Care Home: Acorn Village

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What the care home does well Acorn Village has seven houses offering supported living in small groups, which is appropriate for the needs of the people who live there, as well as providing clean, safe and comfortable homes. A relatives comment seen in the individuals care plan confirmed this, "We are very happy for our relative to live at Acorn Village, it provides an environment, which provides a sense of freedom of movement, whilst not being isolated, but with security. There is a good range of activities and a programme, which helps our relative to develop and face new challenges". People who use this service tell us "I am happy here, I can do what I want, I have the freedom to cycle and move around Acorn Village." I thought that all the people I spoke with, residents and staff were happy, and they all got on very well. Acorn Village is a very big place, but I liked the space and freedom this provides. Overall I thought this is a very nice home. What has improved since the last inspection? Following the key inspection in March 2006 a requirement was made for information and documents required under regulation, with regards to the employment of staff, are obtained and associated records are appropriately maintained. This related to the recording of Criminal Records Bureau (CRB) checks. Discussion with staff and examination of staff files confirmed all relevant recruitment checks, required by regulations, to determine the fitness of the worker had been obtained prior to them commencing employment. An Annual Service Review (ASR) was completed on the 3rd December 2007, which confirmed people living in the home continue to be happy there. Comments, recivied from five relatives `Have Your Say` surveys, included in the ASR confirmed this and they continue to be very satisfied with the quality of the care of their relativies. Comments included, "my relative is treated as an individual, whose views are considered and acted on appropriately" and "very supportive staff in ensuring we are kept fully informed of any changes" and "the staff are always flexible in ensuring people using the service have a good quality of life". The AQAA`s received by us in 2007 and 2008, provded detailed evidence of how the care home has maintained a good service and continue to meet peoples` needs. The AQAA confirmed that opportunities for staff training and development continue to be encouraged, developing skills and awareness of staff to ensure the specific needs of the people living at the home are met. Suggestions as to how the service could improve included communication between management and staff and to ensure all houses are modernised. A tour of the home and discussion with staff confirmed that a modenisation porgramme is in progress and staff felt they were kept fully informed about changes involving the residents and the service. What the care home could do better: To ensure the protection of people using the service, the registered person must obtain and have on file a recent photograph of each person working in the home. This will ensure proof of the individual`s identity and confirm they are who they say they are. The registered manager was also advised there should be a photograph of each resident at the front of the individuals Medication Administration Record (MAR) chart, to avoid mistakes with the person`s identity. Although staff are confident that residents in Catkins House know how to wake the sleeping in member of staff, if they need them, consideration should be given to providing an alarm system, in case of an emergency. CARE HOME ADULTS 18-65 Acorn Village Clacton Road Mistley Manningtree Essex CO11 2NJ Lead Inspector Deborah Kerr Unannounced Inspection 20th November 2008 09:30 Acorn Village DS0000017744.V373494.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 Village DS0000017744.V373494.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 Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acorn Village Address Clacton Road Mistley Manningtree Essex CO11 2NJ 01206 394124 01206 391216 michelle.cook@acornvillages.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) Acorn Village Limited Mr Gary Clive Balls Michelle Marie Cook Care Home 38 Category(ies) of Learning disability (38) registration, with number of places Acorn Village DS0000017744.V373494.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: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 38 12th December 2006 Date of last inspection Brief Description of the Service: Acorn Village is a care home providing personal care and accommodation for 38 individuals with learning disabilities, who may also have physical disabilities. Set in extensive well-maintained grounds, Acorn Village is located on the outskirts of the small town of Manningtree, with shops and local facilities within walking distance. The village was opened in 1975 and consists of seven self-contained bungalows, each with its own ancillary facilities and communal living areas. All bedrooms within Acorn Village are single occupancy and many have en suite bathing facilities. In addition to the accommodation there are communal workshops and day care facilities on site, as well as a coffee shop which is open to people using the service and the general public. Funding is based on an up to date assessment of each person’s individual needs and variable according to the contract agreed with the appropriate funding authority. Fees cover all board and care and personal items, such as toiletries and clothing, purchased, as required by the people using the service. Holiday costs are not generally included within the fees unless specifically detailed within an individual contract. This was the information provided at the time of this key inspection. People considering using this service may wish to obtain more up to date information from the home. Acorn Village DS0000017744.V373494.