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Acorn Specialist Centre
For Working Aged Dementias and
Alcohol Cognitive Impairment, Illnesses and Disorders
Statement of Purpose
Acorn Specialist Centre has been set up in response to the stated facts that 60% of people with
alcohol related illnesses and disorders are misdiagnosed or not picked up until it is too late and
brain damage has already taken a permanent cost to the individual’s physical and social life.
The Centre’s commitment to the local and wider community will be to provide a tailored
quality service to persons with a diagnosis of:
 Working aged dementia (18-75) including vascular dementia, pre-frontal lobe type
and movement disorders with a dementia diagnosis. This will exclude Altimeters
type dementia
 Cognitive impairment, illness and disorder caused by alcohol abuse including
Wernicke’s encephalopathy and Korsakoff Syndrome
The centre’s aim will be to promote an effective ‘person centred care’ based on recovery, which
provides the opportunity for clients to take back and lead a self-directed and meaningful quality
of life.
It is Acorn Specialist Centre’s premise that everyone deserves to have the opportunity to
recover no matter what the level of illness or problem. The Centre’s vision is to be the service
of choice in providing individualised care to those suffering from Alcohol related cognitive
impairment illness or disorders. To achieve this, care will be provided within a learning
environment that uses the most up-to-date diagnostic and therapeutic community recovery
modalities. There is more to developing a Centre than what is written within this ‘Statement of
Purpose’ therefore this should be taken and applied in conjunction with the wider policies,
procedures, practices and protocols of the centre as well as the service user’s guide.
This ‘Statement of Purpose’ demonstrates Acorn Specialist Centre’s willingness to operate
within the requirements and regulations of the Essential Standards of Quality and Safety and
meet its outcome measures, which enhances the improvements developed by the National
Minimum Standards and the Standards for Better Health. Although registered under the service
type ‘Care Home Service with Nursing’ the centre will take in aspects of ‘Rehabilitation Services’
and ‘Long-term Conditions Service’ and this is further discussed within the model of service.
The ‘Statement of Purpose’ will be made available to Commissioning Services, current and
prospective clients, their families or representative, and any other parties such as stakeholders
with an interest in the centres care provision. Whenever any significant part of the ‘Statement of
Purpose’ changes, the Registered Manager will ensure that copies of the updated ‘Statement of
Purpose’ are provided to the regulating body and commissioning services within 28 days of that
change.
Acorn’s Vision
To actively contribute and give support to a positive care pathway that allows individuals
to direct their own care within a recovery model.
‘Statement of Purpose’ Version 4 February 2013
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
This is based on robust evidence and operates within a holistic and open manner in the way it
provides care. In demonstrating best practice skills, contemporary knowledge and therapies, the
specialist centre will, by its actions, minimise the illness impact to clients within a transactional
recovery model by making sure that:
 Working age dementias (18-75) will have the opportunity to be assessed against our
therapeutic programme and those with other types of dementia who would benefit will
also be offered placement.
 The care approach will specialize and seek new innovative ways to manage within a
recovery model, as well as treat, the psychological and emotional problems related to
cognitive impairment, illness and disorder caused by alcohol abuse.
 Develop understanding of illnesses and disorder comorbidity; staff will develop new
learning opportunities within the care provided and therapeutic options that maintain the
individual’s independent life choices, self-esteem, health and well-being.
 The Centre will develop an enlightened and well-motivated workforce that will be
underpinned by a dynamic approach to training and development within a learning
environment.
Acorn’s Objective
To provide a working environment that protect clients and staff from abuse or the risk of
abuse and individual human rights are respected and upheld.
As a service provider, Acorn Specialist Centre will take action to identify and prevent abuse
from happening as well as responding appropriately and in a timely manner if abuse is
suspected. Each staff member has a ‘duty of care’ to report any direct or suspected abuse, any
operational or clinical risks to care, health and safety and breaches to infection control.
