Care Home: Acorn Lodge

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What the care home does well People are assessed prior to admission. Care needs are assessed, kept under review and met. There is an excellent activities programme in the home. There is effective communication to residents, relatives and friends. People confirmed that they have a choice of good food. There are good training opportunities in the home. People are addressed by their preferred name and staff treat all people with kindness and respect. Management system are in place to ensure the efficient running of the home in the best interests of the people who live there What has improved since the last inspection? Activities have been improved and one sitting room is now a sensory room. The home has been extended to provide a sitting room overlooking the garden. A new bathroom has been installed with assisted bath. Staff training has been extended to meet the needs of the people who use the service. What the care home could do better: Prescribed medicines need to be given to people from their own labelled containers. The replacement of some worn beds and the refurbishment of the laundry is in the homes development plan and will be completed in the next few months. Key inspection report Care homes for older people Name: Address: Acorn Lodge Turners Hill Road East Grinstead West Sussex RH19 4LX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sheila Gawley     Date: 1 3 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Acorn Lodge Turners Hill Road East Grinstead West Sussex RH19 4LX 01342323207 01342313742 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Acorn Health Care Limited care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 40 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Dementia (DE) and Mental Disorder (MD) Date of last inspection Brief description of the care home Acorn Lodge is a care home providing personal care and nursing for forty residents in the category of elderly dementia care DE(E). The registered provider is Acorn Healthcare Ltd. The Responsible Individual is Mr V Ghugroo and the Registered Manager is Mrs Mary Wattam. The home is a large detached property located just outside the town of East Grinstead, West Sussex. The accommodation is provided in Care Homes for Older People Page 4 of 24 Over 65 0 0 40 40 40 0 Brief description of the care home twenty four single rooms and eight double rooms, arranged over three floors. A vertical lift provides access to all floors. Communal facilities include four lounges and a dining area located on the ground floor. There are extensive grounds with private car parking to the rear of the property. The fees charged are £640 to £720. Care Homes for Older People Page 5 of 24 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This site visit as part of the inspection process was carried out on 13/10/09. It was undertaken by a lead inspector from the Care Quality Commission and was facilitated by the registered manager and the responsible individual. Prior to the visit all files held by the commission, complaints and safeguarding issues were reviewed. The home had sent us their Annual Quality Assurance Assessment for the inspection, which gave us the information we needed on the home and any documents required on the day were made available. We were in receipt of seven surveys from people who use the service, two from staff and three from professionals. All expressed satisfaction with all aspects of the home. People who use the service and staff were spoken with on the day and surveys Care Homes for Older People Page 6 of 24 undertaken by the home were available. People who use the service spoken with stated that they are happy in the home and that they enjoy the lifestyle and the food. There is a varied activities programme in the home and all of the surveys received expressed satisfaction with the activities on offer. Staff spoken with on the day stated that they were happy working in the home that the management was very supportive, and that there were many training opportunities. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to make an informed decision and needs are assessed prior to admission. Standard six is not applicable. Evidence: People who use the service are fully assessed prior to admission to the home. All medical, nursing and personal care need is assessed and recorded. This includes physical and mental health needs, continence, mobility, and communication. Social need is recorded. Four people who use the service were case tracked and their pre admission assessment was present in the care plans. The AQAA stated that they continue to meet this standard on pre admission assessment and that there is a policy in place for emergency admissions. People and/or their representative are encouraged to visit the Care Homes for Older People Page 10 of 24 Evidence: home prior to admission. An up to date statement of purpose and service user guide is available. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care needs are assessed, recorded and met. Evidence: Four people who use the service were case tracked and their documentation was inspected. All had a plan of care to meet assessed needs. Assessed need covered wound care, body map and all daily personal and nursing care. Mental health needs are met with the support of the local mental health team. A professional survey received commented They provide an excellent caring and supportive environment for people with challenging needs. A relative commented They are very alert to an individuals changing needs. There are daily records and monthly review. Surveys received from people who use the service and comments from their relatives all expressed satisfaction with the home. Some comments were They understand each individuals needs, They notify me about any problems, Very lucky Mum is at Acorn Lodge. Risk assessment is recorded such as risk of pressure wounds and the use of slings and Care Homes for Older People Page 12 of 24 Evidence: hoists. There is suitable pressure relieving equipment in place and it was being used correctly. The AQAA stated Staff treat residents with dignity and respect- especially when personal care is carried out. Screens are provided in shared rooms and staff are taught to knock on doors before entering. Some staff have attended training on care of the dying and bereavement and all staff are educated to support the families of the dying. Spiritual needs are attended to and any wishes are carried out. Open visiting, privacy and hospitality are provided for families to visit a dying loved one. Policies and procedures for dealing with death are in place. Throughout the visit staff were observed interacting with people who use the service in a respectful manner. Medicines are received, recorded and correctly stored in the home. Topical creams and dressings are not currently signed for and the registered manager agreed to put this in place. Not all people are being given their liquid medicines from their own prescribed bottle as staff use one persons bottle for convenience and the need for this to be done was discussed with the registered managerwho agreed to action this immediately. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained and motivated to interact with the people who live in the home and the lifestyle in the home meets their needs. Evidence: There is an activities programme in place,which has been developed and improved at the request of relatives. One sitting room has lights to provide senssory stimulation for people who use the service. There are bingo, games,crafts,music, reading and puzzles. There are seasonal events such as a summer garden party and Christmas party. There is an external music entertained once a month. People who use the service are involved in making cards and invitations to events. There are pleasant well maintained gardens for people to sit or walk in. Four staff are trained in aromatherapy and hand massage. In December two staff are to attend an activities management training day. During the visit people enjoyed bingo with staff assistance where required. The cook, who has worked in the home for seven years was spoken to. She has a four week menu in place and is aware of peoples likes and dislikes. An alternative is offered to people if they do not like the meal on offer. The cook is completing the National Vocational Qualification (NVQ) Level 2 in catering and has an annual food Care Homes for Older People Page 14 of 24 Evidence: hygiene update. The kitchen meets the requirements of the most recent environmental health inspection and food temperatures are measured daily. Peoples birthdays are noted and a birthday cake is baked to celebrate. The lunch of roast lamb was enjoyed by people during the visit and those requiring assistance were offered this in a discrete manner. Five of the seven surveys received responded always to the question Do you like the meals in the Home, the other two replied usually People who use the service are supported to maintain links with family and friends and visiting times in the home are open. Relatives comments on surveys showed that the home keeps them well informed about matters to do with their relative or the home and that they are given the type of food they require, for example, a pureed diet for a peoson with swallowing difficulties. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are listened to and are protected from abuse. Evidence: There is a complaints procedure in place and surveys received indicate that people know how to make a complaint. one relative spoken to on the day stated that she would know how to make a complaint but has not had the need to. There is a complaints book in the foyer but the procedure was not on display. This was discussed with the registered manager who agreed to put this in place. Safeguarding adults training is in place for staff and training records were seen. Staff spoken to demonstrated and awareness of safeguarding adults procedures. One survey commented staff are pleasant, courteous and polite. Advocacy numbers were on display in the foyer. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and well maintained environment. Evidence: The home on this occasion was neat, clean and free from offensive odours. There are comfortable and well maintained communal areas with three sitting rooms and a dining room. The furniture and fittings are homely in style. People are accommodated in seventeen single and eight shared rooms. Screens are available in all shared rooms. Bedrooms are personalised as people choose. Nursing bed are available for those people assessed as needing them. Some of the older style divan beds were worn and in need of replacement. The responsible individual agreed that this would be dealt with in the ongoing refurbishment plan of the home and that he would immediately place an order for these. There are suitable toilet and bathing facilities in the home and one bathroom has been refurbished. The laundry is sited outside of the home and is also due for refurbishment. There is a passenger lift, hoists and grab rails are in place. The home meets the requirements of the recent fire authority inspection. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Needs are met by a suitably qualified and trained staff. Evidence: There were suitable numbers of staff on duty to meet the needs of people who use the service. There is always a registered nurse on duty. There is kitchen, housekeeping and maintenance support. The home does not use agency staff and can cover periods of leave with their existing staff who may work extra shifts. There is a keyworker system in place. Staff files inspected had evidence of identity, Criminal Records Bureau clearance and POVA first. Nursing and Midwifery Council (NMC) Personal Identification Number was on file for registered nurses. Surveys received and people who use the service spoken with all stated that the staff are kind and caring. A professional survey received commented The home provides an excellent, caring and supportive environment for people with challenging needs. There is a training programme in place and evidence of staff training was seen. Induction is in place. As well as mandatory training additional training on challenging behaviour, pressure care, active living, supervision, bereavemment and therapeutic massage. Seven of the fourteen carers have attained the National Vocational Care Homes for Older People Page 18 of 24 Evidence: Qualification in Care level 2. Staff spoken with on the day expressed satisfaction with the support, training and management in the home. A survey received from a staff member commented The employer and manager are approachable and friendly to the staff. Another commented All the staff are well supported by the management in terms of training and development. Staff observed interacting with people who use the service demonstrated a committment to promoting dignity, they spoke kindly and quietly to people and were proactive in offering drinks. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed and is run in the best interests of the people who live there. Evidence: The registered manager is a registered nurse and holds the registered managers award, She has many years experience of working with people with mental health needs. There is a clear sense of leadership in the home and staff state they feel well supported. The registered manager is accessible to staff and has an open door policy. All surveys received were very positive on the management of the home. One professional survey received commented The spirit in the home is amazing considering the fairly advanced needs of the people . I have nothing but the very highest respect for the matron and staff for their care of people Another commented excellent manager and caring Staff A relative commented The home is first class The homes certificate of registration and insurance details were on display in the foyer. The responsible individual spends two days a week in the home and both the Care Homes for Older People Page 20 of 24 Evidence: responsible individual and the registered manager demonstrated a clear commitment to running the home in the best interests of the people living there. A new sitting room overlooking the garden has been added to the home and one sitting room has been developed into a sensory room with stimulating lighting and aromatherapy. There is a commitment to staff training and all staff receive mandatory training , induction and many other courses relevant to the care needs of the people who use the service. The registered manager undertook to ensure all staff are aware of the requirement for medicines to be administered from peoples own labeled bottles. Quality assurance measures are in place. People who use the service and relatives are surveyed annually and the results are collated. A relative spoken with stated the the home is communicative and always respond to requests. There are staff meetings and staff have had a team building meeting outside the home in a social setting with a meal provided. The AQAA states that there is a development plan for the home and the directors and registered manager manage and improve the home within budget. Our annual Quality Monitoring Survey results are favourable on our part and it is very evident that residents families praise the quality of care, ease of access to the Manager, cleanliness of the Home, the hospitality and feel part of our family. Money for people who use the service is held separately and securely and is receipted and recorded. There are robust recruitment procedures in place and staff files inspected contained all the documentation required. Criminal records bureau clearance and a check against the protection of vulnerable adults were in place as were identity documents and two references. Staff supervision is in place and records were seen. Supervision training has been cascaded to registered nurses so they can be involved in the supervision of carers. The health and safety of people who use the service is protected by the provision of policies and procedures, training and a maintenance programme. The home meets the requirements of the local fire and environmental health authorities. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 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 Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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