Care Home: Acorn Lodge

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Acorn Lodge 12 Grand Avenue Southbourne Bournemouth Dorset BH6 3SY     The quality rating for this care home is:   three star excellent service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Heidi Banks     Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Acorn Lodge 12 Grand Avenue Southbourne Bournemouth Dorset BH6 3SY 01202426085 01202426085 acornlodge.ltd@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Acorn Lodge (Bournemouth) Ltd Name of registered manager (if applicable) Mrs Angela Kay Druce Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Acorn Lodge is registered to provide residential care for up to nine adults with learning disabilities. The property is a large family style home located close to the centre and the beaches of Southbourne. People who use the service are accommodated on the ground, first and second floors of the home. All bedrooms are single and two have the benefit of en-suite facilities. There are shared bathrooms on each floor. The communal areas are on the ground floor and consist of a lounge, dining room and a kitchen. The garden is accessible from the dining room. Acorn Lodge is staffed twenty-four hours a day with two waking night staff. The proprietor works in the home on a full-time basis as the Registered Manager. From information provided to us by the home in February 2009 fees charged by the service range from 650-750 pounds per week depending on individuals assessed 9 Over 65 0 care home 9 Care Homes for Adults (18-65 years) Page 4 of 32 Brief description of the care home needs. Further general information on care homes fees and fair terms of contracts can be obtained from the website of the Office of Fair Trading; www.oft.gov.uk. Care Homes for Adults (18-65 years) Page 5 of 32 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: three star excellent 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 of the service. The inspection took place over approximately eight hours on 9th February 2009. The aim of the inspection was to evaluate the home against the key National Minimum Standards for adults since the last key inspection in February 2007 and annual service review that took place in 2008. At the time of this inspection there were nine people living in the home aged between twenty-three and fifty-seven. The inspection was carried out by one inspector but throughout the report the term we is used to show that the report is the view of the Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 6 of 32 During the inspection we were able to meet all the people who use the service. Discussion took place with the Registered Manager of the home, Mrs Angela Druce, and some care workers on duty. A sample of records was examined including some policies and procedures, medication administration records, health and safety records, staff recruitment and training records and information about people who live in the home. Surveys were sent to the home prior to the inspection for distribution among people who live in the home and those who have contact with the service. We received a total of eighteen completed surveys from these sources, information from which is reflected throughout this report. We received the homes Annual Quality Assurance Assessment before the inspection which gave us some written information and numerical data about the service. A total of twenty-two standards were assessed at this inspection. What the care home does well: The needs of people who use the service are assessed before they come to live in the home and a care plan is drawn up to give information to staff about how their needs are to be met in various aspects of daily life. People are supported to make decisions and choices on a daily basis and there was evidence of an individualised approach towards peoples care. People receive good levels of personal care and their health care needs are met with the home seeking advice from health professionals as appropriate. There are robust procedures in place with regards to medication which ensure that people who live in the home receive the medication they require. There are procedures in place to respond to concerns and complaints and thus protect people from harm. People told us that they knew who they would speak to if they were unhappy about the care provided and were confident that the home would respond effectively to this. People who live in the home told us that they were happy living there and facilities were seen to meet their needs. The home is clean and well-maintained providing a safe environment for people to live in. Sound recruitment procedures are in place to ensure that people who come to work in the home only do so after appropriate checks have been completed. This helps to keep people who live in the home safe. Care workers also receive suitable induction training when they commence in post and receive ongoing training both in-house and from external sources to ensure they are able to understand and meet peoples needs. Care workers commented positively on the training and support they receive from the manager of the home and told us that they enjoy working at Acorn Lodge. The home has benefited from consistent management since it was first registered in 2004. The manager is experienced and well-qualified in her role and ensures she is upto-date with current developments in care and good practice issues. The welfare of people who use the service is seen as a priority with appropriate checks being carried out and staff trained in areas of health and safety relevant to peoples needs. In undertaking this inspection we received many positive comments about the service from people who use the service, their relatives, care workers and care professionals who have contact with them. It was clear that people have confidence in the management of the home and are very satisfied with the care provided. Comments we received included; I am very happy living here (service user); Acorn Lodge is a lovely home. We all care for the clients to the best of our abilities with a professional manner. As a member of staff it is also a lovely establishment to work for (care worker); Everything is absolutely fine there (relative); Care Homes for Adults (18-65 years) Page 8 of 32 Excellent...you couldnt wish for anything better...X would not be there if I did not think it was any good (relative); Acorn Lodge is a good service and I know my service users needs are well-catered for (care manager). 