This will be met by staff working:
 Within a ‘Learning Organisational’ model where treatment and care offered ensures it
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has the right leadership, effective and efficient organisational support, training and
development that meet healthcare standards, legislation and best practice models
suggested by the regulatory bodies;
By the use of appropriate assessment (both pre and ongoing assessments)that leads to
effective individual care plans that identify needs and provide safe treatment within a
therapeutic milieu;
Develop partnerships with commissioning services and stakeholders in achieving
common objectives in developing individual recovery;
Gain value from the resources by using evidence based research that promotes safety
and positive risk taking;
Challenge inequality and combat unlawful discrimination including monitoring of ethical
practice and embrace, respect and ensure understanding of diversity;
Committed to eliminating racism, sexism and all forms of discrimination and will not
discriminate on grounds of age, colour, disability, ethnic origin, gender, gender
reassignment, culture, health status, marital status, social or economic status, nationality
or national origins, race, religious beliefs, or non-beliefs, responsibility for dependents,
sexuality, trade union membership or hours of work
Provide appropriate (individual)‘person centred care’ within a recovery model;
Make the difference that counts to all who are involved in providing or receiving care
Recognises that this requires action through positive policies that redress inequalities
and meet all aspects of the Equality Act 2010; and
Cooperate with others involved in the care, treatment and support of a person who uses
services when the provider responsibility is shared or transferred to one or more service,
individuals, teams or agencies.
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
Acorn Principles
In all aspects of care, the centre will apply known best practice that offer clients
individual life choices that enhance both their health and well-being.
Through good workforce management the centre will provide effective recruitment and
workforce development that supports the therapeutic environment (within a learning
organisational model) and provide the opportunity, by employing quality staff that allows each
client to develop independence to their capability.
By assessing risk and proactively adapting the care process to meet client needs, will allow
individuals to be treated with dignity, respect, decency and holistically.
This will be achieved by:
 Provide accommodation and hotel services that meet individual needs;
 Provide effective personal care planning procedures and “Good Practice” policies with
appropriate care models within a range of effective interventions;
 Provide effective clinical audit & monitoring by implementation and maintain clinical
governance and quality assurance documentation;
 Act on concerns and complaints in a pro-active and effective manner;
 Implement and maintain effective procedures that protect and minimise against abuse;
 Maintain effective records in accordance with data protection, confidentiality and
freedom of information policies;
Ensure effective building maintenance and internal decoration;
Establish and maintain effective fire precaution policies and procedures;
Maintain clients’ personal and financial records;
Establish a transparent fee structure which is openly available and maintain occupancy
levels which ensure financial viability and sustainability;
 Notification of a death happening on the grounds of the Specialist Centre and the
individual is treated with dignity and care; and
 Staff will respond appropriately at all times in accordance with all Acts and Legislation
pertaining to the care being provided within Acorn Specialist Centre.
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Aims
Acorn Specialist Centre has been built to provide continuing care for persons suffering
from Working Age Dementia including Alcohol related cognitive impairment illnesses or
disorders with up to 22 single bedrooms, which are designed to provide a step up/step
down transitional rehabilitation programme.
Acorn Specialist Centre
Acorn Specialist Centre is designed to maximise space in a large Victorian house with modern
extensions that provide comfortable living, activity rooms for therapeutic programmes and life
skill development with a designated external smoking area. The grounds are large enough to
include a secure garden and a market garden to produce self-efficiency in organic fruit and
vegetables.
Every effort has been made within the building design to ensure that individual bedrooms are
comfortable and safe with the provision that each individual can develop their room with
personal furniture and mementos. Those clients assessed to have any degree of physical risk
will be located on the ground floor with a passive alarm system in their bedrooms if necessary,
which activates the nurse call system when the client gets out of bed at night. All bedrooms
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
have lockable doors and clients in accordance with the individual’s mental capacity and based
on a risk assessment may be given a key to their room.
Admission Policy (Pre-Admission and Admission Protocol)
The pre-admission and admission protocol ensures a formal and structured process of
assessment and transitional transfer of care. In the first instance, a written referral will be
discussed by the Acorn Specialist Centre Multi-Disciplinary Team (MDT) to ensure the client
needs can be met.
If the client is thought suitable, a pre-admission assessment will be carried out by a member of
the assessment team. The assessor will arrange a visit with the perspective client and family in
his/her own home, in hospital or a current residential unit. This will involve a review of the
medical and multidisciplinary notes, treatment and care plans, risk management plans and a
mental state examination. Following the completion of the report and discussion by the MDT
about meeting clinical care and treatment requirements, a decision on acceptance will be made
and shared with the Commissioning Service or individual requesting admission to Acorn
Specialist Centre.
Following the admission acceptance, an agreed ‘transitional care plan’ will be formulated which
will allow staff from Acorn Specialist Centre to work with the Commissioning Service, client, their
family or representative in orientating themselves to the Centre, the staff and other clients
where appropriate, prior to admission.
