Inspection on 09/06/09 for Acacia House

This is the latest available inspection report for this service, carried out on 9th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Acacia House 20/02/08

Similar services:

St Joseph`s

Ridgemount

Wingham Court

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Acacia House Ashford Road St Michaels Tenterden Kent TN30 6QA Lead Inspector Mary Cochrane Key Unannounced Inspection 9th June 2009 09:30 DS0000070676.V375730.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Acacia House Address Ashford Road St Michaels Tenterden Kent TN30 6QA 01580 765122 01580 765455 acacia@1stchoicecarehomes.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 1st Choice Care Homes T/A Acacia Number 1 Ltd Manager post vacant Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Physical disability (PD) The maximum number of service users to be accommodated is 41. Date of last inspection 30th July 2008 Brief Description of the Service: Acacia House is a large, detached and extended house set in well-maintained gardens. Acacia house provides personal and nursing care for 41 residents. It the owners’ intention to phase out the residential beds and in due course provide nursing care only. The home is on two floors connected by a passenger lift. It provides mainly single rooms, some with an en-suite. There are three shared rooms. The home provides two lounges, a dining area and a quiet room with views onto the garden. Car parking is provided. The home is located on the outskirts of Tenterden on the A28 and is served by public transport. The nearest local amenities are approximately half a mile away. Current weekly fees range between £379.00 and £900.00. Additional charges are made for hairdressing, toiletries, newspapers and chiropody. Information on the Home services and the CQC reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The last key unannounced inspection on this service was completed on 30th July 2008. This visit to the service was an unannounced Key Inspection which took place over one day. We stayed at the home for about 8 hours. The manager and operations manager were available throughout the site visit. The people living at the home and the staff on duty were helpful and cooperative. The visit included talking with residents, relatives and the staff team. They told us things about the home and the support and care they receive and give. General observations were made during the day of how people are supported. We observed how staff supported residents during social activities and when offering care. We looked at and discussed residents individual support plans and their risk assessments and saw some polices. We also looked at staff training records and the homes quality assurance. During this visit, we looked around part of the home. Before we called to the Service, we sent surveys to people who live there and to members of staff and professionals who visit the service. We wanted them to tell us what they think of Acacia House An annual service assurance assessment (AQAA) was also sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people who live at the home. The AQAA we received was completed by the previous manager of the home. We also took into account the things that have happened in the service; these are called notifications and are a legal requirement. We also looked at any complaints received and any issues that affect the safety of the residents. Since the last inspection there has been a social services led safeguarding adults’ alert at the home. This means that concerns have been raised about the home and they are being investigated by the local safe guarding team. This is to make sure the people living at the home are safe and their needs are being met. They have had advice and input from multidisciplinary agencies. At the time of the inspection the alert remained open. Further visits by specialist teams will continue to the home to monitor improvement of the service. This will ensure the residents are being well cared for. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 6 What the service does well: Acacia House provides a friendly, homely and comfortable environment for people to live in. The majority of people living there appeared relaxed and content in their environment. The home makes sure that people have the information they need about the service and what is on offer. People are fully assessed before they come to stay. This makes sure the service can give them the support and care that they need. Family and friends are welcome at the home and are encouraged to be involved in the care of their relatives. The majority of residents have their own room. There are rooms that can be shared by 2 people. If people want to they can bring in personal belongings, which make them feel more comfortable and at home. Residents and relatives told us that the staff are very kind and good. They said they are treated with respect and dignity. We observed this during the inspection. Some relatives told us if they have any concerns they are acted on promptly. What has improved since the last inspection? What they could do better: Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 7 The personal and health care/support required by some people is not being consistently monitored and met. The systems that are in place to check that care planning is being effective are not picking up the shortfalls. Some care plans have not been updated to reflect changing health and personal needs of people. This means that people may not be getting the appropriate and correct care and support. The home needs to make they monitor the effects of medication when it is given for pain. This will make sure that pain relief is effective and people are benefiting from the medication they are taking. The staff need to have guidelines in place when giving medication on a ‘when required’ basis this will make sure that medication is given consistently and for the reason it was prescribed. Processes and procedures in the home do not protect the residents from all types of abuse at all times. This means that people are at risk, as their care needs may not be planned, monitored and reviewed. People told us that sometimes they have to wait a while to get the help that they need. But they said staff come as quickly as they can. Staff residents and relatives told that at times there is not enough staff available to get to people quickly. There needs to be evidence on all staff files that they have had the appropriate safety checks to make sure that residents are protected. The management of the service have not identified some of the shortfalls highlighted in this report. Quality assurance are not fully developed to make sure the people living at the home and stakeholders views impact on the improvement and development of the service. The quality assurance systems are not robust enough to make that the home is being run in the best interests of the people who live there. At the time of the visit the staff were not receiving the supervision they needed to make sure they are supported to their jobs effectively and safely. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking of moving into Acacia House are assessed and asked about what support they need and how they want this to be given. They will only be admitted if the home are confident of meeting these needs. EVIDENCE: The home has a Statement of Purpose and a Service Users Guide. The Statement of Purpose contains the information needed. It sets out the objectives and philosophy of the service and is up to date to reflect the present situation in the home. The Service Users Guide has been reviewed and updated and contains information to assist people in making a decision about whether the home is the right place for them to live. The manager told us she is in the Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 10 process of making sure existing residents have an updated copy of the guide. It does include information on how to make a complaint. We looked at the pre- assessments of 3 people. The service has developed an assessment format which looks at the person as a whole. It identifies the persons care/support needs and also looks at other aspects of their lives. It gives information about their past, their likes and dislikes. People’s pastimes, religious and cultural preferences are respected and acted on. The assessments also look at nutrition, skin integrity, cognition and behaviours The home also uses the assessment undertaken by the local care management team. All this information is brought together to make a decision as to whether or not the home will be able to look after the person and it is used to form basis of a care plan. Once the person arrives at the home a more ‘in-depth’ needs assessment is completed by the nursing staff. These are used to develop a care plan for people. The assessments do focus on what people can’t do instead of looking at what people can do and the support they need from staff to be as independent as possible. The home does not offer intermediate care Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be sure they will receive all the personal and health care they need. They are supported by a multi-disciplinary health care team. The ethos of care ensures that residents are treated equally and with kindness and respect. EVIDENCE: We looked at 3 of the care plans in detail and for specific information in 3 other plans. We found that there are shortfalls in the personal and health planning for the people who live at Acacia House. We found that the majority of people living at the home did have a care plan but we found that one person did not have one. Assessments had been done but these had not developed into a care plan. There was no guidance or Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 12 direction in place to tell staff how support and care for the person in the way that they prefer. The plans we saw focussed on what people can’t do instead of looking at what people can do. They did not promote independence and do not maximise people’s abilities. Some were done to a better standard than others. Some contain information about how people like to have things done and give direction and guidance to staff about how to best meet their individual needs. This is some of the evidence we found in the care plans we looked at. We found that in some cases care needs that had been identified in the assessments had not been transferred into the plans. One person was identified with having several medical problems but there but there was nothing in the plan to say this was being monitored and how the staff were supporting the person to make sure their needs were met. There was specific instructions in the care plans of 2 other people but we found that there was no evidence to show that the instructions had been carried out at the necessary intervals. This means that we do not know if the people received the care that they need. We found that some of the plans are not up-dated to reflect the changing needs of the people living at the home. This will mean that residents are at risk at not having the care they need or receiving care that is not in their best interest. We found that there was no evidence in place for some residents to show that they had received the personal care that they needed. The home mainly relies on charts to indicate that personal care needs have been met. Some of the lists were incomplete and were not dated. They were not kept with the care plans so staff are unable to cross reference what they were supposed to do and the frequency they were supposed to do it. Care plans are not being used as a daily working tool. Some plans contained a lot of detail on how wounds are to be managed and there were risk assessments in place for nutritional needs, skin viability and manual handling. These are reviewed monthly. People are weighed regularly. Daily records are kept but they are clinical do not give a clear picture about how residents spent their time and do not relate to the individual care plans. The home does have a task orientated, clinical approach, they are not holistic. At the time of the inspection the manager and operations manager recognised this. They also were said that they would be undertaking audits on the care plans to make sure they contained all the information needed to give the necessary support and care to the people living at the home. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 13 Each resident is registered with a local G.P. and any area of concern related to health is referred to the G.P. The manager told us they have just started an ‘enhanced team service’ with the local doctor’s surgery. This means that people will see a doctor within three days of coming to live in the home. A complete medical assessment will be done at this time. The doctor will then visit the home twice a week to see anyone who has any medical needs. This means the service are being proactive and are trying to anticipate prevent conditions escalating. They are also developing individual ‘snatch’ files to keep urgent and pertinent medical information so that if the person goes into hospital all relevant information goes with them. The residents have contact with the specialist services and we were told that they have a good relationship with visiting professionals. This means that people at Acacia House are well supported and can easily access the specialist services when they need them. Visiting professionals reported that there have been improvements to the standard of care delivered by the home. One care manager told us, “the home contacts us if there is a problem. They are very hospitable. Communication has