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 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 32 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. The service ensures that peoples needs are assessed before they move in and that they liaise with relevant people about the move to promote smooth transitions. Evidence: Mrs Druce told us that one person has moved into the home in the past twelve months. We looked at documentation on their file which showed evidence of an assessment having been undertaken by the local authority before the move and a review taking place after six weeks of the person coming to live at the home. We noted that the assessment from the local authority was dated February 2007 which was more than a year before the service user moved into the home. We suggest that the home ensures that a more up-to-date assessment is obtained from the local authority when people are admitted in the future. The home had also completed their own assessment, evidence of which was on file. This took account of the individuals capabilities in various areas. There was also evidence of a transition meeting taking place two weeks before the person moved in and evidence that they had been given the opportunity to make visits to the home beforehand. We noted that for the last Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: person to be admitted to the home an Independent Mental Capacity Advocate had been involved in the process which is good practice. All care managers responding to the survey indicated that the care services assessment arrangements ensured that accurate information is gathered and that the right service is planned and given to individuals. One care manager told us; Angela (the manager) came to the transition planning meetings for my service user to gather additional information from his circle of support prior to his move and to agree a plan about what needed to be in place to make the move as smooth as possible. This was in addition to completing her own pre-admission assessment. I found that Angela took on board everybodys views and actioned all the points that had been raised. All service users who responded to our survey told us that they were asked if they wanted to move into Acorn Lodge and received enough information before they moved in so they could decide if it was the right place for them. One person told us I spent three days prior to...moving in at Acorn Lodge and enjoyed it. Care Homes for Adults (18-65 years) Page 12 of 32 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. People who use the service have care plans that reflect their needs and wishes and this is translated into practice by the staff who support them. People are supported to make decisions and choices in their everyday lives. Evidence: We looked at the care plan for the person who was recently admitted to the home. This gave clear information to the reader on the individuals capability in various areas of their daily living, for example, where they could be independent and where they needed support. As the service user concerned did not communciate verbally it was evident in their care plan that the means by which they would make their needs known had also been documented. For example, X will place a mat on the table when he wants a drink and is able to point to a type of drink when shown several different options; I can choose from items shown to me. I will lead staff by the arm / wrist to take them and show them what I need and want. Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: All the care workers who completed surveys told us that they were always given up-todate information about the needs of the people they support or care for. One added that they are always given feedback after meetings and reviews have taken place. The majority of people who use the service who completed surveys told us that they always made decisions about what they did each day. One told us we get treated as individuals and my wishes are respected while another commented I am asked by the staff what I would like to do. This was echoed by both relatives we spoke with during the inspection who were pleased with the person-centred approach towards their family members needs. Health and social care also professionals told us that in their experience the home always responds to the different needs of the people who live there; The service user is consulted in what they would like to do, eat, time they go to bed etc. and are able to plan things with staff which they may like to do (care manager); Individually-based support given to guide to appropriate choice (health care professional); Staff very much see each person as an individual and have shown sensitivity and respect for X...they have recognised his needs (care manager); The home have taken on board my service users likes and dislikes as outlined in his individual service design (care manager). We talked to some people who use the service about their experience of living in the home during the inspection. All the people we spoke with told us that they could make choices on a daily basis about what time they wished to go to bed or the meals they ate. We looked at some minutes from a residents meeting which indicated that peoples views are sought about activities, holidays, meal choices and improvements to the home. We suggest that the home looks to ensure information such as minutes of residents meetings are available in an easy-read format so that people can access them should they wish to. The care plan we looked at indicated areas where there were potential risks to the person concerned, for example, in emergency situations, eating and drinking, mobilising and accessing the community. In general the information in the plan gave sufficient information to the reader about actions to be taken by staff to minimise risks to peoples welfare although we have suggested that general statements such as I need support from staff as I may trip and fall are expanded to contain more detail about the level of support that is needed in different environments. We also noted that Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: there were two full risk assessments on file that had been completed by the individuals previous placement. Although these were dated within the year and the individuals needs are not known to have changed it is suggested that the home revisits the assessments to check they are still relevant to the service user in their new home environment. Comments received from care workers in surveys indicated their understanding of the need to be flexible in meeting peoples changing needs; All members of the staff team continually monitor and make adjustments as and when required to meet identified needs Staff support the clients in being independent but keeping safe If there were any recommendations from professionals, family or friends then we would incorporate it into the clients care plan. Care Homes for Adults (18-65 years) Page 15 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home lead an ordinary lifestyle in their home and community that takes account of their individual needs and preferences. Evidence: All five people who use the service told us in surveys that they could do what they wanted to do during the day, in the evenings and at weekends. This was