Staff Training
Staff will be supported to provide care and acquire updated skills and qualifications that are
relevant to their work. Staff will be supervised and appraised in relation to the work that is
undertaken. Training and gaining new experiences will play a crucial role in ensuring that risk
practises, treatment and care plans are fully implemented. The strategy for training will include
a staff induction programme, and on-going training for all staff in various aspects of clinical and
non-clinical care. It is possible that a client could be placed or arrives under an Order of the
Capacity Act 2005 (DoLS) due to their mental capacity and/or behaviours that could place the
client or others at risk and clients under an Order of the Mental Health Act who come from a
psychiatric facility on a mental health aftercare order. Staff training in challenging behaviour,
Mental Health and Capacity Acts will make sure that all staff respond appropriately to client
needs at all times.
The induction programme covers all aspects of mandatory training, staff and organisational
expected behaviour, with the development of specialist knowledge of persons suffering from
working age dementia. Induction and mandatory training highlights the main issues of risk and
safety. Clients with working age dementia may develop disorders that will often produce
challenging behaviour where there is a need for all staff to understand and apply de-escalation
techniques together with both theoretical and practical management of aggression.
Nursing and support staff training is co-ordinated by the Registered Manager who will provide a
calendar of training and updates specific to individual training requirements. Monthly
supervision and an evidence based practice training programme, which documents critical and
clinical evidential learning will be reviewed yearly.
Registered Provider
1st Care Ltd
90B Handsworth Wood Road
Birmingham
B20 2PL
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
Ownership
Acorn Care Home is owed by 1st Care Ltd. The Proprietor and MD for 1st Care Ltd is Mrs
Jagruti. The address for 1st Care Ltd. is:
90B Handsworth Wood Road,
Birmingham
B20 2PL
Tel 0121 554 5024
Email [email protected]
Web www.acorncarehome.com
Information regarding Jagruti Patel, Managing Director:
Qualifications: BSc Pham, MRPS. Relevant experience: Mrs Patel has some thirty years
plus in care home management and her clinical background is as a qualified pharmacist.
Responsible Individual
Mr Peter Hetherington
Contact details
As under ‘Owenership’
Information regarding Mr Peter Hetherington, Responsible Individual:
Qualifications
RMN, Cert Ed (FE), ENB998, Cert. Management, Cert Clinical Sup.
Relevant experience
Extensive experience in healthcare, which includes 31 years as a Registered Nurse. Direct
experience within the Care Home sector for over 20 years, this includes 7 years as a
Registered Home Manager and 10 years as Director of Operations for a Care Home
provider (1st Care Ltd). Responsible Individual for Orrell Grange Nursing Home (Liverpool)
since 2004. Orrell Grange is accredited at Five Stars (excellence) with Sefton local authority
(2009 to date). Also Responsible Individual for Stubby Leas Nursing Home (Staffordshire)
and Hawthorne Nursing Home (Nottinghamshire).
Range of Service Users previously worked with
Working with a range of adults with varying health needs. This includes supporting older
persons with mental health needs and younger persons with enduring mental health needs
and/or with challenging behaviours including open forensic environments.
Length of time with each group or category.
Over thirty years specialising in the care of adults with a mental health need.
Protect work, professional involvement, memberships and teaching experience
Have worked extensively in auditing and raising care standards, crisis resolve within health
settings and project management. Managed NVQ training and led a training & assessment
centre. Devised a teaching pack for the delivery of the core value unit for NVQ in Care and
has taught students of nursing and BTec Learners in Care. Former Member of Policy &
Procedure Committee for a large health care provider and Member of Steering Group for
Standards of Care for Adults with Complex needs.
Care Manager
Information regarding Mrs Elaine Jean Lancelott, care manager
Qualifications
RGN, SCM, RMA (level 4)
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
Relevant experience
Considerable experience as a nurse and as a care manager. Trained as a nurse locally in
Birmingham over thirty years ago and worked as nurse-manager within the NHS for some
16 years prior to care home management from 1992 to date. This includes managing a 40
bed home in Birmingham for frail elderly for 5 years and a 76 bed care home, also in
Birmingham with specialist dementia care units for some 8 years.