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 3 stars. This means the people who use this service experience excellent quality outcomes. The inspection was unannounced and took place over one and a half days. This was a key inspection, which focused on the core standards relating to adults aged 18-65. The report has been written using accumulated evidence gathered prior to and during the inspection, including a selection of residents, relatives and health professionals ‘Have Your Say’ surveys and the Annual Quality Assurance Assessment (AQAA). This document is issued by the Commission for Social Care Inspection (CSCI) and gives providers the opportunity to inform the Commission about their service and how well they are performing. A number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. During a tour of the home, time was spent talking with six people living in the home and three staff. Both registered managers were available and fully contributed to the inspection process. An Expert by Experience, Darren Cunningham joined us on the first day of the inspection. ‘Experts by Experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care services. The term ‘Experts by Experience’ is used to describe people whose knowledge about social care services comes directly from using them. Darren’s comments and observations are added to this report and can be identified in bold text. What the service does well: Acorn Village has seven houses offering supported living in small groups, which is appropriate for the needs of the people who live there, as well as providing clean, safe and comfortable homes. A relatives comment seen in the individuals care plan confirmed this, “We are very happy for our relative to live at Acorn Village, it provides an environment, which provides a sense of freedom of movement, whilst not being isolated, but with security. There is a good range of activities and a programme, which helps our relative to develop and face new challenges”. People who use this service tell us “I am happy here, I can do what I want, I have the freedom to cycle and move around Acorn Village.” I thought that all the people I spoke with, residents and staff were happy, and they all got on very well. Acorn Village is a very big place, but I liked the space and freedom this provides. Overall I thought this is a very nice home. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: To ensure the protection of people using the service, the registered person must obtain and have on file a recent photograph of each person working in the home. This will ensure proof of the individual’s identity and confirm they are who they say they are. The registered manager was also advised there should be a photograph of each resident at the front of the individuals Medication Administration Record (MAR) chart, to avoid mistakes with the persons identity. Although staff are confident that residents in Catkins House know how to wake the sleeping in member of staff, if they need them, consideration should be given to providing an alarm system, in case of an emergency. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 7 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 Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 8 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 Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 9 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, 3, 4, 5, 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 People who may use this service and their representative are provided with information so that they can make a decision if this is the right home for them. Once they have made a decision, admissions only take place following a full and detailed assessment of the individual, to ensure the home can meet their needs. EVIDENCE: Acorn Village has developed a comprehensive range of information about the service. These include a statement of purpose, service user guide and a colour brouchure, called ‘A focus on Living’, which has supporting photographs of people who live there. There is also a leafelt , promoting activities on offer. Information provided in the AQAA and verified at the inspection confirmed the home has made improvements to their admissions procedure. Care plans contained admittance forms with detailed information about the individual’s history and their current needs. Additionally, pre addmission assessments and Community Care Assessments had been obtained from the individuals Local Authority, funding their placement. Both sets of assessments provided comprehensive information about the individuals needs. The admission process Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 10 includes trial visits and a thirteen week transitional period. Examination of care plans confirmed visits are arranged, and detailed plans are developed to support the individual during their stay. Assessments made prior to and during these visits are used to carefully consider the individuals needs and whether or not the home is able to meet them. Files examined, confirmed residents had been issued with a contract setting out their terms and conditions of occupancy. These provided clear information about the financial details relating to the individuals care and services available. The AQAA states an area service intends to further develop is to adapt the existing service user guide and contracts, to include user friendly versions in varying communication formats, such as large print, brialle or easy read. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 11 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, 8, 9, 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. People using this service know they will have their needs and personal goals reflected in their individual care plans and will be supported to take risks as part of an independent lifestyle. EVIDENCE: Care plans are well organised, person centred and agreed with the individual. These are easy to understand and look at all areas of the individual’s life. Plans are written in a person centred way, using phrases in the first person, such as ‘my name is’ and ‘things that are important to me’. The care plans contained all relevant information, from the pre admission assessments and Community Care Assessments, which covered all aspects of the individual’s health, personal and social care needs. Daily records are well written providing a good overview of how each person has spent their day, including what has worked for the individual, where there has been progress, achievements or any concerns about their health and welfare. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 12 Care plans included a description of the support and interventions required by staff to maximise the individual’s independence and to keep them safe. The AQAA reflects all staff have attended risk assessment training to explore the least restrictive care and promoting realistic risks. Risk assessments seen, have a can do approach, addressing safety issues whilst aiming for positive outcomes for the people using the service. The assessments reflect where people are provided with opportunities to make choices and are supported to do what they want to do, allowing them to be as independent as they can be. Where a risk had been identified corresponding support plans have been developed to provide strategies to manage the risk. Plans include supporting people whose behaviours can be challenging to others or them selves. Support plans have been developed and agreed in consultation with the individual. These identified triggers, which may lead to individual’s behaviour becoming dangerous to others and disadvantageous to them selves. The plans provide good descriptors of how staff are to manage these behaviours. Staff spoken with had a good understanding of what restraint is. They confirmed they had attended Non Abusive Psychological and Physical Intervention (NAPPI) training and described using breakaway and deflection techniques, when managing behaviours, where people are likely to be aggressive or cause them self harm. Information provided in the AQAA and verified at the inspection confirmed, people using the service are encouraged and supported to take control of their lives. Each person has a star profile summary, which reflects their skills and abilty to complete daily living tasks. This is completed following observation and assessment of the individual and demonstrates their social competence. From these asessments, key areas of life satisfaction are establsihed and actions plans are developed where the individual needs additional support to achieve their goals. People told me they are supported to manage their own finances, stating, “staff take me to the bank and I decide how much money to spend.” This was confirmed during the inspection, people using the service are supported to obtain, secure and spend their own personal money. This is monitored by management and staff to protect the individual from the risk of financial abuse. Information in the care plans confirmed people using the service are consulted about their care at all times. Regular reviews involving people important to them, including physocologists and the community nurses are held. Care plans are regularly updated to reflect where the individuals needs may have changed. Evidence was seen that annual reviews highlight new experiences that people living in the home would like to explore and the support required for them to achieve these. This was confirmed in comments taken from service users and relatives ‘Have Your Say’ surveys. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 13 People told us they are able to “make decisions and choices about how they spend their time and identified they can discuss issues with their key worker”. Another person told us, “carers listen to what I say” and “I like living in Jubilee Lodge”. A relative commented, “the home arranges suitable outings, activities and holidays” and “the staff are responsive to our relatives needs, they encourage them to become involved with activities and adult education”. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 14 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): 11, 12, 13, 14, 15, 16, 17, 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. People using this service are supported to live ordinary and meaningful lives, both in the home and in the community, enjoying a full and stimulating lifestyle with a variety of options to choose from. EVIDENCE: Acorn Village provides the people who live there with the opportunity to take part in a full and stimulating lifestyle. The village itself is within easy reach of the local community and people are free to come and go as they choose, with or without staff, according to their assessed needs. Acorn Village’s ‘Focus for Living’ brochure states ‘each person living in the home, what ever their disability is given every opportunity for self development, combined with as much or as little support as they need’. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 15 People spoken with and comments received in relativies ‘Have Your Say’ surveys, confirmed this, they said “social opportunities are always explored and people have access to many onsite and off site activities, including at least one annual holiday away from the home, supported by staff” A tour of the village confirmed, information provided in the AQAA that there is a full onsite programme of activities, including art workshops, needlecraft, woodwork, and a weavery. These workshops provide social interaction and a chance for people to develop their skills through making furniture, pottery, blankets, scarves and rugs, or alternatively helping in the coffee shop or gardens. The village has an in house gardening team who have been working with people who use the service to grow their own fruit and vegetables. Additionally, people are encouraged and supported to access off site colleges or other day care programmes. A team of staff also support people to access horse riding, swimming and sailing. The AQAA states strong links have continued to be made with the local community. This was confirmed in discussion with Acorn Village’s Research and Development Manager, who talked about a joint working project, between a local high school and some of the people from Acorn village, which resulted in various creative and therapeutic activities. A DVD and a supporting booklet called, ‘which Way Up’ has been produced showing some of the learning workshops, exploring and developing the creative and theraputic activties. Additionally, the service has employed a new drama therapist who has been able to work on a one to one basis and create group work. The AQAA identifies an area where there could be further improvement is to explore options of paid or voluntary work for individuals and create links with other organisations, to support this. People using the service are encouraged and supported, through individualised plans to develop their life skills by sharing the responsibility for keeping their home and own personal rooms clean. The are also encouraged to take part in the planning, shopping and preparation of meals. Regular house meetings explore new ideas for menus, internal activities and social opportunities. Each person’s care plan contained a social and personal diary. These detailed activities and if the individual took part or not and reasons as to why they did not. The diaries covered a wide range of individual and group activities, includiung shopping, trips out to various places of interest, trampolining, museums, pubs and most recently a trip to the cinema to see ‘Mama Mia’. I visited four of the houses and spent time with people who live there and the staff. I spent the longest time in Phyllis Mary Lodge (PML). There are four people who live permanently in this house. PML has a big bright dining room, with a large sitting room and television. Outside there is a decking / patio area, which I thought was really nice with views of the surrounding fields. Staff told me that residents eat outside in the summer. The kitchen was very big and well equipped. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 16 I spoke to three people who live in PML, they told me, they loved living there, as they have their own room, with their own, TV, DVD and record player. People said “they go out on public transport with support of the staff, shopping and to the bank, and to visit friends” and “I like going to charity shops, staff support me to go there”. I observed one person doing some artwork; they told me they also enjoy using the computer. Another person told me they like going to the coffee shop, and Christmas shopping and when staff go food shopping for the house they like to go along. Another resident told me they were a keen gardener and last year grew tomatoes and green beans in the garden. The staff and residents used them to make tomato soup for the house. People are able to choose what they want to eat at each part of the day. One person told me their favourite food is curry, and they have this at the house, when they want. Another person told me they enjoyed being able to choose their own food and that they “stay healthy by eating healthy”. I noted during my visit residents in PML each had something different to eat for their lunch. People told me they are able to keep in contact with relatives and friends by telephone. One person likes to see a close relative often and gets anxious when they do not see them, particularly when they are away on holiday, The staff seemed really supportive of this and got other members of the family to visit and showed them postcards sent by their parents to reassure them. Catkins House has recently had a new extension to provide bigger rooms. These are nice and bright. A decking area has been built in the garden. Resident’s told me they are able to choose the colour scheme of their rooms, including curtains and the carpets. People’s rooms were personalised with their own personal photographs and belongings, including, TV DVD and stereo. People told me they are able to go out when they request, and choose what they wear and when they get up and go to bed. They also said they have access to the doctor and dentist, when needed. There are no set meal times, except for the evening meal where all staff and residents sit together to chat through the day. People confirmed they have access to an array of activity, including college, horse riding, and arts and crafts. I spoke with one person who has lived at Acorn Village for twenty years who confirmed, “I like living here”. Oak Lodge has large rooms, with a well-equipped kitchen and a conservatory overlooking the surrounding fields. There were lots of photographs of residents enjoying activities and holidays. There was also an activity rota that showed what was available and when. People living in Oak Lodge told me they are able to go into