Acorn Park Care Home Care Home Service Adults Glen Road College Milton East Kilbride Glasgow G74 5BL Telephone:

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1 Acorn Park Care Home Care Home Service Adults Glen Road College Milton East Kilbride Glasgow G74 5BL Telephone: Type of inspection: Unannounced Inspection completed on: 5 December 2014

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 15 4 Other information 33 5 Summary of grades 34 6 Inspection and grading history 34 Service provided by: Balpride Limited Service provider number: SP Care service number: CS If you wish to contact the Care Inspectorate about this inspection report, please call us on or us at enquiries@careinspectorate.com Acorn Park Care Home, page 2 of 36

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 3 Adequate Quality of Environment 3 Adequate Quality of Staffing 3 Adequate Quality of Management and Leadership 3 Adequate What the service does well The staff working within this service appear to know the residents well. Residents told us that they particularly enjoy the food they are offered and we could see that the kitchen staff were aware of dietary needs. The staff team have been working hard to make some small changes to the environment, this has provided people with an increased choice of areas to relax in. What the service could do better The service should continue to develop the way in which the needs of residents are being met particularly in relation to increasing opportunity to engage in meaningful activity. The service should also continue to make improvements to the care home environment and ensure that the number of showers and bathing facilities are increased. Areas for improvement are further discussed throughout this report. What the service has done since the last inspection At the last inspection of this service we issued an improvement notice detailing 8 requirements for improvement. We found that at this inspection action had been taken to address the areas of concern and these requirements had been met. More information on our findings can be found within section 3 of this report. Acorn Park Care Home, page 3 of 36

4 Conclusion Inspection report continued It was evident that steps had been taken to address areas of concern identified at the time of the previous inspection. We saw that the residents looked clean and comfortable. There was a nice calm atmosphere within the care home and the residents that we spoke to told us that they were fine. Staff working within the care home knew the residents well and seemed to be present in numbers that enabled them to meet the needs of the residents. Acorn Park Care Home, page 4 of 36

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the care Inspectorate on 1 April Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve, we may make a recommendation or requirement. * A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. * A requirement is a statement, which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and regulations or Orders made under the Act or a condition of registration. Where there are breaches of the regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Acorn Park is a care home in East Kilbride. It can provide long term care and short breaks (respite care) for up to 38 older people and people with early onset dementia. It can also provide short breaks for up to 4 adults with physical disabilities or chronic physical conditions. It is owned by a company called Balpride Limited and is one of five homes in Scotland run by the same provider. The care home is built on three floors accessed by a lift. The lounge and dining area is located on the ground floor. The home is located in a woodland area and has an enclosed garden for people to use. It is located on the edge of East Kilbride and is not easily accessible by public transport. Residents are reliant of the provision of transport to enable them to use resources in their community. There were 23 residents living within the home at the time of the inspection. The residents charter states that: 'staff are trained to provide a homelike and caring service to our residents. You will be looked after by sensitive and knowledgeable people prepared to understand your needs and treat you with respect and dignity'. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Environment - Grade 3 - Adequate Acorn Park Care Home, page 5 of 36

6 Quality of Staffing - Grade 3 - Adequate Quality of Management and Leadership - Grade 3 - Adequate Inspection report continued This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. Acorn Park Care Home, page 6 of 36

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a high intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We wrote this report following an unannounced inspection. This was carried out by two inspectors. On day one of the inspection, an inspection volunteer and inspection volunteer coordinator also took part in the inspection. The inspection took place on Thursday the 4th December 2014 between 08:30 and 17:35 and on Friday 5th December between 08:30 and 16:30. We gave feedback to the manager of the service and to the regional manager between 16:30 and 18:15 on the 2nd day of the inspection. This inspection was focussed on following up the progress that the provider had made to meet the requirements made since the last inspection. This included progress made to meet: requirements detailed in the Improvement notice issued to the provider on 26 June 2014 requirements made as an outcome of complaints that had been upheld since the last inspection requirements that were recorded within the most recent inspection report. requirements which were issued as part of upheld complaints made since the last inspection. As part of the inspection process we took into account information within the action plans that we had asked the provider to submit to us as an outcome of recent inspection and the complaint activity. During this inspection process, we gathered evidence from various sources, including the following: *We spoke to residents, relatives and staff throughout the course of the inspection * We met with the Registered Manager of the service Acorn Park Care Home, page 7 of 36