echoed by care professionals, the majority of whom indicated that the care service always supports individuals to live the life they choose wherever possible. Comments we received both from people who use the service and those who have contact with them included; Go out at weekends with a member of staff to Christchurch or Boscombe. Also coach trips...go on very nice holidays (service user); Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: Full range of social activities and interests within the home (care manager); X would like a snooker table but enjoys everything else the home has to offer. X seems to be involved in lots of activities and seems to benefit from being here (relative); Encourages people to get out into the community (care manager); The care service provides...good assistance in order for them to access activities within the community (care manager). We spoke to the relatives of two people who use the service during the inspection who also told us that in their view their relative had enough to do to occupy their time both during the week and at weekends. Both relatives made particular mention of the different experiences their family member had enjoyed since moving to the home; a cruise is planned for later this year and in previous years X went ski-ing and to Mexico where they swam with dolphins. Another relative told us that they thought their family member had enough opportunities to go out on a daily basis; X likes going to the local shops and bakery. They also take him for a carvery lunch. This was echoed by a care manager who had observed that the service was flexible enough to respond to their service users requests to go out for a walk when he asks for this. We talked to the manager about arrangements in place to provide people with daily activities. It was clear from our discussion that people have different arrangements in place which take account of their individual needs and preferences. Three people were reported to attend local day services on a regular basis while two others attended adult education opportunities. The manager told us that the remaining people had elected to engage in home-based activities. One person is able to access their community independently and observation indicated that this is promoted by the home. The relatives we had contact with told us that there was good communication between them and the home; We know whats going on - they are very family-oriented; They keep me updated. They also helped X to make items for Christmas and birthdays; There is good communication between the staff and parents of the clients. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Three social care professionals responding to surveys also indicated that contact and communication with families was something that the home did well. Feedback from care workers in surveys indicated that they are aware of peoples rights to choice and independence. We observed that people have access to their bedrooms as they wish and that these are personalised with their own items to meet their preferences. During the inspection people were observed to be relaxed and settled in the home enjoying various activities of their choice. The homes Annual Quality Assurance Assessment tells us that people who use the service are all encouraged and supported to be involved in the daily routines of their home taking some responsibility for their own bedroom, their laundry and shopping. We noted that there is a key-pad in place on the kitchen door which Mrs Druce has told us was implemented on the advice of an officer from Environmental Health. She told us that one person who uses the service can access the kitchen independently and is enabled to do so. Others were reported to participate in food preparation in the homes dining area. We suggest that the home continues to keep the installation of a keypad under review to ensure that individuals are not unnecessarily restricted. The people who use the service who we spoke with at the inspection told us that they enjoyed the meals provided by the home and were able to make choices about what they ate. Individuals choices were reflected in the records kept of meals eaten. The kitchen cupboards and freezer showed a good variety of foods on offer to people. The manager has told us in the homes Annual Quality Assurance Assessment that they have liaised with a dietitian to ensure that the diet being offered to people is suitable to meet their needs. One person we met told us they enjoyed eating out and it was evident from their discussion with staff that they were given opportunities to do this. Care Homes for Adults (18-65 years) Page 18 of 32 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 who use the service benefit from care which meets their personal and health care needs, intervention from appropriate health care professionals as required and safe medication practices. Evidence: The care plan we looked at for a person who uses the service offered clear guidance to care workers on the level of support they needed in relation to their health and personal care. This included the level of support needed for them to clean their teeth successfully, guidance on supporting them when they were anxious or upset and the input needed for them to be able to eat independently and safely. All five people who use the service told us in surveys that staff treated them well. The relatives we had contact with during the inspection process expressed satisfaction with the personal support received by their family member; Staff are really great...there is good personal care...Im really fussy but I couldnt do any better myself. Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: This was echoed by health and social care professionals who indicated that their clients personal and health care needs were met effectively by the home with respect for their privacy and dignity; If ever the service user needed to see any health care professional, appointments are always arranged. Staff fully consult with doctors etc when necessary; Service user is treated with respect and privacy; They see the positives and strengths that service users have and build on these; The care service provides good care and support for the service user...maintain good level of open and honest communication; They are very thorough with their recording and monitoring of the service users needs...support people who have complex needs...provide a consistent environment; Incidents of challenging behaviour have decreased since X moved to the home which would indicate that he is happier and less frustrated and is receiving the support he needs...I have always been made to feel welcome to visit the home at any time. Records we looked at showed that frameworks are in place to document appointments attended by people in relation to their health care and it was evident from discussion with the manager that relevant professionals