town, go Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 17 trampolining, swimming and horse riding. They also go out to eat meals when they choose to places such MacDonald’s, Burger king and a fish bar in Clacton. One person told me “I like to cycle around the village, on my own and go to the coffee shop”’. People confirmed they are able to choose their room colour and decoration and had private bathrooms. They appeared to be very happy at the house. Their comments confirmed this, including “I get to choose my favourite foods such as spaghetti bolognaise” and “I go home some weekends to see my family and I like to go into town shopping at weekends”. People also told me they are able to spend their time as they choose, “I like to watch movies in the main room eating popcorn with the other residents and “I like to help with the house food shop”. People also told me, “I feels safe around the house and the village” and “I have no concerns and love living in Oak house”. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 18 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, 20, 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 health and personal care people receive is based on their individual needs and preferences. The principles of respect, dignity and privacy are put into practice. EVIDENCE: People using this service receive personal and healthcare support using a person centerd approach. Care plans provided full details of the support required, including intimate personal care. There was evidence that these were being regularly evaluated and ammended, as and when required. Observation and discussion with staff confirmed that they are fully aware of the individual needs of people using the service and were able to provide a verbal account of each persons health and well being. Staff also confirmed delivery of personal care is responsive to the needs and preferences of the individual. Staff support people who need it or wish it, alternatively where people are able to manage their own personal care staff support them to do this. Personal care takes place in the privacy of peoples bedrooms, which have full en-suite facilities. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 19 Information provided in the AQAA and verified at the inspection confirmed that people living in the home are supported to have access to health care services. Care plans contained individual health plans, which provided clear information about the individual’s health, physical and mental health needs and how these were to be met. They also include a portable section to take to health appointments. We (The Commission) received positive feedback from relatives and health professionals ‘Have Your Say’ surveys, about how the service supports people to manage their healthcare. A relatives survey commented” we never cease to be amazed that people living in such close contact with each other keep in very good health, and in case of illness, the care is first class”. Two health professional’s surveys, told us “I have always found the care by staff to be excellent” and “referrals to the community nurse are timely and appropriate, and the advice given to staff is always carried out”. They also said, “People are supported to live the life they choose” and “staff training is provided by the health service and commissioned privately by Acorn Village” and “if I have had concerns about the safety of a service user whilst on a home visit, meetings were held to resolve the issues”. Entries in care plans confirmed people have regular appointments with dentists, General Practitioner (GP), opticians, family planning and epilepsy clinics. People also benefit from a range of therapies, such as speech therapy, psychology, physiotherapy and hydrotherapy. Additionally, the service has a well equipped multi sensory room, and a ball pool, which provides sensory stimulation for individuals and group sessions. Gregory House are in the process of establishing a music therapy room, with percussion instruments and drums. The home has an efficient and comprehensive medication policy and procedure in place for ordering, storing and administering medication. The practice for administering medication is generally well managed. All people using the service undergo assessments to determine whether they are able to manage their own medications. Examination of Medication Administration Records (MAR) charts and information provided in the AQAA confirms the home continues to have a high level of residents who are supported to store their medication in their bedrooms. Internal assessments of self-medication ensure they are fully involved within this process. MAR charts inspected against the stock of people’s medication were found to be accurate. Each MAR chart had a drug profile and current list of medication, however there was no photograph of the individual. The registered manager was advised there should be a photograph of the individual to avoid mistakes with the persons identity. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 20 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): 22,23, 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 this service have access to robust and effective procedures, which enable them to express their concerns and which protect them from abuse or being placed at risk of harm or abuse and have their rights protected. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed the service has recently reviewed and updated their policies and procedures for managing complaints and adult protection and prevention of abuse. These provide clear information about how to make a complaint and include guidance of the procedures staff must take to report allegations of abuse. People using the service are provided with information (available in appropriate communication formats) about bringing forward complaints. They also have regular input from independent advocacy services, providing a forum for people to raise any concerns independently of the staff in the home. The complaints log identified that there has been seven complaints made since January 2008. These had been fully investigated and responded to within the agreed timescales and a record made of the outcomes, as to whether the complaints had been upheld or not. People spoken with gave me mixed information about if they knew how to make a complaint, one person told me they did not know how to do this, but another person and staff said they would know who to speak to if they were unhappy about something. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 21 Several senior management staff are involved within Essex Vulnerable Adults Protection Committee (EVAPC) meetings and have good contacts with representatives from local Protection of Vulnerable Adults (POVA) teams, to address any concerns, which may arise as a result of an alledged case of abuse. The registered managers continue to let us know about incidents that have happened, since our last key inspection. There have been four separate incidents referred to the safeguarding team. These have been managed well and fully investigated and appropriate action taken to safeguard the people using the service. The AQAA provides evidence that work is ongoing to ensure that individuals have appropriate mental capacity assessments that address where there may be restrictions that affect them. Additionally, care plans contained information where peoples rights had been infringed, to protect their own helath, welfare and safety. The service continulally explores training sources, to ensure staff are kept up to date with new legilslation to support individuals to know their rights. Most recent training has included Deprivation of Liberties (DOLS) and Mental Capacity. The service has robust recruitment procedures in place. Staff files seen confirmed all staff are subject to Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) checks, prior to commencing employment. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 22 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, 26, 27, 28, 29, 30, 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. Acorn Village is designed to provide the people who live there with small group homes, set in an environment, which provides a sense of freedom of movement, but with the added security of being part of a village community. EVIDENCE: Acorn Village is in a rural location and has seven separate houses. Each house caters for people with different needs. Central to the village is the main house, (Mistley Hall) which provides training facilities, meeting rooms, and reception and administration services. There is also an arts room, tapestry room and coffee shop. Due to maintenance work I was unable to see this in action, however I did like the idea of having this facility on site. The village has extensive grounds that many of the resident’s artworks were on display. These included paper Mache statues made for Halloween and Christmas displays in the walled gardens. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 23 A tour of the premises confirmed information in the AQAA that there continues to be a programme of modernising, maintenance and redecoration of the environment. Catkins house has recently been extended to provide larger bedrooms and ensuite facilities and Spring lodge was in the process of having a new kitchen fitted. Most of the houses have had decking style patios built at the the rear of the property to provide space for people to enjoy in the nicer weather. Redecoation and expansion of Oak room and the coffee shop are near completion. Oak room is an an on site communal hall used for training sessions, social events, drama performances, fund raising activities and daycare activities. The new space and improved facilities will give a more comfortable working space for those living and working at Acorn Village. A new generator has been installed to allow for power failure that can occur due to rural environment. The inspector visited each of the seven houses over the two days. Each house is self-contained, with its own ancillary facilities and communal living areas and gardens. All bedrooms are single and have private en-suite toilet, washing and/or bathing facilities. Some bathrooms have been adapted to create walk in shower/wet rooms. Bedrooms are suitable for the needs of their occupants, with appropriate furniture and fittings, including appropriate lighting, window restrictors and safe radiators. Peoples rooms are nicely decorated to reflect individual personalities, hobbies and interests, including personal effects such as tactile boards and sensory equipment for an individual with impaired vision. Spring Lodge has three separate flats within, which have their own bedroom, ensuite bathroom and lounge with facilities, such as a kettle and microwave, so that the people living in them can make their own hot drinks and snacks, as and when they require. These flats provide the individuals occupying them with maximum independence. Physiotherapists and occupational therapists have assessed appropriate aids and equipment to transfer people safely and comfortably. These include grab rails, adjustable beds with integral bedrails fitted and assisted baths. Records seen confirmed regular checks are carried out on all equipment so as to ensure that it was maintained in good working order. Each of the houses, were found to be bright, cheerful, airy and free from any unpleasant odours. Inspection of the laundry facilities confirmed each house has good procedures in place to prevent and control the spread of infection. Appropriate hand-washing facilities of liquid soap, paper towels, gloves and aprons are situated in people’s rooms, bathrooms and toilets where staff may be required to provide assistance with personal care. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 24 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, 33, 34, 35, 36, 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 using this service have confidence in the staff at the home because they are trained, skilled and sufficient in numbers and checks have been done to make sure that they are suitable, however the home must have a recent photograph on the staff’s file to prove their identity. EVIDENCE: Each house has it’s own manager and deputy manager, and staff team. The duty roster for each of the houses reflects these are staffed appropriately to meet the needs of the people living there. However, discussion with staff raised concerns about staffing arrangements in PML at weekends. Normal staffing ratio during the week for four service users is three staff in the morning and two in the afternoon. At weekends the roster confirmed what staff had told us (The Commission) that on several occasions this dropped to one member of staff during the waking hours. One of the registered managers provided a new and up to date rota to show the minimum number of staff at weekends was two. They also stated they are in the process of renegotiating Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 25 funding for some service users whose needs have increased to provide more staffing hours. There are four people who live permanently in Phyllis Mary Lodge (PML). There is one staff member on night shift at all times. They are sleeping staff although people told me they know how to alert them. One person has an alarm, which wakes the night staff as soon as they steps out of bed. People told me “they thought the staff were friendly” another person told me “I am happy with the staff” and “I feel safe living in PML house”. I spoke to three staff in Jubilee House who told me they get extra staff in when required. There is two night staff on duty, at all times, one waking and sleep in. When a resident is ill there is two staff on the night shift in Catkins house, otherwise most nights there is one sleeping in staff. Staff told me “residents know how to wake them if they need to and that the house was really quiet at night and they would hear if the resident needed them”. I did not think this was a very good situation and that maybe they should have an alarm system in place. Staff ‘Have Your Say’ surveys, identified that staff feel they are kept up to date with information about the people in the home. Staff confirmed the onsite training and induction they receive is first class, which ensures they have the knowledge and skills to ensure the needs of the people living in the home are met. This was supported by a comment received in a relatives ‘Have Your Say’ survey, “new staff and staff from other units are given guidance or information they need to support the residents”. Acorn Village has its own training department, which provides a wide range of training and development opportunities for staff. Examination of staff files and training information provided during the inspection confirmed this. Most recent training has included dementia, risk assessment, health and safety, Non Abusive Psychological and Physical Intervention (NAPPI), first aid, food hygiene, medication awareness, challenging behaviour, autisim, infection control, fire safety and safeguarding adults. The AQAA states the service has further plans to increase opportunities for staff to explore external training for subjects related to their role, specific to individuals health needs, such as diabetes and subjects that they are interested in. Acorn village has their own induction training programme, which meets the requirements of the Skills for Care Induction Standards and includes the City and Guilds award ‘Induction Award in Supporting People with a Learning Disability’. Staff are issued with their own workbook, which is used to monitor their progress through the probationary period. Information in staff files confirmed that new employees had completed their induction training within the first six to twelve weeks of their employment. Information provided in the AQAA and verified at the inspection confirmed that Acorn Village is registered Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 26 as an accredited National Vocational Qualification (NVQ) training centre with City and Guilds, offering NVQ 2 and 3 with onsite assessors and verifiers. The majority of home managers have gained NVQ 4 or are registered to undertake it. A trainee registered manager is working through the new qualification, leadership and management in care award. The home employs a total of ninety-nine permanent staff, forty-six have obtained an NVQ 2 or above. These figures reflect the service has met the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. Following the key inspection in March 2006 a requirement was made for information and documents required within Regulation 19, Schedule 2, of the Care Homes Regulations 2001 are obtained and associated records are appropriately maintained. This related to the recording of Criminal Records Bureau (CRB) checks, which did not show whether the date entered referred to when the check was applied for or when the disclosure was received, nor did it give any indication as to the outcome of the check. Discussion with staff and examination of staff files confirmed all recruitment checks have been obtained to determine the fitness of the worker prior to them commencing employment. However, staff files did not have a recent photograph of the individual to confirm their identity. Staff files had records to confirm that regular supervision takes place, this was also confirmed in discussion with staff. The documentation reflects that these sessions include discussion of general work objectives, performance and development and identify training needs. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 27 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, 42, 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. Competent and qualified managers run Acorn Village in the best interests of the people using the service. This is tested by an effective quality assurance system. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed the senior management team have a good cross section of qualifications and experience of working in nursing and mental health. Managers are encouraged to undertake regular training to update their knowledge and feedback to staff. The senior management team are heavily involved in day to day running of the service, including delievering training, hands on care, when required and fully involved within recruitment processes. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 28 This was confirmed in a relative’s ‘Have Your Say’ survey’s, comments, which included, “Acorn village is forward looking, they are always looking for ways to improve” and “from conversations we have with various member of the public, and with other relatives, there should be more places like Acorn Village”. Information provided in the AQAA and verified at the inspection confirmed that the home has an effective quality assurance monitoring process. This was demonstrated through the completion of the Annual Quality Assurance Assessment (AQAA) requested by The Commission. This was completed when we asked for it, and provided clear and relevant information. The AQAA lets us know about the changes they have made to the service and the areas, which they need to improve and clearly shows how they are going to do this. Acorn Village issues annual questionnaires to service users and their relative’s to obtain their views about the service. Analysis of ‘Have Your Say’ surveys issued by the Commission and the homes own quality assurance reflects people are satisfied with the service they receive. Acorn Village’s relatives survey provides an option for them to write a comment about the home. A selection of these reflected people’s satisfaction with the service, for example, “I am very impressed with the homes atmosphere, activities, friendliness and support given by the staff “and” staff treat my relative as an individual “and” the commitment to practical ways of enhancing people’s quality of life and minimising difficulties”. People using the service were asked the same question. Their comments included, “I enjoy living here” and “I like that I can read a book before bedtime and go to bed when I like and get up when I like” and “I can do what I want to do and people help me, when I want them to”. The AQAA and statement of purpose also reflects Acorn Village’s commitment to improving quality of services, through training their own employees and providing training to other learning disability services in North Essex, to improve standards for people with a learning disability across the county. Records examined and information provided in the AQAA confirms the home takes steps to safeguard the health, safety and welfare of people living and working in the home. Time was spent with the maintenance and building services manager, who is also responsible for health and safety. Each house has their own health and safety and maintenance files. These included the most recent Gas and Electrical Safety certificates, including Portable Appliance Testing (PAT). Regular audits are completed of all houses to ensure compliance with health and safety requirements. The fire logbooks showed that fire alarms are tested weekly and regular fire training and drills take place. The homes fire risk assessment was seen, this is up to date and complies with current legislation. Care plans seen contained individual fire safety risk assessments, which included, evacuation strategies in the event of a fire. Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 29 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 4 2 4 3 4 4 4 5 3 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 4 25 X 26 4 27 3 28 4 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 4 X X 4 X Acorn Village DS0000017744.V373494.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES 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 Schedule 2 Requirement To ensure the protection of people using the service, the registered person must obtain and have on file a recent photograph of each person working in the home. This will ensure proof of the individual’s identity. Timescale for action 31/12/08 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. Refer to Standard YA20 Good Practice Recommendations Each MAR chart had a drug profile and current list of medication, however there was no photograph of the individual. The registered manager was advised there should be a photograph of the individual to avoid mistakes with the persons identity. Although staff are confident that residents in Catkins House know how to wake the sleeping in member of staff, if they need them, consideration should be given to providing an alarm system, in case of an emergency. DS0000017744.V373494.R01.S.doc Version 5.2 Page 31 2. YA33 Acorn Village Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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