8 *We met with the regional manager of the service * We observed practice of staff on duty at several points during the time of inspection *We carried out observations using the Short Observational Framework for Inspection (SOFI) We looked at documentation including: Inspection report continued * personal plans * Incident and accident reports * complaints activity * medication records * policies and procedures * staffing schedule * staff rota's * Maintenance records and some equipment * staff files including recruitment information, training information supervision records and personal development plans Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Acorn Park Care Home, page 8 of 36

9 What the service has done to meet any requirements we made at our last inspection The requirement The provider must review systems in place for the management of skin care and ensure that all personal plans are fully completed to reflect best practice and that care provided is fully documented to reflect that treatment, including the application of any creams or lotions has been applied. This is in order to comply with SSI 2011/ 210 Welfare of users 4. (1) A provider must- (a)make proper provision for the health, welfare and safety of service users; Timescale: within 48 hours of receipt of this report. What the service did to meet the requirement We saw that people were not having creams applied to their skin in the way they were prescribed. While we saw some improvement in the way general skin care was being provided, the service need to be more vigilent about following the prescribers instructions. We have made this a repeat requirement. The requirement is: Not Met The requirement The provider must take steps to ensure that all staff are aware of situations which constitute referral to the adult support and protection team and must take steps to ensure that all such events are referred following the protocol established by the local authority and notification to the Care Inspectorate. This is in order to comply with SSI 2011/210 Welfare of users 4. (1) A provider must- (a) make proper provision for the health, welfare and safety of service users; Timescale: within 24 hours of receipt of this report. What the service did to meet the requirement We saw that nursing staff had been provided with information about the need to make notifications to the relevant agencies in the event of an adult protection concern and that internet access had been improved throughout the home to enable staff to process such information. The requirement is: Met - Within Timescales Acorn Park Care Home, page 9 of 36

10 The requirement The provider must ensure that all staff, including the senior team, attend training in Adult Support and Protection which includes training on the local authority protocol applicable to this service. This is in order to comply with SSI 2011/210 Staffing 15. A provider must, having regard to the size and nature of the care service, the statement of aims and objectives and the number and needs of service users (a) ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users; and. (b) ensure that persons employed in the provision of the care service receive. (i) training appropriate to the work they are to perform; and. (ii) suitable assistance, including time off work, for the purpose of obtaining further qualifications appropriate to such work. Timescale; Within 8 weeks on receipt of this report. What the service did to meet the requirement We saw evidence that training in adult support and protection had been provided and that on completion staff were required to complete a reflective practice exercise. We saw that at the time of inspection 18 staff had completed this training and further dates were planned. The requirement is: Met - Within Timescales Inspection report continued The requirement The provider must ensure that they report any incident which is detrimental to the health or welfare of a service user to the Care Inspectorate. This is in order to comply with SSI 114 Regulation 19 (3) Records A provider shall keep a record of(a) any occasion on which restraint or control has been applied to a user, with details of the form of restraint or control, the reason why it was necessary and the name of the person authorising it;(b) the procedure which is to be followed in the event of a fire or other emergency;(c) all fire drills and alarm tests which have been conducted;(d) any incident which is detrimental to the health or welfare of a service user;(e) any maintenance of equipment which is used in the provision of the service;(f) any complaint made by a service user or a representative or relative of a service user or a person employed in the care service about the operation of the care service, the outcome of such complaint and the action taken;(g) the persons who were employed in the provision of the service each day;(h) all money or other valuables deposited by a service user for safekeeping or received on the service user's behalf, which(i) shall state the date on which the money or valuables were deposited or received, the date on which any money or valuables were returned to a service user or used, at the request of the service user, on the service user's behalf and, where applicable, the purpose for which the money or valuables were used; and(ii) shall include the written acknowledgement of the return of the money or valuables;(i) the date, time and cause of death of any service user who has died while the care service was being provided to the service user and the name of the doctor certifying death;(j) medicines for the Acorn Park Care Home, page 10 of 36