Elaine is in the process of applying for registration with CQC as a registered manager for Acorn
Organisational structure
Staffing Configuration
1 Registered Manager
1 Deputy Manager
4 Registered Nurses
2 Senior Care Assistants – (NVQ3 or working towards NVQ3)
10 Care Assistants – (NVQ2)
1 Administration
1 Housekeeper 1 Chef 2 Housekeeping
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
1 Laundry
1 Handyman/Gardener
Additional Support will be provided by 1st Care (HR and Payroll)
Medical Cover
The Surgery
2 The Slieve
Handsworth Wood
Birmingham B20 2NR
Pharmacist Cover:
All medicines are given safely, securely and appropriately and within published guidance within
polies and procedures. We have entered into an arrangement with a local Pharmacy. Our lead
Pharmacist is
Mr Surjit Pawar BPHarm(Hons)Lon,MRPharmS
Medex Health Ltd T /A Brutons Pharmacy
Head Office
101 High Street
Moxley
Walsall WS10 8RT
The services to be provided are as follows:
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A Monitored Dosage System (MDS) namely the NOMAD CONCISE monthly system
Provision of training and Standard Operating Procedures (SOP)
Prescription collection and delivery service
Supply of compliance aids for self medicating residents
Maintenance of patient medication records
Quarterly audits including medication audits, weight management, safe keeping of
medication, records etc
 Pharmaceutical advice and access to resources
 Medication Use reviews (Pharmacists involved are MUR accredited)
Management of medicines as per regulations and standards, wherever possible, clients and
staff will have information of the drugs function and contraindications and its prescribed use and
limitation as well as administration times.
Other external professionals who are available to attend the Centre include:
 Dentist
 Chiropodist
 Pharmacist
 Hairdresser
 Chaplain
 Mental Health Advocacy
Dealing with complaints, Comments and Suggestions
Acorn Specialist Centre takes complaints seriously and encourages comments and suggestion
as to further improve the services and address any issues of concern or uncertainty. It is also
important to respond appropriately as this provides the Centre with an opportunity to identify
and understand areas of concern to the health and well-being of clients, by staff, their families
or representatives.
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
The complaint policy clearly states the response following the receipt of a complaint and it will
be the centre’s intention to respond as per the policy in a timely manner and there will always
be a senior person on duty to receive concerns or a direct complaint. If individuals are not
satisfied with the response, a complaint form and an envelope addressed to the Registered
Manager will be provided who will investigate the complaint in line with the Centres complaints
policy.
An initial response will be forwarded within five working days. Pending further investigations the
manager will respond with the outcome detailing any actions required to resolve the issue within
28 working days. If any individual feels the issue has not been resolved or handled
appropriately, they may also raise the issue with:
Care Quality Commission at National Correspondence,
Citygate,
Gallowgate,
Newcastle upon Tyne, NE1 4PA,
Telephone the National Contact Centre on 030000 616161 or email to [email protected]
The notice board in the reception area will have a clear statement of the Centres complaint
concerns and suggestions procedure and the complaint form and envelope available at the
reception.
Acorn Specialist Centre will maintain and operate a complaints procedure in accordance with
relevant policy based on recommendations made by the Care Quality Commission (CQC)
Nursing & Midwifery Council (NMC) and National Institute of Care of Excellence (NICE) and
ensure that there is no discrimination against anyone for making a complaint. Annual audits in
respect of complaints procedures will be provided and reviewed by the appropriate
management committees of:
 Staff Training and Development,
 Clinical Care
 Management and Governance
 Development
As part of the ongoing clinical management a monthly meeting between the centre’s client’s and
management will take place where comments and suggestions will be discussed to resolve any
issues that may, if not discussed, turn into a complaint. There is a comment and suggestion
box in the reception area if a client wishes to remain anonymous. This box will be cleared of
contents for each meeting.
Safeguarding
This policy applies to all levels of staff in the involvement of vulnerable people aged 18 years
and over. The underpinning guidance is provided by the document “No Secrets” which makes it
clear that “abuse is a violation of an individual’s Human and Civil Rights”. Where the Council of
Europe defines abuse as “any act or failure to act, which results in a significant breach of a
vulnerable person’s Human Rights, civil liberties, bodily integrity, dignity or general wellbeing;
whether intended or inadvertently; including sexual relationships or financial transaction to
which a person has not or cannot validly consent or which are deliberately exploitative”. Each
staff member needs to understand the role of the independent Safeguarding Team and their
duty of care and responsibility to report any act or suspected act of abuse to the Registered
Manager who will report such acts to the Safeguarding Team.
This statement is written with a broad approach as it is impossible to cover every eventuality
and each allegation or incident will be dealt with on its own merit.
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
(It is not the Registered Manager or seniors’ job to interview or have any discussion with the
staff member or client about any allegation of abuse; this is the Safeguarding Team’s
responsibility).
