Care Home: Acorn House Residential Home

What the care home does well Some progress had been made in regard to the care files of people living at Acorn House and there were also more specific risk assessments in place. People are happy living at Acorn House. The staff are friendly and interact well with people living there. Meal are said to be very nice, of good portions and there are alternatives available. Staff know the residents and they were observed to interact very well with people and treated people with respect. A visiting professional spoke extremely highly of the staff and was very positive about the relationships between staff and people living at the home. They were also positive about the committment from the manager in their engagement with training. They said of the staff, "Staff are amongst the best". "They are very kind, their emotional and respect side is second to none". What the care home could do better: The contracts of residency need to be dated and there is the need to review the section that signposts people to raise their concerns directly with CQC. There is the need to continue to develop the assessment of need for people, more specific risk assessments as well as specific more detailed care plans. An effective monthly evaluation of care also needs to be introduced.Where incidents occur in the home there is the need to record this as such and where necessary involve relevant professionals. Accident recording also needs to contain more information. A systems for analysing accidents needs to be developed and introduced as well as a system for recording incidents that occur in the home. Bathing temperatures should not exceed 42 degrees, but there is the need to ensure that the temperature is not too low. Random inspection report Care homes for older people Name: Address: Acorn House Residential Home 310-312 Norton Road Stockton-on-Tees TS20 2PU two star good service 17/04/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jacqueline Herring Date: 1 1 1 1 2 0 0 9 Information about the care home Name of care home: Address: Acorn House Residential Home 310-312 Norton Road Stockton-on-Tees TS20 2PU 01642559378 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Carol Lynn Trainor care home 14 Number of places (if applicable): Under 65 Over 65 0 6 dementia old age, not falling within any other category Conditions of registration: 8 0 The maximum number of service users who can be accommodated is: 14 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 6 Dementia Code DE, maximum number of places 8 Date of last inspection Brief description of the care home Acorn House is a care home registered to provide care for 14 older people. There is one unit for 8 people who have dementia and another unit for 6 older people. The home is a two storey building converted from two Victorian terraced houses. It stands on an elevated site overlooking Norton Road. Access to the front is via a path with steps, a handrail is fitted. At the back of the building there is ramped access to the Care Homes for Older People Page 2 of 10 1 7 0 4 2 0 0 9 Brief description of the care home home. The garden and elevation of the building allow for privacy. Acorn House is located near to local shops, post office, public houses, social clubs and churches. It is situated on a bus route providing access to Stockton town centre. The weekly fees vary between £356 and £374, but the actual amount payable depends on peoples individual circumstances. Care Homes for Older People Page 3 of 10 What we found: This was a random inspection undertaken to follow up a number of issues raised at a previous random inspecton of 12 May 2009. A number of requirements and recommendations were made in respect of people having their needs assessed, appropriate care plans being in place and the need for more specific risk assessments. Two care files for people living at Acorn House were looked at. There have been no recent admissions to the home. The files of someone who has lived at the home for some time was looked at and for someone who was recently admitted to hospital and has since returned. Within both files there was a contract of residency, which now included their room number and also the fees. These however are not dated. There is also the need to review further in the area of complaints and the current contract signposts people to make complaints to CQC if not satisfied with how the service had dealt with their concerns. In both files there was a copy of a fully completed pre admission assessment and also evidence to show that a further pre admission assessment had been completed prior to the person returning from hospital. The full assessment had not been updated, so it remained unclear if the existing care plans were still relevant. Assessments of need were in place for both people whose files were looked at. It would enhance the assessment more if additional comments were made, making the assessment much more detailed and person centred. A number of the current assessments are of a tick box nature. Some progress had been made in respect of risk assessments and it was evidenced that individual and specific risk assessments for risks such as falls are now in place. There is the need to develop these further to include other risks such as aggressive behaviour. Care plans were in place for a number of areas of need. In some instances the level of detail again needed to be developed further, for example, the care need for one person was that they could be aggressive to staff, it did not detail in what way or whether there were any triggers. There were also some care plans in place for which no assessed need had been previously identified, examples of this were shared with the supervisor. There was also idenfied areas of need for which care plans should have been developed but had not, for example, refusal of medication, regular refusal of fluid and meals. Whilst care plans are being reviewed on a monthly basis, a value based evaluation of care is not taking place. The monthly evaluation should be a judgement outlining the effectiveness or not of the care that is taking place. It was also identified that there is the need to ensure that information is cross referenced, for example CPN information should be cross referenced to the specific care plan and form part of the review/evaluation. Through discussion with staff it was identified that they would benefit from further training in peoples specific conditions, this primarily related to peoples mental health care needs. The manager is in the process of trying to source some training. Care Homes for Older People Page 4 of 10 Accident records were also looked at and again it was identified that the level of information both within the actual accident form and the daily records needs to be increased. In two accidents looked at there was insufficient information in regard to the extent of the accident and the action taken by staff as a result. In discussion with one of the care supervisors, it was unclear if any analysis in respect of accidents is taking place. Information contained within some of the records looked at also needed further exploration such as in the event of person to person altercations, there is the need to complete an incident report, along with any investigation and action taken as a result, such as for example, a safeguarding referral. Discussion took place with staff and one person living at the home. They generally believed that the staffing levels are sufficient to meet the needs of the people living at Acorn House. There is however the need to keep this under review as staff are detracted from direct care delivery to prepare and cook breakfast and tea. A requirement was made at the last inspection in respect of water temperatures. The records for these were looked at and it was noted that people were being bathed at temperatures that may be a little cool, such as 37. Staff said they were happy working at Acorn House and said, I like it here, it is homely and you are able to sit and spend time with the people livimg here. When asked about areas of improvement, they said social events, outings and activities for people as there were few opportunities for this. What the care home does well: What they could do better: The contracts of residency need to be dated and there is the need to review the section that signposts people to raise their concerns directly with CQC. There is the need to continue to develop the assessment of need for people, more specific risk assessments as well as specific more detailed care plans. An effective monthly evaluation of care also needs to be introduced. Care Homes for Older People Page 5 of 10 Where incidents occur in the home there is the need to record this as such and where necessary involve relevant professionals. Accident recording also needs to contain more information. A systems for analysing accidents needs to be developed and introduced as well as a system for recording incidents that occur in the home. Bathing temperatures should not exceed 42 degrees, but there is the need to ensure that the temperature is not too low. 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 set out on page 2. Care Homes for Older People Page 6 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 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, 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 7 13 More specific risk assessments must continue to be developed further and need to include risks associated to potential challenging behaviour. This will ensure that people needs are being met and that they welfare and safety needs are being attended to. 19/11/2009 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 2 2 3 The new contracts need to be dated and a further review should take place in respect of the complaints information. Individual assessments of people would be enhanced further with more specific personal information. There is also the need to ensure that all needs have been assessed. The care plans would benefit from additional information particularly into the specific care need and more details care intervenetion. There is also the need to complete a monthly evaluation in 3 6 Care Homes for Older People Page 8 of 10 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 respect of care plans, which details whether the care and support given is being effective or not. 4 7 Where incidents occur between people living at the home there is the need for this to be properly recorded, investigated and the appropriate people informed of the incident, with agreed action taken. Bathing and showering temperatures should be monitored to ensure that they do not exceed 42 degrees centigrate but also that they are not too low. More detailed information needs to be recorded in the event of accidents and there should be an accident analysis in place to show that accidents are being monitored and that appropriate action is taken as a result of the analysis. 5 38 6 38 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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