11 use of service users which are kept on the premises from which the care service is provided; and(k) details of any instance in which medication has been administered to a service user without the consent of that service user or of a person duly authorised to consent on the service user's behalf. Timescale: Within 24 hours of receipt of this report. What the service did to meet the requirement The provider had made retrospective notifications to the appropriate agencies at the time of the previous inspection as requested. We saw evidence that further notifications had been made as appropriate in the intervening period. The requirement is: Met - Within Timescales Inspection report continued The requirement The provider must review the procedure for responding to first aid emergencies including falls and ensure that staff are fully aware of the observations they need to make including the frequency of observations and the documentation they need to complete to record their findings This is in order to comply with the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011,( SSI 2011/210) regulation 4(1)(a). For completion by the 8th August 2014 What the service did to meet the requirement We saw from incident reports and from records that we saw that appropriate action was now being taken in the event of an accident, recording of information had improved The requirement is: Met - Outwith Timescales The requirement The provider must ensure that people who use this care service are offered a range of appropriate, purposeful, recreational, and stimulating activities. They must take into account the interests, needs and beliefs of people to enable them to fulfil their aspirations and potential and help maintain their independence. - Each resident must have a choice in everything they do. - A clear record of people's previous interests must be taken account of when planning a person centred activity plan. - Staff must receive training in relation to meaningful activity, which is reviewed and updated when required - There must be suitable staffing numbers in order to maintain resident's recreational and social preferences and interests. Acorn Park Care Home, page 11 of 36

12 - The staff must record the resident's preference for recreational and social activity with regular reviews in order to ensure staff are meeting their needs. This is in order to comply with the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011,( SSI 2011/210) regulation 4(1)(a). For completion by the 8th August 2014 What the service did to meet the requirement We did not see evidence of improvement in this area. We were aware that the provider was actively recruiting to the post of activity worker but we have requested that additional staff should be deployed to this role in the interim to ensure that residents are supported to engage in activities of their choice. We will repeat this requirement. The requirement is: Not Met Inspection report continued The requirement The provider must: review the toilet facilities available to people while they are being supported to shower and ensure that toilets are made available for this purpose take steps to ensure that the practice of using the toilets within the bedrooms areas which are close to the shower area but which are designated personal areas for other residents is stopped This is in order to comply with the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, (SSI 2011/210) regulation 3 and 4(1)(a). For completion by 8th August 2014 What the service did to meet the requirement Toilet facilities are now available in bathroom and shower rooms. The requirement is: Met - Outwith Timescales What the service has done to meet any recommendations we made at our last inspection The service have worked hard to take action on the recommendations made. Further detail is recorded in section 3 of this report. Acorn Park Care Home, page 12 of 36

13 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Inspection report continued Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The Care Inspectorate received a completed self assessment document from the provider. The provider identified what it thought the service did well and identified some areas for development. Taking the views of people using the care service into account Residents were very positive about Acorn Park home during this inspection. Both the inspectors and the inspection volunteer heard a range of positive quotes from people including "I was involved in interviews for new staff" "the staff here work very hard" "the home is always clean and tidy, staff here are good" "I am happy here, they look after you, I like the staff" "on the whole the staff are pretty good" "I am happy her, the staff are good, they do my nails" Taking carers' views into account Carers said "I am happy with the level of care my mother receives in Acorn Park, I consider they look after my mother very" well "I am more than happy with the care my mother gets, they involve me at all times with the service" Acorn Park Care Home, page 13 of 36

14 Acorn Park Care Home, page 14 of 36

15 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We have considered the way in which service users and carers participate in assessing and improving the quality of care and support, the environment, staffing, management and leadership within this service. We have found that the service is performing at an adequate level for this quality statement. At the last inspection we found that where staff members had obtained the views of service users and/or their carers use of this information was not evidenced within the personal plans. We found at this inspection that the staff had worked to improve this, we saw an increase in participation of both residents and their carers in the personal plans that we saw. Relatives told us in care standard questionnaires that they were involved 'at all times' in the care of their relative, one person said 'staff make time to discuss concerns they have with me'. Information held within personal plans had been reviewed and improved to provide clear information about the relatives including those who with power of attorney with accurate contact details clearly recorded within the personal plan. We had made this a recommendation in the last inspection report and it was encouraging to see that action had been taken to improve this. We saw that the provider had continued to use a new quality monitoring tool which had been used by some residents and relatives to provide feedback to the care home on aspects of the service that could improve, we thought that this was a good initiative. It was encouraging to see an increase in involvement of service users in the Acorn Park Care Home, page 15 of 36

