Care Home: Acorns

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What the care home does well The atmosphere at the home is warm and friendly and visitors are made to feel very welcome. The staff show respect to people living at the home and were observed being kind and courteous throughout the day. People feel that they receive good care from the staff. One person said, "The staff are lovely and kind, we couldn`t manage without them`. Another person said, "I have settled in really well, I am very happy here everyone is very kind". A relative commented, " The manager and staff are all very caring and helpful. My mother is very happy with the care she receives". People looked clean, well dressed and had received a good level of personal care. People feel that they are able to choose how they spend their time. This helps them to have control about how they live their lives. People said that they had a choice of food and that the quality of food served is very good. Comments about the meals included " The cooks are very good, the meals are always very warm and tasty" and " The food is lovely, I`ve no complaints". People said that they felt very comfortable in going to the manager knowing that any concerns they may have would be addressed without delay. Staff feel they are well supported, they can access regular meetings and one to one sessions with their manager to discuss how well they are doing, or if they need any more training or support with their work. This better ensures that they can provide a good standard of care for the people who use the service. The home is clean and comfortable for people who live there. One person said, "The cleaners come into my room every day, the home is kept nice and tidy"` and everyone who returned surveys to us commented that the home is always fresh and clean. People were very satisfied with the laundry service. What has improved since the last inspection? There has been positive action on the requirements listed within the last inspection report. All the requirements and recommendations had been acted upon and resolved. Admission procedures have been improved to make sure people are properly assessed and the home accepts individuals whose needs they can meet. The manager is carrying out audits on different aspects of the home so that any problems can be identified at an early stage and acted on to improve standards, the quality of care and safety. Parts of the home have been redecorated and refurbished. This makes the environment more pleasant, comfortable and safer for the people living there. People`s care plans have been improved upon. They are much more "person centred" and contain more information about their wishes and interests so that staff are clearer about what care is needed, and how it should be provided. This also helps the people using the service to have choice in how they are cared for and helps them stay as independent as possible. People who are working in the home have been given training around keeping people safe from harm, this helps them understand how to look after individuals and speak up if they think anything is wrong. People who are working in the home have been attending more training around safe working practices to make sure they look after their health and safety and that of the people living in the home. The manager of the home has made sure she completes all the police checks and receives sufficient information and references about new staff before they start work, to protect the people living in the home from harm. If people with positive police checks apply to work in the home, the manager should record all discussions with the worker and decisions made to support their employment. The person who owns the home has made sure that the service is looked at on a regular basis to see if it is meeting the needs of the people using it, is working within the guidelines of good practice and is looking after the wellbeing of the people living in the home and the people who work there. What the care home could do better: The lunchtime period needs to be improved for some people so that they are not waiting long periods for assistance. People working in the home have made sure that the way they record and give out medication is better but some more improvements are needed with aspects of recording, temperature monitoring and administration to ensure that people are fully protected. CARE HOMES FOR OLDER PEOPLE Acorns 29-31 Welholme Road Grimsby North East Lincs DN32 0DR Lead Inspector Jane Lyons Key Unannounced Inspection 11th September 2008 08:45 X10015.doc Version 1.40 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 Acorns DS0000063879.V371605.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 Older People. 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. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acorns Address 29-31 Welholme Road Grimsby North East Lincs DN32 0DR 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) 01472 340129 acorns@mypostoffice.co.uk Pindy Enterprises Limited Mrs Delilah Jane Tilling Care Home 27 Category(ies) of Dementia - over 65 years of age (27), Old age, registration, with number not falling within any other category (27) of places Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2007 Brief Description of the Service: The Acorns is a large Victorian house, which retains many of its period features, but has been adapted to meet the needs of the people using its service. The home is in the centre of a large residential area of Grimsby, overlooking Peoples Park, a well-known beauty spot. Local shops and other amenities are close to the home. The home has three floors, accessed by stairs and a passenger/chair lift. There are a number of sitting rooms and a large dining room. The house has parking to the front and rear and an adequate sized garden. The staff have their own working areas and there is also a large kitchen and outside laundry room. The home provides personal care for up to 27 older people, some of whom may have dementia and they receive medical support from the local district nursing service and GPs. Information about the home and its service can be found in the statement of purpose, service user guide and the latest inspection report. These documents are on display in the entrance hall of the home and copies are available from the manager. Information given by the manager on 11/09/08 indicates the home charges a fee of £361.00. There are no additional charges other that those for hairdressing, taxis, private chiropody treatment, toiletries and newspapers/magazines. A full list of prices for these additional services is available from the manager. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This inspection included an unannounced site visit carried out by Mrs Jane Lyons on the 11th September 2008. During the visit we spoke with some of the people who live at the home, a number of relatives, care staff, the cook, the laundry assistant, the manager and the registered provider. We looked round the home to see if it was kept clean and tidy. Some of the records kept in the home were checked. This was to see how the people who live in the home were being cared for, that staff were safe to work in the home and that they had been trained to their job safely. We also checked records to make sure that the home and the things used in it were safe and were checked regularly. The manager at the home also completed an annual quality assurance assessment that was requested by CSCI (Commission for Social Care Inspection), which includes information about people who live at the home, the staff that work there, the service provided, complaints and any incidents or accidents that have occurred. Prior to this visit, surveys were sent out to obtain the views of people who live at the home and staff who work there. Ten surveys were returned from people who live at the home and eight from the staff; the feedback was very positive. Comments from surveys have been included in the main body of this report. We would like to take this opportunity to thank everyone who participated in the inspection process. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 6 What the service does well: The atmosphere at the home is warm and friendly and visitors are made to feel very welcome. The staff show respect to people living at the home and were observed being kind and courteous throughout the day. People feel that they receive good care from the staff. One person said, “The staff are lovely and kind, we couldn’t manage without them’. Another person said, “I have settled in really well, I am very happy here everyone is very kind”. A relative commented, “ The manager and staff are all very caring and helpful. My mother is very happy with the care she receives”. People looked clean, well dressed and had received a good level of personal care. People feel that they are able to choose how they spend their time. This helps them to have control about how they live their lives. People said that they had a choice of food and that the quality of food served is very good. Comments about the meals included “ The cooks are very good, the meals are always very warm and tasty” and “ The food is lovely, I’ve no complaints”. People said that they felt very comfortable in going to the manager knowing that any concerns they may have would be addressed without delay. Staff feel they are well supported, they can access regular meetings and one to one sessions with their manager to discuss how well they are doing, or if they need any more training or support with their work. This better ensures that they can provide a good standard of care for the people who use the service. The home is clean and comfortable for people who live there. One person said, “The cleaners come into my room every day, the home is kept nice and tidy”’ and everyone who returned surveys to us commented that the home is always fresh and clean. People were very satisfied with the laundry service. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 8 The lunchtime period needs to be improved for some people so that they are not waiting long periods for assistance. People working in the home have made sure that the way they record and give out medication is better but some more improvements are needed with aspects of recording, temperature monitoring and administration to ensure that people are fully protected. 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. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 6 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Proper pre-admission procedures are in place and followed so that people who are thinking about moving into the home can feel confident that their needs will be met. Up to date written information is also available to them to help them with their decision-making about whether the home can meet their needs. EVIDENCE: The home has a detailed statement of purpose, service users guide and brochure, which gives very clear and up to date information about the services provided. Views from people who use the service and results from the quality assurance programme have now been included in the service user guide. The Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 11 manager confirmed that the service user guides are given to people living in the home and those who are considering a move to the home. Information provided by the manager prior to this visit taking place indicates that people are able to visit the home without the need for an appointment prior to them or their relative moving in. Earlier in the year concerns were raised to the us about the assessment procedures in the home following the admission of an individual with complex needs who was later transferred to more appropriate placement, the management have clearly taken action from this and reviewed their assessment procedures to ensure that people are properly assessed and placement