Care Home: Acorn Lodge

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What the care home does well Acorn Lodge provides a bright environment for the people who live there. People and staff said the home has a calm, relaxed and friendly atmosphere. Three people told us that they are `happy and settled here`. Care plans are developed from assessments with people who use the service. Regular reviews take place. People who use the service are involved in the day-to-day running of the home and make decisions about how they spend their time. Staff said they `help people to feel independent and are always available to offer support`. Staff receive appropriate training and support to carry out their role. What has improved since the last inspection? The service has changed its registration with the CSCI to reflect the people currently using the service. The assessment format has been developed to include information about important relationships, ensuring that all needs are recorded and can be met. Healthcare plans have been developed with people who use the service. A training programme has been put into place with staff completing training in Safeguarding, ensuring that they offer an appropriate service. CARE HOME ADULTS 18-65 Acorn Lodge 361 Ewell Road Surbiton Surrey KT6 7BZ Lead Inspector Emma Dove Unannounced Inspection 19th June and 6th August 2008 12:30 Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acorn Lodge Address 361 Ewell Road Surbiton Surrey KT6 7BZ 0208 296 9633 0208 296 9622 alfredtagoe@btinternet.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Younoos Jeetoo Mr Alfred Nii Okine Tagoe Care Home 10 Category(ies) of Learning disability (10), Mental disorder, registration, with number excluding learning disability or dementia (10) of places Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: Learning disability - Code LD 2. Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 10 1st June 2007 Date of last inspection Brief Description of the Service: Acorn Lodge is a residential care home for up to ten adults who have mental health problems or learning disabilities. Nine people are currently living there. The home is owned by a private individual who has three other homes in neighbouring towns. Accommodation is provided over three floors with a lounge/dining room, kitchen, staff office, laundry room, three single bedrooms and a bathroom on the ground floor. Five single bedrooms, an office and bathroom are on the first floor with one single bedroom on the second floor. The home is located in a residential road on the borders of Surbiton and Tolworth. There are good local bus links to surrounding areas. Shops and local facilities are easily accessible. Information about the CSCI service is included in the Statement of Purpose and Service User Guide. The current fees are £1084 per week. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means people who use this service experience good quality outcomes. This unannounced inspection took place over three and a half hours on the 19th June and two and a half hours on the 6th August 2008. One regulation inspector visited, looked at records, spoke with people who use the service, the manager and staff. Questionnaires were sent to people who use the service, placing social workers, health professionals and staff. We have received two completed questionnaires. The manager completed an Annual Quality Assurance Assessment (AQAA), which provided good information which has been included in this report. What the service does well: What has improved since the last inspection? The service has changed its registration with the CSCI to reflect the people currently using the service. The assessment format has been developed to include information about important relationships, ensuring that all needs are recorded and can be met. Healthcare plans have been developed with people who use the service. A training programme has been put into place with staff completing training in Safeguarding, ensuring that they offer an appropriate service. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home understands the importance of having sufficient information when choosing a care home. Admissions are not made until a full needs assessment has been completed. EVIDENCE: The Statement of Purpose and Service Users Guide give people information about the aims of the service, staffing, activities, individual’s rights, fire and health and safety policies and how to make a complaint. These documents should be updated to include the changes in inspection frequency and the change in contact details for the CSCI. People who use the service said they had chosen to move in and had enough information to help them decide. The manager said that he had been to complete as assessment of the person who moved in most recently. We saw a detailed assessment of needs and preferences in the person’s case file. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The service involves people in planning their care. Staff understand the importance of people being supported to take control of their lives. People are encouraged and supported to make their own decisions and choices. Risk assessments are in place. EVIDENCE: We saw detailed care plans developed with people who use the service from the assessment of need. We saw annual reviews of the care and support provided. The manager told us that they still experience difficulties getting social workers to attend care reviews. We saw case files contain a lot of information and consideration could be given to archiving old information to make it easier to access current care plans, reviews and risk assessments. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 10 The manager and staff told us that people make decisions about their lives with support from staff, the manager and owner. People who use the service confirmed that they make decisions about what they do and are involved in reviews. We also saw people make decisions about how they decorate their rooms and spend their time during the day. The service demonstrates a balance between people taking risks and living full meaning full lives. Risk assessments are in place and kept under review. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The service has a commitment to enabling people to develop or maintain their skills including social, emotional, communication and independent living skills. People are involved in daytime activities of their choice. People who use the service have the opportunity to develop and maintain important personal and family relationships. People are encouraged to be involved in the day-to-day running of the home and are expected to do help with domestic chores, particularly their rooms, meal planning and cooking. EVIDENCE: We saw people involved in community activities, going out to clubs, cafes, shopping, to see friends and working in the local area. People told us that they do what they want during the day. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 12 We saw case files contain details of people’s religion and any support or assistance they may require to attend services or celebrate festivals. The manager said that they will need to look at different employment and leisure activities to ensure people’s needs are met in the future. We saw that staff have discussed the annual holiday with people who use the service and have planned where they want to go. One person said ‘I enjoy going on holiday’. We saw that people are supported to maintain important relationships. Two people told us that they keep in regular contact with their families. Staff told us that people who use the service are involved in domestic tasks around the house and are responsible for cleaning their bedrooms. We saw one person supported by staff to clean their room. People felt that the division of household chores was ‘fair’. We saw in the house meeting minutes that this is an area which is discussed regularly. We saw a varied menu, which takes into account people’s food preferences and caters for any medical or religious dietary needs. We saw people offered a choice or meals. People told us that they enjoyed lunch and that they generally like the food. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who use the service receive appropriate personal and healthcare support. People have access to community healthcare facilities. Medication is well managed. EVIDENCE: We saw case files contain details of peoples health needs. Clear records are kept of health appointments and any actions to be taken. The manager said health passports have been developed with each person who uses the service, which, will help improve their care if they go to hospital. We saw details of health appointments and any actions for staff. People told us that staff are available to attend health appointments if required. One person confirmed that they deal with their own health appointments and said staff can be available if they need support. One person told us that staff help them to book health appointments and are available to attend appointments. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 14 Appropriate medication policies and procedures are in place. We saw medication appropriately stored with records of medications received and administered up to date, correct and signed by staff. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. Appropriate policies are in place for safeguarding and staff complete training on a regular basis. EVIDENCE: The manager said the complaints procedure is available to all people who use the service and their representatives. The procedure is in written and pictorial format to ensure it is accessible to all people who use the service. We saw the procedure in the Statement of Purpose and Service Users Guide and displayed in the home. Three people said they had no issues or concerns. One person told us that they have raised concerns in the past and felt ‘listened to’ and said the ‘issues were addressed to their satisfaction’. The manager said they have developed a new system for recording complaints, which includes noting the actions taken and outcome. This is a good improvement and allows the owner to track complaints and see clearly if the complainant is satisfied. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 16 The manager told us that all staff have received training in Safeguarding. Two staff confirmed that they have completed this training. Staff training records showed that staff completed training in Safeguarding in May 2008. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28 and 30 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to meet the needs of the people who live there. Bedrooms are single and people are encouraged to personalise their rooms. The home is well lit, clean and tidy. EVIDENCE: Accommodation is provided over three floors with a lounge/dining room, kitchen, staff office, laundry room, three single bedrooms and a bathroom on the ground floor. Five single bedrooms, an office and bathroom are on the first floor with one single bedroom on the second floor. We saw bedrooms have been personalised to individuals taste and choice. The manager told us that people have chosen the colours their rooms are painted. One person said they had asked for their room to be redecorated and that this had been completed to their choice. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 18 The manager said they plan to continue with the redecoration schedule and keep reporting repairs and ensuring any issues are dealt with quickly. This will be better in the future due to the appointment of a maintenance person within the organisation. All areas of the home were clean and generally well maintained. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People have confidence in the staff who care for them. There are enough staff to meet the needs of the people currently living there. Staff recruitment is in line with regulations and protects people who use the service from harm. Staff have access to appropriate training and support to ensure they carry out their job and meet the needs of people who use the service. EVIDENCE: The manager said there is a stable and consistent staff team with a balance of male and female staff and staff from a variety of different backgrounds. We saw some positive, supporting and respectful interactions between staff and people who use the service. People who use the service made positive comments about the staff and the care and support that they receive. We saw two members of staff on duty during the day with the manager available in addition on weekdays. One member of staff is asleep but on call at the home from 8pm in the evening. People who use the service confirmed that Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 20 staff are available after 8pm should they need them and that staff levels do not prevent them from going out in the evening. Staff files are kept at the office with a checklist of checks completed on all current staff available at the home. The checklists confirmed that application forms have been received, references taken up and Criminal Records Bureau (CRB) checks have been completed. Two staff told us that the organisation took up references and did a CRB check before they started work. The manager told us that a staff training programme had been developed since the last inspection, ensuring easy access to which refresher training individual staff members require. This training programme is being worked through with staff completing training on Safeguarding, food hygiene and working with people with mental health issues. Staff said that their induction covered the information they needed to know ‘very well’ and ‘partly’. The manager said they could improve the level of staff supervision to ensure all staff receive regular supervision. Staff told us that they receive supervision and support to do their job. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The manager has a clear understanding of the principles and focus of the service and is working to improve the services provided. The AQAA contains clear relevant information and lets us know about changes since the last inspection. The home works to a clear health and safety policy with checks and records up to date. EVIDENCE: The manager has been at the home for over two years and previously worked in another of owner’s homes. He is aware of the aims of the home and showed a commitment to continue improving the services provided to people and developing staff to provide better support and assistance. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 22 The manager told us that they hold monthly ‘residents’ meetings when people have the opportunity to comment about the services provided, discuss any issues, plan any events or activities. People who use the service confirmed that they attend regular ‘residents’ meetings and have the opportunity to plan events and activities for the future. The manager told us that he sends out a questionnaire to people who use the service and their representatives every year to check on how people are feeling about the services provided and to give them the opportunity to make suggestions to improve the service. We saw the manager’s response from the most recent questionnaires which include some actions being taken and some actions to be completed in the near future to improve the service for the people who live there. The manager said that this response is used to feedback to people who use the service. The manager said they have monthly staff meetings, although records indicate that there was a six month gap between September 2007 and March 2008. This is an area they need to improve to ensure that staff have up to date information and have the opportunity to raise issues and the team has the opportunity to act on issues raised at residents meetings. The manager told us a representative from the organisation visits the home every month to check on the quality of the services provided. We only saw two reports from visits made in January and March 2008. Appropriate systems are in place to monitor health and safety. Records showed the gas safety, portable electrical appliances and the fire alarm were tested at the appropriate intervals. The records for the portable electrical appliance test should include when an item is disposed of following the electricians advice. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA39 Regulation 26 Requirement A visit must be carried out every month with a report written and available at the home, to comply with Regulations. Timescale for action 05/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA1 YA12 YA42 Good Practice Recommendations The Statement of Purpose and Service Users Guide should be updated to include the new contact details for the CSCI to ensure people have access to correct information. Consideration should be given to exploring employment opportunities for people who use the service, to ensure that their needs are fully met. Records should include when equipment has been replaced following the portable electrical appliance test, showing that equipment at the home is safe to be used. Acorn Lodge DS0000013386.V364768.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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