16 recruitment process, we saw that people were being more encouraged to give their opinions in relation to the environment and staffing. Areas for improvement We recognise that the provider and the staff team are at an early stage in developing a culture which promotes participation through seeking the views of people who use the service and taking action to reflect their views in the delivery of the service. We would encourage them to continue to develop this through policies and practice, supervision, learning and development and quality systems. They should consider collating information to reflect the way in which they have changed or developed the service as a result of service user and carer involvement to help them to see the impact this cultural change can have across the service. We will continue to monitor this at future inspections (recommendation 1). Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. The Manager should promote participation across the service ensuring that all staff actively promote a service user led service at all times. National Care Standards 8 Care Homes for Older People - Making Choices You can make choices in all aspects of your life. National Care Standards 17 Care Homes for Older People - Daily Life You make choices and decisions about day-to-day aspects of your life and about how you spend your time. Acorn Park Care Home, page 16 of 36

17 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths We have found that the service is performing at an adequate level for this quality statement. We were pleased to see that the provider, the management team and the staff within this service had acted to make improvements across all aspects of the service and had started to introduce systems that we could see were improving outcomes for residents. We have also reported on improvements made within the service which relate to the quality of care and support within the compliance with improvement letter issued to the service on 18th December 2014, this can be accessed through We saw that work had been done to improve the information within the personal plans, this means that there was more accurate and meaningful information recorded about the needs wants and wishes for each individual. The information recorded set out ways in which the person should be supported. This is important as it is used both to guide staff in the care and support required to meet the persons needs and act as a record of care which can be used to evaluate progress for that person and reflection to ensure the most appropriate care is being provided. We met a number of residents who told us that they liked living within the care home, the inspection volunteer reported that people they spoke to were happy with the care and support they received. They said 'My family take care of my care plan if changes are needed' 'The food is good' * I enjoy staying at the care home * The home is nice * I look forward to family and friends that come to visit We saw that there was significant improvement in the quality and accuracy of important information recorded within personal plans to guide staff in the way in which care and support should be provided. Accurate information about the needs of people receiving support helps staff to provide care in a way that leads to good outcomes for people and reduces potential for harm. We looked at specific aspects of care relating to nutrition, hydration, mobility, skin care and found that staff were recording that care was being delivered in a way that reflected best practice and that this was leading to good outcomes for people, for example, weight was increasing or stabilising, Acorn Park Care Home, page 17 of 36

18 We found that the service had introduced a falls champion and were using a multi factorial falls assessment, this is a tool that is used to assess potential for people to fall and identifies action that can be taken to reduce the likelihood of falls. They were liaising with the falls prevention team and It was good to see that there was a marked reduction in the frequency of falls within the service. We looked at personal plans and records indicated that the service was meeting the individual needs of residents in a manner that was reflecting their individual assessed needs. We saw that where supplementary recording sheets were being used to record information that these were being completed. We spoke with residents who told us the service was meeting their needs. We saw that all care plans had been reviewed within the previous six months and that the service had developed a matrix to ensure that reviews would continue to be held within each six month period or sooner if required. We saw evidence that there were well established links with the local GP practice, the GP visits the home twice each week and supports the staff in relation to health diagnosis and treatment. We continued to see that people were being supported to have regular consultations with audiology, dentists and opticians. We made a requirement at the last inspection in order that the provider review the procedures for responding to first aid emergencies this was both in relation to action being taken and records of action taken. We identified that evidence from the incident forms we saw indicate that this requirement is met. We made a requirement at the last inspection stating that staff should ensure that they follow their own adult protection policy and make referrals to the local authority as appropriate. We saw that the service had improved the way in which concerns were raised and notifications were made and this requirement was met. Areas for improvement We had serious concerns at the last inspection about the way in which people were admitted to this care home, to a care service can lead to harm for older people particularly where cognitive function is impaired. We were unable to monitor the way in which the service had addressed this issue as a moratorium put in place by the local council had led to no admissions since the last inspection (requirement 1). We had made a requirement at the last inspection in relation to promoting opportunities for people to engage in meaningful activity within this care home, however, we continued to identify that there was a lack of opportunity for people to engage in activity that was meaningful to them at this inspection. We did see that some improvement had been made and that on the day of the inspection people were being supported to go on a bus run to see the christmas lights in Glasgow but we continue to identify a need for a cultural change in this aspect of life. We did not Acorn Park Care Home, page 18 of 36