were involved in meeting peoples needs. We observed that medication is stored securely in a metal cabinet which is fixed to the wall of the office area of the home. Prescribed creams were also seen to be stored securely. The manager told us that medication is currently supplied to the home by a local pharmacy. Medication administration records were seen to be in place for each person who uses the service. We looked at the records for two people, both of which had been fully completed. Where handwritten instructions had been added to the record by the home these had been double-signed. At the time of the inspection all the people using the service required support with their medication. The care plan we looked at gave guidance to staff on how they should administer medication to the person concerned. Mrs Druce told us that one person who uses the service had previously been independent in this area but following a recent review the service user themselves had acknowledged that they needed increased support which was now in place for them. We undertook an audit on one persons boxed medication and compared it with their medication administration record. The expected amount of medication was found to be in the box which suggests that it has been given as Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: prescribed. Mrs Druce told us that only staff who have been trained and assessed as competent with administering medication were permitted to undertake this task. She reported that seven people working at the home have been assessed as competent. Inspection of two care workers training records showed that both had accessed training in medication administration. We discussed with the deputy manager systems in place for assessing peoples competence and have suggested that the home looks at identifying suitable training for people who are designated as assessors. One person who uses the service was reported to have an Epipen prescribed for them for use in the event of them experiencing a severe allergic reaction. Mrs Druce told us that administration of the Epipen had not been required by the individual since they moved to the home some years ago. Although documentation in relation to staff training in use of the Epipen was not available on the day of the inspection Mrs Druce provided us with copies of this shortly after our visit. Care workers we spoke with at the inspection confirmed they had received instruction in use of the Epipen and this was updated on a regular basis. Care Homes for Adults (18-65 years) Page 21 of 32 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 live in the home and those who have contact with them know how to raise concerns should they need to and are protected by the homes procedures. Evidence: Mrs Druce told us in the homes Annual Quality Assurance Assessment that the home has a complaints procedure that is on display in the home and is given to people who use the service and their relatives on admission. Mrs Druce told us at the inspection that there have not been any complaints or safeguarding issues arising at the home in the past twelve months. The Commission has not received any complaints about the home. Mrs Druce was aware of the fact that, in the event of the service receiving a complaint, a record would need to be made detailing the nature of the complaint and the outcome. Out of the five surveys we received from people who use the service all said that carers listened to them and acted on what they said. All five also indicated that they knew who to speak to if they were unhappy. We spoke to two relatives of people who use the service, both of whom indicated that they had not needed to raise any concerns about the home. One relative told us; If I had a complaint I would get straight onto Angela. I have never had to complain. There Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: is good communication. The other person told us that they knew how to make a complaint if they needed to but theres nothing to complain about. All of the health and social care professionals who completed surveys told us that the care service always responded appropriately if they, or the person using the service have raised concerns about their care. Positive comments were received about the communication received from the home in relation to any concerns about people who use the service. All six care workers who responded to our survey told us that they knew what to so if a person using the service or their relative had concerns about the home, the Annual Quality Assurance Assessment also indicating that this forms part of staff training in the home. The home has told us in their Annual Quality Assurance Assessment that staff training on the recognition, recording and reporting of abuse forms part of the homes induction programme. We were told that training is undertaken through use of videos which are accompanied by questionnaires and workbooks to check peoples understanding. We looked at the training records for four care workers employed by the home all of which indicated that they had completed this training. We also looked at the training records for Mrs Druce which showed certification for a Train the Trainer course in adult protection awareness. There have been no safeguarding referrals or investigations in relation to the home in the twelve months preceding the inspection. Inspection of a sample of care workers recruitment records showed that robust procedures are in place to ensure that appropriate checks are undertaken on them before they come to work in the home. Care Homes for Adults (18-65 years) Page 23 of 32 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 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 satisfied with their home environment which is clean, well-maintained and meets their needs. Evidence: Bedroom accommodation at Acorn Lodge is provided on three floors. All the people who use the service have their own bedrooms which have been personalised and furnished to their own tastes. Some rooms have en-suite facilities but all have access to toilet and bathroom facilities. Commual facilities include the lounge and dining area on the ground floor with access to a garden at the rear of the home. The home has told us in their Annual Quality Assurance Assessment that they continue to make improvements to the environment and in the past twelve months have purchased new leather lounge suites and laid new flooring in the dining area. People we spoke with during the inspection told us that they were happy with the home environment and their bedrooms. We observed people having free access to their bedrooms and making use of communal facilities to socialise and engage in personal interests during the inspection. The home has told us in their Annual Quality Assurance Assessment that they have a policy in place on infection control. They have also told us that since the last