this inspection stated Acorn House Care Centre supports the principle of equal opportunity and opposes all forms of unlawful discrimination, and this commitment extends to all areas within employment, for example, recruitment, and selection, pay and benefits, supervision and performance, and opportunities for promotion. Records made available for this inspection showed good recruitment practice was followed. Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check had been applied for, prior to employment. References had been received. On appointment members of staff were issued with a contract of terms and conditions of employment. All staff were given a job description/specification outlining duties and expectations. Both units were staffed separately and consisted of a unit manager and senior carers. Rotas completed showed the compliment of staff on duty at any given time. These levels were to cover all essential duties in providing care, and maintaining essential standards in the home such as hygiene and catering, with senior staff on duty at all times. However how staff are deployed must take into account important periods Care Homes for Older People Page 24 of 31 Evidence: during the day such as meal time. Observations made during the inspection showed there was insufficient staff on duty to manage this period effectively. Relatives who provided written comments for this inspection thought improvements could be made with staffing, in particular with staff escort and ensuring people confined to bed are given more one to one quality time to ensure basic care needs are met and residents are not isolated. The skill mix of staff on the units ensured a least one skilled carer was always on duty at all times. Staff confirmed that they received Induction training and records showed other training provided was varied and included for example, literacy awareness, moving and handling, and first aid. It is important that specialist training is provided for staff working on the dementia unit. Records show just over half of the staff had been trained. The manager said she had sourced other training by the Alzheimers Society Tomorrow is another Day. Staff supervision records showed training needs being identified. 73 of staff had achieved or was working toward a National Qualification (NVQ) in care level 2 and above. Staff interviewed said they enjoyed their work and felt supported by management. Residents who provided written comments and those spoken to during inspection were happy with the staff team. Relatives who also provided written comments generally thought the staff usually responded to different needs of individuals, and sometimes care workers have the right skills and experience. Additional comments included, All of the staff are very friendly and pleasant. And the staff here, work very hard and are considerate. Care Homes for Older People Page 25 of 31 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. The health and safety of residents and staff working in the home was considered which meant the home was run in the best interests of residents. Evidence: The manager is both experienced and qualified to manage the home and since the last key inspection has been registered as manager with the Commission. The roles of the management team as a whole includes seniors, unit managers and deputy, who take responsibility for a number of residents and staff employed. There are clear lines of accountability, and the entire service is audited on a monthly basis by an operations manager to oversee management performance, and provide the managers supervision. Southern Cross organisations strategic and financial planning systems mean the manager works within corporate budgetary control. There is a commitment to meet with good practice standards and meet with regulatory requirements. Minutes of the different meetings for all parties showed for example, heads of department meetings, care staff meeting and residents/relatives Care Homes for Older People Page 26 of 31 Evidence: meetings. Quality assurance is also carried out in the home and relatives, residents, and staff are given the opportunity to have their say. There was evidence issues raised were taken seriously. For example concerns from relatives over low staffing levels when residents were going to bed and getting up had been addressed with the introduction of an additional staff on duty during these times. Records showed staff supervision was given regular. This meant staff could discuss any issue they have relating to their work, express themselves, their concerns, and their plans for the future or to receive feedback on their performance. Staff received six monthly appraisals. Staff meetings were held regular. A random selection of residents financial records of monies paid into the homes account for safe keeping was checked. Good accounting procedures were followed and provided a clear audit trail of expenditure. There were no arrangements for residents to access their money at weekends. Resident and staff records kept were of a good standard and regularly completed. The home had access to professional business, legal, and financial advice and had all the necessary insurance cover in place to enable it to fulfill any loss or legal liabilities. Information received at the Commission indicated regular auditing of essential services for example fire, electric and gas had been completed authorised and qualified contractors. Individual risk assessments for resident response to the need to evacuate the building should be completed. This will support staff to know how individual residents would respond, particularly residents on the dementia unit. Mandatory training such as fire safety, first aid, food hygiene, moving and handling and first aid was provided for all staff. Care Homes for Older People Page 27 of 31 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 28 of 31 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 2 5A The cost of staff escort service for residents must be clear in the level of fees charged. This will allow for proper arrangements to be made to support residents receiving a basic minimum personal allowance 03/07/2009 2 15 12 Residents requiring assistance at meal times must be given proper care and supervision. This will ensure residents dependent on staff supervision will get the right support they need. 03/07/2009 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 Care planning should be clearer and more person centred. Page 29 of 31 Care Homes for Older People 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 This will help to make sure individual needs are identified properly and support will be provided in a consistent way, and should include detail that identifies who will take responsibility to ensure needs are met, such as carers, ancillary staff, family, and management. 2 8 Where risk assessments show special measures are needed to reduce an identified risk to health such as weight loss, it should be clear who will take responsibility to ensure the risk is minimised. A better record should be kept of activities residents are involved in. This will help to identify any shortfalls for all individuals and keep an accurate account of their daily experiences. Residents should have a daily living plan to support them exercise choice and control over their lives. This will help to make sure all staff will support them as they wish and require and their care will be more person centred. Proper arrangements should be in place to ensure food served to the dementia unit is timely to avoid residents sat waiting being restless. The dining area in the dementia unit should accommodate all residents comfortably. This will allow residents to sit together for meals and allow staff to supervise them better. How staff are deployed should take into account the level of supervision residents require. This will help to ensure sufficient staff are available to provide hospital escort and supervision at meal times. Dementia training should be offered to all staff working on the dementia unit. This will ensure that staff are skilled and confident when dealing with the diverse needs of this specialised client group. Arrangements should be made for residents to access their money during out of office hours. This will ensure cash is readily available should they wish to use it. Individual risk assessments for resident evacuating the building in any emergency for example a gas leak, should be completed. This will help staff to know what to do to help people safely and without risk. 3 12 4 14 5 15 6 20 7 27 8 30 9 35 10 38 Care Homes for Older People Page 30 of 31 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 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!