19 see evidence of any level of interaction with the local community and this should be developed. We have made this a repeat requirement (requirement 2). Through the use of the short observational framework for inspection (SOFI) we observed that while there were some good examples of positive interaction with residents, there were also a number of areas where engagement and communication with service users could be improved. For example, we saw that staff often interrupt colleagues while they are in one to one discussion with residents and that the engagement with the resident stops without reason or apology, staff frequently stood in front of the television to speak to colleagues with no apparent consideration for those who may be watching television at the time (recommendation 1). We were concerned to see that from records and from the amount of cream used since date of opening that it appeared that topical creams were not being applied as prescribed. In addition, we saw that records of medicine administration were poorly completed, for example where a variable dose, that is 1 or 2 tablets were prescribed, records did not always show which had been administered, there was no evidence that special precautions which must be followed in relation to some medicines had been taken, handwritten changes or entries in the medicine administration record did not reflect best practice and were not always signed by two people (requirement 3). While we recognise the improvements made in that people living within this service now have their care needs reviewed at least once in every six month period, the quality of information recorded in this process at times poor, the review process should always be focussed on improving outcomes for people who live within the care service (recommendation 2). Grade awarded for this statement: 3 - Adequate Number of requirements: 3 Number of recommendations: 2 Requirements 1. The provider must ensure that they have sufficient information about the needs of service users at the point of admission to the care home to enable them to meet their needs in a manner that promotes health and wellbeing. This is in order to comply with: SSI 2011/210 regulation 4(1)(a) - requirement for the health and welfare of service users. Timescale: to start at the point of admission for all service users from receipt of this report. 2. The provider must ensure that people who use this care service are offered a range of appropriate, purposeful, recreational, and stimulating activities. They must take Acorn Park Care Home, page 19 of 36

20 into account the interests, needs and beliefs of people to enable them to fulfil their aspirations and potential and help maintain their independence. - Each resident must have a choice in everything they do. - A clear record of people's previous interests must be taken account of when planning a person centred activity plan. - Staff must receive training in relation to meaningful activity, which is reviewed and updated when required - There must be suitable staffing numbers in order to maintain resident's recreational and social preferences and interests. - The staff must record the resident's preference for recreational and social activity with regular reviews in order to ensure staff are meeting their needs. This is in order to comply with the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011,( SSI 2011/210) regulation 4(1)(a). Timescale; for implementation within 24 hours of receipt of this report 3. The provider must review systems in place for the management of skin care and ensure that all personal plans are fully completed to reflect best practice and that care provided is fully documented to reflect that treatment, including the application of any creams or lotions has been applied. This is in order to comply with SSI 2011/210 Welfare of users 4. (1) A provider must- (a)make proper provision for the health, welfare and safety of service users; Timescale: within 48 hours of receipt of this report. Timescale for to start within 24 hours and be completed within 4 weeks of receipt of this letter. Recommendations 1. The manager should facilitate observations of practice and use findings to support staff to be more conscious of the way in which they communicate and engage with residents. National Care Standards 10 Care Homes for Older People - Exercising Your Rights You keep your rights as an individual. Inspection report continued 1 You are confident that staff will treat you politely at all times and always respect your individuality. 2. The manager should ensure that reviews of care are carried out and recorded in a manner that is professional and useful, reviews should be focussed on improving outcomes for people who use the service. National Care Standards 6 Care Homes for Older People - Supporting Arrangements Acorn Park Care Home, page 20 of 36

21 You can be confident before moving in that the home will meet your support and care needs and personal preferences. Staff will develop with you a personal plan that details your needs and preferences and sets out how they will be met, in a way that you find acceptable. Acorn Park Care Home, page 21 of 36

22 Quality Theme 2: Quality of Environment Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths Please see quality statement 1.1 for comments on this quality statement. Areas for improvement Please see quality statement 1.1 for comments on this quality statement. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Acorn Park Care Home, page 22 of 36