All abuse or suspected incidents of abuse need to be reported to the Safeguarding Team as
soon as it is known. Who carries out the investigation will be determined by the Safeguarding
Team and will investigate the allegation of abuse and what level of response is necessary, but
the main role is to make sure that the victim is protected, if abuse had been taking place that it
has been stopped and the appropriate action has been taken.
Model of Service
The service model will be appropriate to the Centre’s defined client group (working age
dementia and alcohol related cognitive impairment, illnesses and disorders) and will be agreed
with each Commissioning Service. The service model will include the components in Table 1.
Table 1: Service Model
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Therapeutic Community ethos
Care Programme Approach
Multi-disciplinary working
Interagency working
Advocacy
Referrals
Risk assessment and management
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Physical environment and security
Pre-admission protocol
Admission protocol
Treatment care plans
Throughput arrangements and protocols
Discharge arrangements
Aftercare formulation
Up-to-date operational policies and procedures will be made available to relevant bodies on
request.
A Care Pathway protocol will be in place and made available to the Commissioning Service
and/or referring agencies. Acorn Specialist Centre retains the authority to determine client
access and termination of contract due to physical or psychological risks not able to be met by
the Centre within agreed contracts.
A recovery-focussed therapeutic community model will be integral to provide treatment and care
that will support individuals by:
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Understanding the therapeutic community ethos
Focusing on the person and adapting through a stepwise progression;
Monitoring outcomes rather than performance;
Emphasising strengths rather than deficits or dysfunction;
Combating stigma;
Fostering collaboration between those who need support and those who offer support
and is not coercive;
 Enabling and supporting self-management; and
 Promoting autonomy and, as a result, decrease the need for people to rely on formal
service and professional supports.
During periods where it is necessary to increase a client’s level of observation the Centre will
endeavour to respect their privacy and dignity whilst maintaining well-being and quality of life.
Consideration will be balanced against clinical risk and where this is temporarily withheld, will be
restored at the earliest possible opportunity.
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
Notification of any person going absent without leave (AWOL), notifiable infections, abuse and
incidents/accidents as listed in the policy and procedures will be acted upon in a timely manner
and reported to the appropriate people or authority body.
As part of the service model staff development and training becomes an important part of the
client’s care as well as the team approach in obtaining and maintaining best practice. As part of
reaching stated standards, each staff member has a duty of care to maintain their skills to meet
individual client care. This places a responsibility on the senior staff to maintain vigilance and
support to junior staff to make sure that quality care practices are maintained.
The importance of maintaining the client’s care plans with factual information about the
individual’s day-to-day care, allows reviews to update care to meet the clients changing needs.
Monthly audits allow, not only that the entries meet the prescribed standard, that it also provides
evidence that the care plan is meeting individual client needs.
Monthly supervision of all staff by appropriate senior staff and a yearly staff development
programme provides each staff member the opportunity to improve knowledge and improve
individual skills to benefit the care clients receive.
Evaluation of Care
 Monitoring the programme treatment integrity and delivery will be an integral part of
service provision;
 There will be ongoing evaluation of the treatment’s impact on clients and staff delivering
the treatment programme;
 Recognised Clinical Outcome scales will be used to measure clinical progress; and
 Evaluation of the short and long term risk effects of therapeutic interventions will be
monitored and used as informed service delivery expectations and reliance for ongoing
improvement.
Clinical review process (Personal Care Plan)
The Centre will implement a full Clinical Review Process to reflect the individual needs of all
clients (Care Programme Approach and National Service Framework NICE and CQC
guidelines). All clients will have a review when necessary or a review every three months and
discussed at weekly clinical team meetings.
Physical Health Monitoring for clients
Developing and maintaining optimum physical health as part of the holistic care intervention
strategy. Severely mentally and cognitive impaired clients have been found to have greater
rates of physical illness than the general population. Epidemiological and clinical studies have
demonstrated that various psychological factors can influence and exacerbate physical illness.
The Centre will provide measures to try to ensure that physical health is maintained; problems
recognised and any deviation from the individual’s normal base-line of physical functioning will
be quickly detected and treated accordingly. All clients will be reviewed regularly and as
necessary by the dedicated GP service.
Clients will also be able to access a wide range of (NHS) healthcare services, as appropriate.
These include; dentist, physiotherapist, chiropodist, dietician, optician and any other specialist
provision as required.
All clients will have a quarterly health review, documented in the individual’s care management
notes, which will include general base-line observation, (weight, blood pressure, pulse,
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
monitoring), blood testing may also be required, in addition to the above, clients will be offered a
full annual health screen by the GP.