is offered to individuals whose needs can be met. Pre-admission assessments are now solely carried out by the manager or deputy manager who visit the person at their own home or in hospital which ever is applicable at the time. Community Care Assessments are obtained from the funding authority, these outline the person’s current health and personal care needs. The information collated from visiting people and that supplied by the funding authority is taken into consideration when making a decision as to whether the home is able to meet the person’s needs. There was evidence in three peoples’ care records to confirm that their needs were properly and thoroughly assessed prior to being offered a place at the home. People who completed our surveys confirmed that they received enough information about the home before they moved in, one person told us that he had chosen the home following recommendations from friends, the home was ideally placed for him to access the local community and he had settled in well. The manager explained that due to peoples’ frailty it is usually relatives who visit the home to see if it meets their expectations as far as being the right type of home for their loved one. Improvements have also been made with the levels of training the staff have accessed since the last inspection visit; records showed that care staff were up to date with mandatory courses and all care staff had now accessed dementia and challenging behaviour training courses. This helps to make sure that the staff have the skills and knowledge to deliver the services and care which the home offers to provide. A number of the staff surveys received were very complimentary about the training they received and two commented specifically about the dementia training, one said “ I have been on many courses recently, the one on dementia gave me more confidence to manage people with more difficult behaviours” The home does not have any intermediate care beds and therefore standard six does not apply to this service. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ care plans are more detailed and outline the level of support and care each person requires in ensuring their health and welfare needs will be met. Improvements have been made to the management of medication and generally the systems are well managed and safe. People’s rights to privacy and dignity are supported by caring staff. EVIDENCE: The staff have worked hard to make improvements to the care plans since the last inspection visit, a new documentation system has now been put in place and the care plans are more person focused with much more information about an individual’s abilities, strengths, weaknesses, personal preferences, likes and dislikes. The care plans are generally more detailed to direct staff on the actions they need to take to meet the needs of the people they are caring for, Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 13 although some of the care plans for personal care need to fully describe all the support individuals actually need and staff should not use phrases such as “provide all support” and clearly write how much and what assistance the individual requires. The care plans are regularly reviewed to keep the information up to date, relatives and people who use the service are involved in the monthly evaluations which is very positive with records kept of their comments and views about the care given and received. People did say that staff sit down and talk to them about their care. A key worker system is in place to enable people to receive one to one support. A staff survey said, “we are always kept up to date with information about the needs of people. Information is recorded in daily reports and people’s care plans and we have handover periods between shifts”. Many of the staff have now had training on care planning, discussions with the manager evidenced that some staff were much more confident in this area of practice than others however the management were providing ongoing support to staff to ensure that staff competence was continually improving. The daily records were up to date, they contained a lot of information about how people’s physical needs are met and also staff had recorded how people spend their time and things they have enjoyed. Annual reviews take place to discuss people’s care with their family and others who are involved in their care. Information about people’s wishes prior to and following their death is included in the care plan where people have chosen to discuss this aspect of their care. Risk assessments are carried out to identify any risks to the individual. Where a risk has been identified, a care plan is produced to minimise the risk. Nutritional screening records were seen, and the manager said that this is undertaken on admission and subsequently on a periodic basis. The records confirmed this. A record is maintained of people’s weight gain or loss, improvements could be made to this document to provide a cumulative weight balance and staff should be consistent in recording weights in imperial measure or metric. Manual handling plans used to identify the support people require with their mobility describe in detail the assistance required so staff are clear about what is expected from them. Staff have not yet accessed any training in risk assessment although the manager is looking to access courses for the senior staff in this years training programme. The local Primary Care Trust has approached the home to provide support in introducing a risk management system for identifying and monitoring pressure damage; this system is more user- friendly for the staff and will replace the current documentation in place. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 14 Care plans show that people’s health is monitored and people have access to health care facilities and any relevant specialists that are necessary, the staff support people in attending appointments. Healthcare information is recorded in the care plans about why people are attending appointments and outcomes from these. This helps in making sure that everyone is aware of the person’s health needs and how these are to be met. Those people spoken with during this visit said that staff are good at getting the doctor when you need one. Relatives spoken to said that they usually accompanied their loved ones to appointments but the home would provide an escort if they were unable to. People looked clean, well dressed and had received a good level of personal care. Comments received in surveys and during the visit from people and their relatives show that they are very satisfied with the care and support offered by the staff. Comments included: “All the girls are lovely, they are always there to help me” and “ The staff are very good, they look after us all so well and always have a smile and a kind word” and “Lila and her team are great, the care is super.” People said that they receive support in a way that respects their privacy and dignity and this could be observed during the visit. One person said, “staff are kind, thoughtful and sensitive”. People are asked when they move in if they want a key for their bedroom door. The home has a number of double rooms although these have been used for single occupancy over recent months. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. One staff member commented on a survey “The home assists elderly people to their full potential, we encourage our residents to help themselves and provide assistance for all care”. Staff said they had completed an in-depth training programme. This gained them the competencies needed to administer medications. The medication is appropriately stored. The manager audits the medication systems weekly so that any discrepancies can be identified at an early stage and acted on. The stock balance of the previous month’s medication is now recorded on the Medication Administration Record so that medication can be more accurately accounted for. The records are well completed with no gaps in signatures. Where staff are handwriting medication on to the sheets (transcribing) improvements could be seen in the quality of the recordings, the amount, type and strength of the medication is recorded and two staff have signed the entry. The medication records all contained a photograph of each person living in the home. Stock control is well managed. Controlled drugs are stored and administered properly, it was noted however that staff were not recording the running balance of liquid medication Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 15 administered which is good practice. It was also noted that staff should be recording the temperature where the medication is stored and that it is no longer acceptable practice to administer liquid medication from a communal bottle (such as Lactulose) and that all individuals should receive medication from their individually prescribed bottle. Records in the care plans show that the manager writes to the individual’s G.P. to request medication reviews and in the main they are carried out regularly. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are able to make their own choices about how they spend their time and are offered activities. They maintain contact with their families as they wish and communication between the home and relatives is good. Meals served at the home were of a good quality and offered choice to ensure people receive a balanced diet. EVIDENCE: People spoke of how they are able to make their own choices such as when they get up and go to bed, the meals they eat and generally how they spend their time. One person said that they liked to spend time in the sitting room during the morning and then liked to rest in their bedroom for the afternoon, that they also enjoyed going out with a friend to the local shops from time to time. People said that they feel there are enough activities on offer if they choose to join in. Activities are organised in-house and there is opportunity for people to enjoy some trips out in the local community. The home employs an activity coAcorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 17 ordinator three times a week from 10 a.m. until 3p.m. who organises a range of activities including bingo, sing a longs, film afternoons, craftwork and baking. Time Care is an organisation which specialises in reminiscence work with the older person and they are booked to come to the home about every two months; musicians and other entertainers also visit the home regularly. One person said they liked to read but had poor eyesight so books were provided with large print and also from the “Talking Books “range. Staff support people to attend local church services if they wish and there are visits to the home from representatives of the different churches to meet people’s spiritual needs. Discussions with people living at the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the community. People can see family and friends whenever they want. Relatives said they are always made to feel welcome when visiting the home, which was observed during the visit. Comments received during the visit show a high level of satisfaction, these included “There is always a good atmosphere when I visit, the staff are lovely and everyone seems very happy and well cared for” and “The staff are all friendly and kind, they always keep us up to date with everything.” People said they enjoy the meals that are on offer at the home. The menus are on display in the dining room and people can notify the cook in advance if they do not like the menu options and wish for an alternative meal. The menus have been changed following information received in questionnaires completed by people who live at the home and discussions at “residents” meetings. The majority of people choose to eat their meals in the dining room and other individuals have their meals in the two lounge areas. Observation in one lounge area during lunch time identified that two of the individuals required support and that their meal had gone uneaten and had cooled, staff were busy assisting people in other areas of the home. Discussions with the manager and staff identified that the activity co-ordinator usually provided extra support at mealtimes during the week and that she was on holiday but this should have been identified and the manager would have provided the support required or individuals should have been provided with their meals at a time when staff could have been present. Discussions with the cook identified that she is given information about people’s specific nutritional needs and dietary preferences; the home is currently providing fortified diets and diabetic diets for a number of individuals. One of the cooks has accessed training in nutritional support. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the 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’s concerns are listened to and acted on. Systems are in place to safeguard people from abuse. EVIDENCE: People and their representatives have been provided with a copy of the homes complaints procedure, which is also on display in the entrance hall. This contains details of who to speak to at the home and who to contact outside of the home to make a complaint should they wish to do so, the procedure has been reviewed and is clear and user- friendly. People who completed surveys responded ‘yes’ when asked if they knew how to make a complaint. One person wrote, “ Yes, I would open my mouth and say what I think”. Those people spoken with during the day said that they felt very comfortable in going to the manager knowing that any concerns they may have would be addressed. No complaints have been received by the home or the commission, the manager has systems in place to support the investigation and management of complaints. The manager has followed advice from the previous inspection and Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 19 introduced a “niggles book”. The manager talks to each person daily and records any concerns they have, the manager confirmed that this has made a difference in that she can identify any issues or concerns quickly and take action to improve matters, recent examples she gave were providing someone with an extra pillow and moving furniture in an individual’s room. Earlier in the year concerns were raised to the local authority and an investigation was carried out under safeguarding procedures. The outcome from the investigation was a number of recommendations were made around improvements to the home’s assessment procedures, care plans, risk assessments and statutory training; findings from this visit indicate that all the recommendations have been met. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use the 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 standard of environment within the home is good, providing people with a very clean, comfortable and homely place to live. EVIDENCE: The accommodation is over three floors and can be accessed via a passenger lift and a stair lift and there is level access to the home so it is suitable for people with mobility problems. There are three communal lounges where people can watch television and sit with other people; the garden and patio areas are pleasant with seating and shade provided for people to sit out. The home is clean, tidy, well maintained and has a good friendly atmosphere. People said they liked their bedrooms, which are personalised to suit their Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 21 individual tastes. All double rooms currently have single occupancy. Since the previous inspection visit some lounges, bedrooms and corridors have been redecorated and it is planned that other areas will also have re-decoration as part of the ongoing maintenance programme. New furniture, curtains and blinds have been purchased. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of people at the home. Hoisting equipment was available to assist people with their independence and mobility. All surveys received indicate that the home is always clean and fresh and some comments were received about the improvements made to the décor of the home which include: The current manager is trying to improve the look of the home by re- decorating, new furnishings and trying to make the home look better for the residents” and “The home is always very clean and tidy, my room has been redecorated which I like”. The laundry for the home is located in an outside building. A new washing machine and flooring in this area has been provided. The home employs a laundry worker to attend to people’s personal clothing and bedding. People looked smartly dressed and their clothes were clean. The home carried out a survey of the laundry services earlier in the year which indicated that everyone was very satisfied with the new laundry assistant and the service she provides. Staff said that there are plentiful supplies of soap, aprons, gloves and paper towels to help maintain good hygiene practices, all staff have received infection control training. The last environmental health report for the kitchen was October 2007, and this showed the home is improving its standards and is providing better quality outcomes for the service. The environmental health officer has arranged to visit the home again to help staff improve their paperwork. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including random and key inspection visits to this service. People at the home are cared for by a sufficient number of staff who receive the training they need to meet people’s needs. Improvements in the way that people have been recruited to work at the home will help in making sure that people are not at risk from unsuitable workers. EVIDENCE: People spoke highly of the staff team and said staff always listened and acted on what they said. Comments from the people using the service, relatives and staff are generally very positive about the staffing levels within the home, and individuals feel that there is a good standard of care being given to the people living in the home. There were 21 people living in the home at the time of the visit, which is the same as the previous visit and the staffing levels have remained the same. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 23 Information from the annual quality assurance assessment and staff rotas about the number of staffing hours provided, and information gathered during this visit about the dependency levels of the people living in the home, is used with the Residential Staffing Forum Guidance and shows that the home is meeting the recommended guidelines. The dependency calculations are carried out by one of the providers on a monthly basis, these figures are not currently held at the home, it is advised that the manager has more input into the dependency calculations to ensure they are up to date and reflect any recent admissions or changes. Comments have been made in an earlier section of the report about the findings from observation of the lunch time meal in one of the lounges; the manager confirms that extra support is usually provided by the activities coordinator to assist with feeding for a number of people and it is important that arrangements are made to ensure that this support is in place when the staff member is on leave or absent from the home. The home employs cleaners, cooks, kitchen assistants, a handyman and a laundry person in addition to the care staff. This means that the care staff have time to spend with people and are not diverted from this by having to do other duties. The home does not use agency staff and the permanent staff team cover all vacant shifts. Comments from surveys include “ We work well as a team”, “The seniors always make sure there are enough staff on, we will always work extra shifts to cover sickness and holidays” and “ The management always makes sure that everyone in the home is cared for properly, clients as well as staff”. Information from the annual quality assurance assessment shows that 50 of the care staff have completed their National Vocational Qualification (NVQ) level 2 training and the remainder are currently working through the course. This helps to ensure that people are receiving care from staff with the right skills and knowledge. Staff spoken to said they felt they received good training to support them in providing care to people, some of the comments on surveys included “ We are being trained all the time, we have all kinds of different courses to go on” and “I’ve been on many courses so my self- confidence, knowledge and skills are correct for my job, there is always a new course to attend”. New staff have a full induction before they are expected to carry out any tasks that they are unsure of. The manager keeps an overview of the staff training programme to assist her in the planning of training in the home. The home provides a good staff training programme with staff accessing annual updates in statutory courses and a variety of general and service specific courses. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 24 Records evidenced that staff are up to date with mandatory courses in fire safety, moving/ handling, first aid and food hygiene. All staff have completed safeguarding courses and updates in infection control. Senior care staff have completed accredited medication courses. All the staff have now completed training in dementia, those staff interviewed said how useful the course had been in giving them more understanding of the people’s needs in this area and how they should be cared for. The home has employed an external trainer to provide sessions in house and many staff have also attended courses run by the local authority; the manager told us that the home had now purchased a number of up to date DVD training packages on subjects such as communication, diversity, relationships and Diabetes which will enhance the current programme. The manager explained the recruitment procedure, this includes a new “recruitment pack” which was found to be satisfactory. She said that two written references are obtained before appointing a member of staff, and any gaps in employment records are explored. Checks on three new staff members’ records confirmed this and show that new staff are confirmed in post only following completion of a satisfactory police check, and satisfactory check of the Protection of Vulnerable Adults register. These checks are necessary to help protect people from potentially unsuitable staff. It was noted that one staff member’s police check detailed a previous conviction, the manager confirmed that she had discussed this matter on employment however it is advised that records are completed to support all discussions and decisions made by the home to support employment. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 35, 36 and 38 People who use the 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 home is well managed in the best interests of the people who live there and proper attention is given to their health and safety. EVIDENCE: The manager of the home is Mrs Delilah Tilling and she was registered with the Commission in September 2007.She has many years experience in working with older people and is currently working towards her Registered Manager’s Award which she hopes to complete in December. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 26 It is clear from this inspection visit that the manager and registered provider have worked hard to improve many of the management and administrative systems in the home with very positive results in areas such as the care records, staff training, quality assurance, supervision and recruitment. The manager is committed to ensuring that people staying in the home are consistently well cared for, safe and happy. People, staff and relatives said they were all happy to approach the manager at any time for advice, guidance or to look at any issues. They all said that they were confident that she would respond to them appropriately and swiftly. Comments from discussions and surveys include: “We have good management who are easy to talk to and always there”, “ Lila, the manager has always been there to talk to and her door is always open, the owners visit regularly and they are friendly and supportive” and one person who uses the service said, “ The manager is very approachable and always on the ball”. The home has a comprehensive quality assurance system. There is evidence of internal auditing of the homes environment, services and records. Regular surveys are also sent out to people who use the service, relatives and other interested parties such as health and social care professionals. Results of the audits and surveys are analysed and actioned by the management, they are also published in the home and the service user guide. Staff meetings are held and minutes of these meetings were seen. The responsible individual visits the home on a regular basis, a report is written following the visits. An annual development plan has been produced which details the direction the service is going and the improvements the home is planning to make over the next twelve months. People who use the service meet with the management of the home. These quality assurance systems will help to ensure that the service is operating in the best interest of the people who live there. The home has good policies and procedures in place, and the manager explained that they review and update these as and when required. The records confirmed this. The home holds small amounts of personal monies on behalf of people. Records are made of any incoming and outgoing monies and are signed by two members of staff. Records and receipts are kept of all transactions so that money can be easily accounted for. All staff said that they now receive regular supervision and regularly meet up with their manager to discuss ways of working, checks of records confirmed this. Staff meetings take place to enable staff to voice their views and opinions and to discuss any issues in the home. The manager said that due to the cancellation of the equality and diversity training she is discussing equality and diversity issues in staff meetings and supervision so that staff are aware of and Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 27 can respond appropriately to people’s rights and individuality. The manager has carried out appraisal sessions with the staff, a new format to document these meetings is currently being introduced. The home has systems in place to manage health and safety in the home and appropriate records are maintained. Risk assessments are undertaken for all safe working practices; an improvement was seen with the individual risk assessments for people living in the home. Staff receive a range of health and safety training. The self-assessment form completed by the home indicates that all the required maintenance and servicing of equipment is up to date and the records we looked at confirmed this. Fire safety checks and procedures are regularly carried out and recorded. The home’s fire risk assessment has been developed by an external company, this document and the other fire safety measures in the home have all been recently checked by the local fire safety officer. Audits of accidents are completed and action taken to minimise risk in this area are recorded. Where bed rails are being used, bumpers have been fitted to prevent people getting trapped. Records showed that the rails were checked regularly and detailed risk assessments are in place to support provision. Hot water temperatures are regularly monitored, recent records show that some of the recordings were higher than they should be however the management has this in hand and a number of thermostatic valves are scheduled to be changed. More regular checks are being carried out on wheelchairs in the home; foot plates were seen to be in use which promotes safety when transferring people. The management are working with the local wheelchair services department to make sure people who need this equipment have been properly assessed however there have been some delays in the provision of new wheelchairs for individuals which the manager is chasing up. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 29 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. Standard Regulation Requirement Timescale for action 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 OP8 Good Practice Recommendations The registered person should review the systems for recording people’s weights to ensure that staff can easily identify any weight loss/ gain and that staff consistently record in imperial or metric measurement. The registered person should review the medication systems to ensure staff record the cumulative balance of liquid Controlled Medications, record the room temperature where medications are stored and that staff administer from the individual bottles of liquid medication that are prescribed. The registered person should ensure the staffing levels at lunch times are adequately maintained to provide cover when staff are absent. Meals at the home should be served at times convenient to the individual when assistance is available. The registered person should ensure that the manager is more involved in the Residential Forum Staffing DS0000063879.V371605.R01.S.doc Version 5.2 Page 30 2. OP9 3. OP27 4. OP27 Acorns 5. OP29 calculations and that records of these are held in the home. The registered person should ensure that records are in place to support decisions around recruitment of staff with positive police checks. Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Acorns DS0000063879.V371605.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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