23 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths We have found that the service was performing at an adequate level for this quality statement. At the last inspection of this service we reported on a number of areas of concern relating to the standards of cleanliness throughout the home, we were pleased to see that the issues of concern has been addressed and that general cleanliness had improved. We saw that action had been taken to ensure that all equipment used to support residents to mobilise had been checked and maintained in line with manufacturers requirements. We had made a requirement in relation to the lack of toilet facilities in or near bathroom / shower areas. Toilets had been installed in the bathrooms and shower rooms in order that residents could use these facilities if required at their convenience and that the practice of using toilet facilities in the bedrooms located nearest the bath and shower facilities had stopped. We saw that areas such as boiler rooms were secured and on further examination we saw that these areas were no longer being used as storage areas. Signage had been improved throughout the care home. We saw that general improvements had been made to flooring and furnishings throughout the home. We saw that water temperature checks were now being carried out and recorded. The provider had made a number of improvements to the general environment in relation to creating more areas for residents to choose to spent their time in, this was resulting in positive outcomes for residents and was helping to reduce potential to all sit in one area for most of the day. Areas for improvement We had made a requirement that all residents should have access to a system that would enable them to summon assistance should they require this. We saw at this inspection that a new system had been installed throughout the care home which comprised of portable units which residents would take with them. We saw that for some people this system was not being used, when, for example when they went to the toilet and in the event of the need to summon assistance there was no other means to do so (recommendation 1). Acorn Park Care Home, page 23 of 36

24 The lounge area of the care home felt cold, some residents that we spoke to said they were cold. The manager and the maintenance team acted promptly to address the issue when we raised our concerns however temperature control needs to be improved in this area as it is a challenge all throughout the year as the lounge is a glass fronted conservatory and at the last inspection of the service the temperature was extremely hot (recommendation 2). Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 2 Recommendations 1. The manager should ensure that a risk assessment is carried out for all residents to ensure they are able to use the system in place to enable them to summon assistance. Where they cannot use this system steps should be taken to introduce a system that they are able to use. National Care Standards 9 Care Homes for Older People - Feeling Safe and Secure 2. The manager should ensure that an effective system is put in place to monitor and regulate the temperature of the lounge area of this care home. National Care Standards 4 Care Homes for Older People - Your Environment Your environment will enhance your quality of life and be a pleasant place to live Acorn Park Care Home, page 24 of 36

25 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths Please see quality statement 1.1 for comments on this quality statement. Areas for improvement Please see quality statement 1.1 for comments on this quality statement. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Acorn Park Care Home, page 25 of 36

26 Statement 2 We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service strengths We saw from evidence that we sampled that there had been significant improvements made to the recruitment policy and practice. We found that for staff appointed to the service since the last inspection there was evidence that safe recruitment had been followed. This included the introduction of a new system in place to check the status of professional registration with the NMC and with the SSSC. We found that the service had developed a new interview assessment tool and were actively involving residents in recruitment. A new employee handbook had been introduced. Areas for improvement The service need to ensure that new systems established to promote safe recruitment are used consistently and that the improvements noted in this inspection are sustained. We will continue to monitor the quality of safe recruitment in this service at future inspections. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Acorn Park Care Home, page 26 of 36

27 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We have found that the service was performing at an adequate level for this quality statement. The service had taken action to improve staffing and address areas of concern recorded within the previous inspection report, the improvement notice issued to the service on 26th June 2014 and letters to the service detailing the outcome of complaints which were upheld by the Care Inspectorate in September and October These documents can be found at We looked at off duty for the service and from sampling information available to us, we saw that the numbers and skill mix of staff on duty complied with the analysis of the dependency tool that we saw. We found that nursing staff were on duty at all times and that the service was complying with this requirement. We found that there had been improvements in relation to staff learning and development, we saw, for example evidence of staff having completed training in adult support and protection, catheterisation, application of topical creams. Stress and distress training was being rolled out in partnership with NHS Lanarkshire. From evidence we looked at, we found that staff were now working within the scope of their professional competency. The manager informed us that all care staff had applied for registration with the Scottish Social Services Council. Areas for improvement As part of a complaint investigation we had identified that the service had not acted appropriately in their duty to report allegations of misconduct to the care inspectorate. We made a requirement which we were unable to follow up on as there have been no reports of misconduct. We will make this a repeat requirement and monitor this at the next inspection (requirement 1). We saw evidence that training had taken place but from the training needs analysis and it was difficult to see how learning needs were identified and addressed, information was not fully completed or dated (recommendation 1). Within a requirement that we made as part of an upheld complaint we identified that there was a need for staff to have training in relation to falls management, we did not see any evidence of this (recommendation 2). Acorn Park Care Home, page 27 of 36