Health education will be promoted within the therapeutic programme. Opportunities will be
provided within the care programme to participate in regular exercise. Healthy eating will be
promoted and special dietary needs will be catered for.
Risk Assessment
Risk Assessment and management will incorporate the principles of areas for concern, risk
reduction, risk elimination, risk evaluation and a recognised risk communication process. An
up-to-date Risk Assessment will be in place in each individual’s care plan to support clinicians in
making day-to-day decisions about individual client’s care.
The service will implement and maintain a risk assessment model to support the evidence and
develop and monitor the Centres Improvement Plan. This will detail the provision of staff
resources and other resources required to safely and appropriately minimise risk issues, and
set down a contingency management plan in case of untoward events.
All available and suitable equipment needs to be safe and no client should be placed at risk
from unsafe or unsuitable equipment or by bad practice of medical and non-medical equipment,
furnishings or fittings. Training is provided to all staff and auditing of the effective use of
equipment will be reviewed monthly.
Risk reduction will be assessed and evidenced throughout treatment providing a clear care
pathway. The individual’s care plan is developed from the risk assessment and presented to
and discussed with the client and his key worker/clinician. MDT and any agencies or services
that the client will access as part of the individuals rehabilitation will also be consulted.
Staff will participate in CPA Reviews, where necessary, share any findings and
recommendations with Commissioning Services that changes the care being provided. The
Centre will ensure that the National Suicide Prevention Strategy complying with the DoH
Guidance on ‘Management of Violence and Aggression’ is in line with; The Mental Health Act
1983 (2007) Capacity Act 2005 and Criminal Justice Act 2003.
Confidentiality
All staff that work for the Acorn Specialist Centre will not disclose to any third party information
which concerns the identity or personal details of any individual without that person’s consent,
except where legally required doing so. Confidentially is a crucial part of maintaining the client’s
anonymity and should only be discussed with people who need to know as part of their
treatment and care provided at the Centre. All Staff, as part of their induction, are provided with
the Centres policy on confidentiality and the consequences of it being breached.
Auditing and Monitoring
In order to audit and monitor the quality and safety of the service, regular monthly checks are
undertaken by the Registered Manager or a nominated person and independent contracted
services annually by the registered provider. The areas which are monitored include:
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Health and safety including clinical accident/incidents;
Infection Control
Clinical Issues including medication and health and welfare;
Operational Audit;
An action plan is reviewed and updated following each audit; and
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
 A copy of the report(s) go to the monthly management meetings for discussion; and the
Clinical Governance body who sets and monitors standards of practice throughout the
Centre.
Security
The Centre security shall ensure that the following are provided at all times:-
 The entrance to the Centre will be via a secure access via the reception and visitors,
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contractors and any other person needing to do business or see a client can be safely
escorted into the centre;
Security checks (I.D. etc.) will be undertaken on all visitors to the Site and will be
entered into a visitor’s log;
Clients’ visitors may be searched for contraband if risk assessment identifies need;
There will be a regulation of people and restricted items into the secure perimeter of the
Centre. This will be governed by Acorn Specialist Centre’s policies on visitors and
prohibited items and search procedures;
There is limited access to parking facilities and will be at the owner/drivers own risk; and
Where the fabric of any part of the building of the Centre acts as part of the secure
perimeter, the specification shall be such that it will prevent external access to the
Centre ensuring that contraband items cannot be passed over a fence/wall or through a
window.
Internal environment of the Centre will ensure the following:
 Areas such as bedrooms, corridors, bathrooms and toilets are provided as outlined in
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‘Safety, Privacy and Dignity in a Centre guidance on mixed sex accommodation (not
applicable) for mental health services (National Executive, 2000). The Centre at this time
is male only, but if this changes appropriate notification and timelines will be applied
prior to this happening;
Provision of exercise space with access to fresh air within the service perimeter;
Educational, rehabilitation, therapy and recreational facilities for clients sited within the
Centre;
Provision of alarm systems appropriate to the functions of the Centre and procedural
security checks (insecurity policy);
Locked doors to regulate access and movement of clients and visitors within the Centre;
Specific child visiting area, supported by specific policy within the Centre, but not within
a clinical area;
Effective designs based on a risk assessment of the environment e.g. pipes, wires,
heating are hidden and inaccessible to clients;
Wall mounted emergency buttons with audio/visual output are installed as they also offer
protection for clients.