inspection Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: they have introduced the use of paper towels to prevent cross-infection. The home presented as clean at the time of the inspection. All five people who use the service told us in surveys that the home is always fresh and clean, one person adding that it never smells. We looked at training records for four staff, all of which showed that they had undertaken training in infection control practice in the past three years. Care Homes for Adults (18-65 years) Page 25 of 32 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. People who use the service can be confident that care workers employed to support them are recruited safely and trained to a suitable standard to meet their needs. Evidence: We looked at the recruitment records for three care workers. In each case there was appropriate documentation in place to evidence that suitable pre-employment checks had been carried out including a full employment history, written references and proof of identity. For two care workers who were employed from overseas there was evidence of police clearance from their country of origin as well as checks with the Criminal Records Bureau on their arrival in the United Kingdom. We also noted that the home has made efforts to ensure that care workers from overseas are aware of the nature of the work they will be employed to do before they arrive in the United Kingdom. All six care workers responding to our survey indicated that Acorn Lodge had carried out checks and references before they started work. Inspection of a sample of peoples training records indicated that the home has made sure care workers access an appropriate induction programme when they commence employment and that a system is in place to ensure they access update training as necessary. Training records were well-organised in files dedicated to this purpose. All Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: care workers responding to our survey told us that their induction covered everything they needed to know to do the job very well when they started and they were being given training that is relevant to their role, helps them meet the individual needs of service users and that keeps them up-to-date with new ways of working. Mrs Druce submitted data with the homes Annual Quality Assurance Assessment which told us that five out of eleven care workers currently hold a National Vocational Qualification (NVQ) in Care or Health and Social Care and there was evidence on record of others working towards these qualifications. One person commented The management at my establishment is very hot on training and development, for example, NVQs, LDAF (Learning Disability Award Framework), diversity and equality, team leading and mandatory training. The ability of staff to carry out their work effectively was also indicated in surveys from health and social care professionals with all seven indicating that care staff always had the right skills and experience to support individuals needs. Comments received praised staff for their professional and friendly approach. This was echoed by the relatives we were able to speak to during the inspection who told us that the staff they had met were really great and very good with their family members. Care Homes for Adults (18-65 years) Page 27 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a sustained track record of providing a service that is well-run and promotes the safety and welfare of the people who live there. People who have contact with the service speak highly of the way the service is managed and the outcomes achieved for the people who live there. Evidence: Angela Druce has been involved in the running of the home both in an ownership and management capacity since it was first registered with the Commission in October 2004. Mrs Druce is a qualified adult and mental health nurse and has a Level 5 Diploma in Management. Inspection of Mrs Druces training records indicated that she has kept herself up-to-date with developments in health and social care while managing Acorn Lodge. Mrs Druce has told us in the homes Annual Quality Assurance Assessment that this includes establishing links with Skills for Care, Investors in People, City and Guilds and participating in local learning hubs. Feedback in surveys from people who have contact with the service was extremely positive about Mrs Druces ability to run the home and indeed the Commissions last key inspection report Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: in 2007 and annual service review in 2008 indicated good outcomes for people who use the service which they have sustained through to this key inspection. Mrs Druce is supported in her role by a deputy manager and two senior care staff. The home has implemented a quality assurance process by which people who live in the home and those who have contact with them respond to questionnaires about various aspects of service provision. Mrs Druce has based the process on outcome areas in the government White Paper Valuing People. The surveys we looked at indicated positive responses with regards to all aspects of service provision. Mrs Druce told us that she recognises that more work could be done with regards to increasing feedback from care professionals and in obtaining qualitative data about how the service can improve. Mrs Druce will be reviewing the current process in light of this. We looked at a sample of health and safety records maintained within the home. These showed that water temperatures are checked on a regular basis, the last check being carried out in January 2009. We also saw certificates in place to demonstrate that electricity and gas safety in the home had been checked and appropriate fire and health and safety risk assessments were in place. The home has a contingency plan in the event that they need to evacuate to ensure the welfare of people who use the service. We looked at a sample of training records for four staff, all of which showed evidence of relevant training being undertaken in food hygiene, emergency aid, health and safety and moving and handling. Mrs Druce confirmed that first aid and moving and handling training both contain a practical element and that she has received instruction to be able to deliver this training to the staff team. We saw certificates on Mrs Druces file to evidence this. Since the last inspection we have only received notification of one incident in the home reportable under Regulation 37. We discussed this with Mrs Druce who confirmed that this is because there are very few incidents and accidents occurring in the home. However, Mrs Druce is aware of her duty to report such incidents as and when they occur. Care Homes for Adults (18-65 years) Page 29 of 32 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 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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