28 overall the service should continue to build on newly established systems to ensure that all staff are supported to operates to National Care Standards, legislation and best practice, we will continue to monitor progress with this at the next inspection. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 2 Requirements 1. The provider must notify the Inspectorate within 24 hours of an allegation of misconduct which warrants investigation, dismissal or other disciplinary action. This is in order to comply with: SSI 2002/114 regulation 19(3)(d) - requirement about notification and records and SSI 2011/28 regulation 4(1)(b) - requirement about records, notifications and returns. Timescale: to start within 24 hours and be completed within 48 hours of the receipt of this report. Recommendations Inspection report continued 1. We recommend that the manager of the service reviews the way in which systems are being completed to ensure that where learning needs are identified, action required or taken to meet these is recorded, dates of planned learning and development are clearly stated and that learning is linked into supervision which is focussed on the needs of service users and improvement. National Care Standards 5 Care Homes for Older People - Management and Staffing Arrangements You experience good quality support and care. This is provided by management and staff whose professional training and expertise allows them to meet your needs. The service operates in line with all necessary legal requirements and best-practice guidelines. 2. Staff should be supported to attend training in falls management and should be supported to ensure that learning is being implemented in practice. National Care Standards 5 Care Homes for Older People - Management and Staffing Arrangements You experience good quality support and care. This is provided by management and staff whose professional training and expertise allows them to meet your needs. The service operates in line with all necessary legal requirements and best-practice guidelines. Acorn Park Care Home, page 28 of 36

29 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths Please see quality statement 1.1 for comments on this quality statement. Areas for improvement Please see quality statement 1.1 for comments on this quality statement. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Acorn Park Care Home, page 29 of 36

30 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service strengths At this inspection, we found that the performance of the service was adequate for this statement. We found that the manager and the staff team had worked hard to meet the requirements and recommendations which had been made through regulatory activity since the last inspection. A range of audit tools had been developed and we could see that these were being used to identify areas for improvement throughout the service. We saw that there were improvements in information recorded in personal plans, we saw that infection control audits and environmental audits were leading to improved outcomes across the service. We saw improved systems in place to monitor performance and activity across the care service. Acorn Park Care Home, page 30 of 36

31 Areas for improvement We were disappointed to see that there continued to be a number of discrepancies in relation to medication management within this care home. We have made a requirement in quality statement 1.3 about this however we were concerned that the audit practices within the care home are not identifying and addressing the issues identified (requirement 1). We recognise that systems established to improve the service across the quality themes are relatively new and we encourage the manager to continue to use these to monitor the areas of strength and improvement across all the quality themes. We will continue to monitor this at future inspections. We have discussed the need to ensure that the improvements we saw at his inspection are sustained and that ongoing improvement is made. We were concerned about the way in which future new admissions to the service are managed and the impact of this on the quality of the service and have requested that the manager ensures that in future people are admitted to the service in numbers that are manageable and do not compromise the quality of care and support within the service (requirement 2). Grade awarded for this statement: 3 - Adequate Number of requirements: 2 Number of recommendations: 0 Requirements 1. The provider must ensure that audit systems, including the medication audit tool, are fit for purpose and that issues identified through using such tools are addressed and improvement made. This is in order to comply with: SSI 2011/210 regulation 4(1)(a) - requirement for the health and welfare of service users. Timescale: Within two weeks of receipt of this report. Inspection report continued 2. The provider must improve the admission process to ensure that proper provision for the health of new residents is made. In order to do this you must: Demonstrate that the needs of people who use the service are regularly assessed and adequately met. Ensure that the preadmission/admission process includes a full assessment and how needs will be met; Ensure that people who use the service are provided with a choice in the ways in which the service is provided for them; Ensure that at all times suitably skilled and experienced staff are working in the care service in such numbers as are appropriate for the health and welfare of people who use the service. This is in order to comply with: SSI 2011/210 Principles Acorn Park Care Home, page 31 of 36

32 3- requirement about quality, respect and choice & regulation 4(1)(a) - requirement for the health and welfare of service & regulation 15(a) - requirement about staffing. Timescale: to start within 24 hours and be completed within 8 weeks of receipt of this reports letter. Acorn Park Care Home, page 32 of 36

33 4 Other information Complaints There have been 2 complaints about this service upheld since the last inspection. Information about the complaints can be found at Enforcements Since the last inspection we have taken enforcement action against this service in terms of section 62 of the Public Services Reform (Scotland) Act 2010 ("the Act"). An improvement notice was issued to the service on the 26 June This was followed up with an extension to improvement notice issued on the 11 August The provider worked with the care inspectorate to make improvements to the service. We formally concluded that the service had complied with the improvements and issued a letter to this effect on the 18th December Additional Information Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Acorn Park Care Home, page 33 of 36

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