Religious needs
Through comprehensive care planning, religious needs of the clients are identified. Clients who
are able to use community facilities will be able to attend religious services at local places of
worship of their choice. A Minister of Religion of the client’s choice will be contacted to attend
the Centre for those clients unable to access the community regularly or unescorted.
Specialist Therapists
Any specialist therapies or non-typical therapeutic interventions will only be administered
following a comprehensive review with the client and the multi-disciplinary team. Acorn
Specialist Centre will act at all times in accordance with the Mental Health and Capacity Acts
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
and other legislation pertaining to specialist needs. It is recognised that obtaining full informed
consent from the client is fundamental if the individual has the capacity to do so.
Client Satisfaction
All clients will be encouraged to play a part in the development of the service and the Centre will
hold weekly community meetings in order to gain a collective opinion of progress as well as
individual perceptions of the service. A ‘suggestions box’ is located in the reception area in
order that clients, family or representatives may raise issues anonymously. A client, family
representative, Commissioning Services and other stakeholders’ satisfaction survey will be
requested annually and the information collated and used to improve the level of service.
It is important that all clients feel that their views are listened to and acted upon. It is imperative
that all views are given importance regardless of where they came from. Staff must be able to
demonstrate that they listen and act upon client’s views, encourage discussion and act on
issues raised. The Organisational management within the Centre will create an open, positive
and inclusive atmosphere in order for clients to benefit.
An individualised approach tailored to the client’s preferences, circumstances and resources is
critical. The Centre’s open philosophy increases opportunities for the client to feel more involved
in planning their own care, and empowered during the care or treatment process.
Clients Relatives or Representatives
The Centre values and recognises the importance of the opinions of relatives and significant
others. Regular discussions will be held and questionnaires distributed. As part of the
therapeutic community programme clients are involved in the opportunity to play a key role in
their own treatment. This will also involve forming strong family related networks and an
opportunity for relatives to become a member of the Relative Committee.
Great emphasis will be placed upon the links with the client’s family and friends and uppermost
at all times will be the client’s wishes. Visitors will be welcome at appropriate times and visiting
rooms and areas are available away from the main areas. Some relatives and some clients
may not want this level of engagement and we understand the impracticality at times and that
there may be many reasons for this.
In maintaining contact with friends and relatives, the decisions to prohibit a visit by a person
who the client has requested can be regarded as a serious interference with the human rights of
the client and can only be made in exceptional circumstances. Any decision to exclude a visitor
will be fully documented and available for independent scrutiny. The Mental Health Act
recognises two principle grounds, which may justify the exclusion of a visitor and these will be
reflected in the Centre’s Operational Policies. These grounds for exclusion are identified as
being (1) restriction on clinical grounds dictated by the Multi-disciplinary Team (2) restriction on
security grounds that places the client or others at risk.
The Centre has identified written policies pertaining to arrangements for the visiting of clients by
children under the age of 16 years. A visit by a child will only take place following a decision
that the said visit will be in the child’s and client’s best interest. The well-being and
development of the child is paramount. The decision to allow such visits will be based on a
multi-disciplinary risk assessment and will be reviewed on each request.
Client Relationships
It is recognised that physical relationships between clients can be open to manipulation,
particularly where a client is vulnerable due to their presenting mental state or illness.
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
Relationships between clients will be closely monitored and supervised whilst respecting the
individual client’s human rights.
Encouragement of appropriate social relationships and every opportunity will be made for
clients to develop positive interpersonal relationships with their fellow peers.
Advocacy
Through the implementation of the advocacy system, it is intended that clients may use an
advocate if a complaint needs to be raised with the clinical team. Leaflets will be provided to
clearly identify the use of an advocate.
Contact names and addresses
Heart of Birmingham Voice Advocacy Scheme
17 Braithwaite Road, Sparkbrook, Birmingham, B11 1LB
Tel: 0121 212 8424
Email: [email protected]
Care Quality Commission
Citygate,
Gallowgate,
Newcastle upon Tyne, NE1 4PA
Telephone the National contact centre on 030000 616161 or Email [email protected]
Mental Health Act Commission: Is now under the Care Quality Commission and can be
contacted on the CQC web site, telephone numbers and email
Quality Assurance
Acorn Specialist Centre will carry out the services in accordance with best practice and shall
comply in all respects with the standards and recommendations:
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Issued by the National Institute of Clinical Excellence;
Issued by Care Quality Commission or any other relevant professional body;
From any audit and Adverse Incident Reporting;
Healthcare Standards;
Work towards the Investors in People Standard;
Work towards the ISO 2000 Standard; and
National Guidance, Policies and Procedures, which relate to service provision.
