Care Home: Acorn Residential Home

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What the care home does well People told us `I like living here`, `people are friendly`, `I go out`, `I want to stay here`, `I have all I need in my room` and `I enjoy doing the garden and other household tasks`. Acorn provides a homely environment for the people who live there. Medication is well managed. Good systems are in place for health and safety. What has improved since the last inspection? The manager has developed daily routine sheets for each person, which enables staff to support people to do what they want to. Three new members of staff have been appointed on a full and part time basis. What the care home could do better: Some people who live there do not feel in control of their lives. The manager and staff must make sure that the care is not controlling and that individuals are able to make their own decisions. Records must be factual and descriptive rather than judgemental, to ensure that information is not opinion but what actually happened. Seek advocates, to support people in making decisions for their future.Where attending health appointments causes distress for individuals, this must be clearly recorded and referred on to ensure that people`s health needs are fully met. Staff recruitment must include a full employment history, evidence to show that references are from previous employers and have evidence of checks completed through the POVA first list, especially when new staff start before their CRB check has been received. This will ensure that people who use the service are protected from harm. The manager must ensure that the CSCI are notified of issues and incidents regarding people who use the service, so we have up to date information about the service and can use this to help form our judgements. CARE HOME ADULTS 18-65 Acorn Residential Home 47 Mitcham Park Mitcham Surrey CR4 4EP Lead Inspector Emma Dove Unannounced Inspection 26th September and 2nd October 2008 11:30 Acorn Residential Home DS0000027205.V372209.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 Residential Home DS0000027205.V372209.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 Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acorn Residential Home Address 47 Mitcham Park Mitcham Surrey CR4 4EP 0208 648 6612 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) nithi1@hotmail.co.uk Mr Kanagaratnam Nithiyananthan Mrs Yoheswari Nithiyananthan Mrs Yoheswari Nithiyananthan Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Acorn Residential Home DS0000027205.V372209.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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 8 27th September 2007 Date of last inspection Brief Description of the Service: Acorn Residential Home is a registered care home providing care and accommodation for up to eight adults with a learning disability, seven people are currently living there. The home is owned and managed by two private individuals. The property is a large two-storey house located in a residential area of Mitcham, close to shops and public transport. Accommodation is provided over two floors. All bedrooms are single. A lounge, dining room, kitchen, staff office, three bedrooms and a bathroom are on the ground floor. Five bedrooms, a staff room and bathroom are on the first floor. The fees are from £749, depending on people’s needs and income. Information about costs in addition to the fees is included in contracts and the Statement of Purpose. Information about the CSCI is available at the home. Acorn Residential Home DS0000027205.V372209.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 two star. This means people who use this service experience good quality outcomes. This unannounced inspection took place over two and a half hours on the 26th September and three hours on the 2nd October 2008. One regulation inspector visited on the 26th September. On the 2nd October we were joined by an ‘expert by experience’ and their personal assistant. We looked at records, spoke with people who use the service, the owner, manager and one member of staff. An ‘expert by experience’ is a person, who because of their shared experience of using services and ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live there. The owner/manager completed an Annual Quality Assurance Assessment (AQAA), which provided good information that has been included in this report. What the service does well: What has improved since the last inspection? What they could do better: Some people who live there do not feel in control of their lives. The manager and staff must make sure that the care is not controlling and that individuals are able to make their own decisions. Records must be factual and descriptive rather than judgemental, to ensure that information is not opinion but what actually happened. Seek advocates, to support people in making decisions for their future. Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 6 Where attending health appointments causes distress for individuals, this must be clearly recorded and referred on to ensure that people’s health needs are fully met. Staff recruitment must include a full employment history, evidence to show that references are from previous employers and have evidence of checks completed through the POVA first list, especially when new staff start before their CRB check has been received. This will ensure that people who use the service are protected from harm. The manager must ensure that the CSCI are notified of issues and incidents regarding people who use the service, so we have up to date information about the service and can use this to help form our judgements. 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 Residential Home DS0000027205.V372209.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 Residential Home DS0000027205.V372209.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 and 2 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. Information about the service is available to help people make the decision to move in. Assessments are completed by placing social workers before admission. EVIDENCE: A Statement of Purpose and Service Users Guide are in place. These documents include details of the services provided and what people can expect from the home. They are available in written format. The manager said they are planning to improve the format of the Service Users Guide, to make it more accessible. The manager said there have been no admissions since the last inspection. She said they would like to get more information about individuals before decisions are made about new people moving in. This would ensure that the service has the information they need to meet people’s needs. People who use the service have all lived there for over five years, some since the service first opened thirteen years ago. Acorn Residential Home DS0000027205.V372209.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. Care plans are in place and these are kept under review. Risk assessments are in place and reviewed. EVIDENCE: We saw care plans developed for people who use the service and a separate person centred plan. These documents include people’s likes and dislikes, details of their life and their weekly timetable. Individuals have developed goals, which they are supported to achieve during the year. Care plans are kept under review and annual reviews take place. We saw statements such as ‘single minded’ and ‘exhibits negative behaviours’ with no guidance on how staff should respond and support the person. The language used in care plans must be factual, not judgemental, to ensure people’s needs are known and can be met. Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 10 The manager has completed a ‘daily routine’ sheet for each person which details the time the individual gets up, their household tasks, daily activities and preferred bedtime. This document helps staff support people to live the life they choose. Risk assessments have been completed and are reviewed annually. Acorn Residential Home DS0000027205.V372209.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. People who use the service have the opportunity to take part in a variety of activities in the home and the local community. People have the opportunity to maintain important family relationships. People who live there enjoy the food provided. EVIDENCE: The manager told us that people have an activity schedule in place, which includes individuals attending day centres, although the number of days they attend has reduced due to local policies. She also said people go out shopping, bowling, eat out and have visits from family members. We saw people who use the service return from day centres, go shopping, go out to a group, have visits from family members and assist with household tasks during our visits. Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 12 Staff said that they celebrate people’s Birthdays and have Christmas dinner together. People confirmed that they like the way they celebrate their Birthday. Staff told us that people go to their rooms after dinner as they all have televisions in their room. One person told us they would like to go out to the pub. The only place people can have visitors is the lounge, which may not always be private. One person told us they ‘can’t have friends or family stay over’. This was discussed with the manager who said it has not been an issue previously. People said they can have visitors, although they said they don’t have many from outside. We saw the manager answer questions for some people rather than give individuals the opportunity to reply. This may not help people who use the service feel in control of their lives. We saw people have a packed lunch and a cooked meal in the evening. People made positive comments about the food. One person told us they would ‘make different kinds of food and puddings’. We saw individuals involved in food preparation and clearing away after meals. People were happy being involved in household tasks. Acorn Residential Home DS0000027205.V372209.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’s health needs are noted, although it is not always clear that individual’s health needs are met. Medication is well managed. EVIDENCE: People are registered with a GP and access other health professionals as required. However, we saw records for one person note that the person does not attend health appointments with no clear guidance about how their health needs are to be met. Records must include actions staff should take to support this person attend appointments or get health care treatment. Medication policies, procedures and practice are good. We found medication to be appropriately stored and labelled. Medication Administration Record Sheets were up to date and signed by staff. Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 14 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, which is available for people who use the service and their representatives. People are aware of how to make a complaint. Policies for safeguarding people are in place. EVIDENCE: The complaints procedure is included in the Statement of Purpose and is displayed in the office which can be accessed by everyone who uses the service. People told us that they would speak to the manager, owner or staff if they had any worries or concerns. No concerns were raised during the visits. The manager told us that they have received two complaints, which have been responded to appropriately. Three members of staff are due to complete training in safeguarding in November 2008. Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 15 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, 27, 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. People live in a safe, homely well maintained environment. Bedrooms are single and people are encouraged to personalise their rooms. All areas are kept clean and tidy. EVIDENCE: We saw people access the kitchen, dining room and lounge on the ground floor. Bedrooms are single. A bathroom with toilet is available on the ground and first floor. We did not see any showers, only baths. People who use the service did not raise this as an issue. There is a small step at the bottom of the stairs and the entrance to the kitchen which could be a trip hazard to people who use the service. Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 16 People who use the service confirmed that they have everything they need in their rooms. One person told us they were glad they have a lock on their door, to prevent others going into their room. Two people told us that staff chose the colours their rooms are decorated, although they ‘like it’. All areas of the home were clean and tidy. Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 17 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 and 35 People who use this service receive adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People are happy with the care they receive. Staffing levels are sufficient to meet people’s needs. The recruitment process needs improving to ensure appropriate checks are made before new staff start work. Staff have access to training. EVIDENCE: Acorn is a small family run home with five members of staff employed on a full or part time basis to help the owners and their son provide care and support. Two members of staff are on duty during the day with one staff asleep but on call at night. There is also time in the afternoon for the morning staff to handover to the afternoon staff. Staff files contain an application form, references and a Criminal Records Bureau (CRB) check although the references for one person were not on headed paper and had not included the name of the previous employer. The application form must be updated to include staff completing a full employment history and any gaps in employment must be checked with details Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 18 recorded in the individuals file. There was no evidence to show that a POVA first check had been completed for two new members of staff when they started work before the CRB check was received. The manager said that the member of staff was supervised at all times during the period before the CRB was received. The manager said the services uses the local authorities training with two staff due to do safeguarding training in November 2008 and working with people with challenging behaviour in October 2008. One member of staff is due to complete person centred planning training in February 2009. one member of staff has completed NVQ to level 2, one staff is doing NVQ to level 3 with another member of staff due to start this course in December 2008. Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 19 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 is experienced and trained to run the home. Good systems are in place to monitor health and safety. EVIDENCE: The owner and manager have a good knowledge of the people who use the service and how to meet their needs. Good systems are in place to seek the views of people who use the service and their relatives or representatives. The manager sent out surveys to relatives of people who use the service in August 2008. Responses received so far included positive comments about the care and service provided ‘excellent care’ was just one of the comments. One of the people who use the service Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 20 did surveys with 6 other people in August 2008. All people had ticked that they liked their room, the food and staff with no concerns raised. The manager said all health and safety checks were up to date. We saw the fire alarm system, electrical supply and the portable electrical appliances have been tested at the required intervals. Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 21 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 2 2 3 3 X 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 X 26 X 27 3 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 22 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 YA34 Regulation 19 (1), (4) & (5) Requirement Staff recruitment must include a full employment history, evidence to show that references are from previous employers and have evidence of checks completed through the POVA first list, especially when new staff start before their CRB check has been received. This will ensure that people who use the service are protected from harm. The manager must ensure that the CSCI are notified of issues and incidents regarding people who use the service, so we have up to date information about the service and can use this to help form our judgements. Timescale for action 25/11/08 2. YA38 37 (1) 25/11/08 Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 23 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. Refer to Standard YA6 Good Practice Recommendations Records must be factual and descriptive rather than judgemental, to ensure that information is not opinion but what actually happened. Seek advocates, to support people in making decisions for their future. Where attending health appointments causes distress for individuals, this must be clearly recorded and referred on to ensure that people’s health needs are fully met. 2. 3. YA7 YA19 Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 24 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. Extracts may not be used or reproduced without the express permission of CSCI Acorn Residential Home DS0000027205.V372209.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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