Acorn Specialist Centre shall ensure that all staff adherence to such standards and
performance is routinely monitored so that remedial action is promptly taken where such
standards are not attained. Clinical Audit is an integral part of service provision / culture in order
to monitor service responsiveness to the various aspects of care. Effective monitoring of clinical
care with high quality systems for clinical record keeping and the collection of relevant
information is maintained at all times.
Assessing and Monitoring the Quality of Service Provision
Acorn Specialist Centre will:
 Identify, monitor and manage risk to people who use, work or visit the service;
 Take professional advice about how to run the service safely, where Acorn Specialist
Centre does not have the expertise or knowledge;
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
 Take into account comments and complaints, investigations into poor practice and
records held, advice and reports from the Care Quality Commission;
 Attend and participate in Contract Review Meetings with Lead Commissioners;
 Allow Commissioning, their servant or agents to attend and inspect the premises or
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when required, for the purposes of quality monitoring visits;
Allow Commissioning, their servant or agents to attend and inspect the premises in
direct response to incidents or to preserve Lead Commissioners confidence in service
provision.
Allow Commissioning, their servant or agents the right to initiate and commission
independent service and specific incident reviews;
Ensure that clients are involved at managerial and monitoring levels of service provision;
and
Provide reports requested by Lead Commissioners to further explore trends highlighted
by Key Performance Indicators (KPI’s.).
Acorn Specialist Centre will improve the services offered by learning from any adverse events,
incidents, errors and near misses as well as the outcomes from any complaints to improve
service outcomes.
Acorn Specialist Centre will ensure compliance with the Essential Standards of Quality and
Safety and its Outcome Measures as well as any other pertinent best practice guidance and will
self-review performance against the standards on an annual basis. The results will be
published in a local report and shared with the CQC, Commissioners and other relevant parties,
to reduce the need for repetition.
Client Satisfaction
Acorn Specialist Centre will provide a system for monitoring and reporting client views and
presented in the annual report on client satisfaction surveys and the results will be sent to the
Commissioning Services and made available on request.
Documentation and Good Record Maintenance
All clients’ personal records with documented care plans and all medical and personal care are
accurate, fit for purpose, are held securely and remain confidential.
All records will be kept in line with appropriate policies and procedures and made available to
the Care Quality Commission for inspection of documents in relation to the management of
client regulated activity.
Serious Untoward Incidents
Serious Incidents will be notified to the Commissioning Services and Protection of Vulnerable
Adults as appropriate with a review report subsequently prepared and shared as per policies
and procedures. Where a report raises a commissioning issue; the matter will be included at the
next review meeting with the Commissioning Services and an appropriate response agreed.
Freedom of Information
Appropriate safeguards to govern access to and storage of confidential client information as
recommended in the Caldecott Report and the Data Protection Act 1998. Information will be
made available as per the Freedom of Information policy.
Race Equality / Cultural Sensitivity of Services
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Acorn Specialist Centre for working age dementia and cognitive impairment, illnesses and disorders caused by alcohol abuse
The Centre is committed to equal access to the services provided by Acorn Specialist Centre for
clients from all ethnic (BME) groups.
Acorn Specialist Centre will ensure there is absolute compliance with the Race Relations Act
1976 as amended and the Guidance for Ethnicity and Diversity as provided by the Commission
for Racial Equality. Progress on these matters and issues identified will be monitored via regular
review meetings.
Further Service Requirements
Acorn Specialist Centre shall ensure that:
 The Mental Health Act 2007 and Criminal Justice Act 2003 are complied with, and all
child visiting arrangements adhere to HSC 1999/222 ‘Mental Health Act amendments
2007 and its Code of Practice: ‘Guidance on the visiting of psychiatric clients by children’
and any amendments;
 Demonstrate adherence to the Research Policy Framework, as specified by PiC
Research and Ethics Committees; and
 The centre complies with any subsequent or successor guidance, Acts and any
prevailing law that effects the Centre carrying out its duty of care.
Full address and contact details
Acorn Specialist Centre
88 Handsworth Wood Road
Handsworth Wood
Birmingham B20 2PL
Tel: 0121 507 1763
Fax: 0121 554 4624
‘Statement of Purpose’ Version 4, February 2013
Email [email protected]
Web www.acorncarehome.com
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