improved. I am impressed with how staff treated and spoke to residents. Things seem to be improving at Acacia House”. The residents have regular appointments with opticians, a chiropodist and dentists. We looked at the medication procedures in the home. Some aspects of this have improved since the last inspection. This means that there is evidence in place to show that people receive their medication on time and it has been stored correctly and safely. Trained nurses administer medicines to people who receive nursing care. Some people living at the home do not require nursing care. Senior care staff have been trained to give these people their medication. A sample of prescription sheets was seen. All prescriptions sheets had been signed to indicate that residents had received their medication on safely and on time. This was a requirement at the last inspection and it has now been met. The recording of receipt, administration and disposal of drugs is sufficient to allow an audit trail. Controlled drugs are disposed according to legal requirements. Medication is now stored at the correct temperature in the clinical rooms and this is monitored. This requirement from the last inspection has now been met. Some of the people living at the home are prescribed medication (this includes pain relief, topical creams, eye drops) on a ‘when required’ basis. There was an Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 14 absence of instructions for staff to guide them when giving out ‘as required medicine. There was no monitoring system when pain relief was given to people. As the resident group have varying communication difficulties, staff would be expected to observe and record the effect of such medication by using the guidance that should be in the care plan. We were told by staff that when people go out for a day they are not given their medication to take with them. The staff sign to indicate it has not been given. The manager of the home told us she thought the medication went out with people. She said the company has policies and procedures about this. This means that people are missing their medication. We also found that people who were independent and able had not been given the option to self medicate if they wanted to. The operations manager told this would be looked into as the facilities and policies and procedures are in place to accommodate this. Most postal survey comments from residents and relatives about privacy and dignity were positive. We saw that people were taken to their rooms for private consultations when the doctor came. We saw staff knock on people’s doors before they went in. Through observation and from talking to the residents and staff there was evidence to show privacy and dignity is up-held for the majority of the time. Some staff were observed assisting the residents in a caring and supportive manner and were seen treating them with respect and understanding. Some members of staff were observed demonstrating good body language and communication skills when interacting with the residents. Members of staff spoken to confirmed an understanding and commitment to caring for older people. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are activities for people to do if they wish. People are free to receive visitors. Good quality meals are served. EVIDENCE: There is an activities organiser working at the home part time. She oversees a weekly activities plan, which includes in-house activities such as reminiscence, cooking, bingo and quizzes and entertainment with singers, musicians and pets. She also told us that she does one to one work with people who do not wish to come to the communal areas. We saw some activities taking place during our visit and people were joining in with support from staff. At the time of the visit a Summer Fayre was being organised. The activities person keeps record of the activities people have done. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 16 Some of the people go out independently and some are supported to go to local day centres. People are encouraged to go out on trips with their family and friends. People told us that they enjoy the activities that happen at the home. One person said “you can usually find something to do”. Another said “I would like more company sometimes the staff have time to chat”. One relative told us they would like to see more stimulation for people who are bed bound. From the surveys we received people did tell us that activities in the home are getting better. Residents are encouraged to maintain contact with family and friends and are able to receive visitors in the privacy of their own room if they wish. The staff were observed making visitors welcome and involved. Some relatives told us that they are kept up date with what is happening. Some people said they had to ask. We did see that some people had their own telephones in their rooms. This means that they were independently able to ring and chat to people whenever they wanted. The people we spoke to felt they are able to have some choice in regards to their day-to-day life’s’. Examples given were that they could get up and go to bed when they liked. They could choose what to eat and where to eat their meals. Generally they felt happy with the limited choices they are offered. The manager told us that people are able to choose how they decorate their rooms and choose what they put in them. We did see evidence of this. The home does need to evidence and demonstrate more how it offers more diverse choices to people so they are encouraging them to be as independent and in control of their lives. All residents and their relatives are invited to attend residents meetings, which are held at regular intervals. The meetings give people the opportunity to express their views and make suggestions regarding their care at Acacia House. They can also to make suggestions on how the service can be improved in any way. The home has a full time cook who works five days a week and a part-time cook who covers the other two days. Menus have recently been reviewed and people were given choices about what they want to eat. There is a daily set Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 17 menu and choices are always available. We observed the end of a lunchtime meal in the dining room. People told us the food is good they enjoy and look forward to mealtimes. There was a friendly, relaxed and sociable atmosphere. The tables and the food were well presented. Staff were available to offer discreet assistance if required. People were given time to eat their meals without feeling hurried. Staff were seen to ask people what they want and offer them a choice of food and drinks. The service does not keep a daily record of the diet taken by everyone at the home. They keep a dietary record of people who have been identified as at risk of poor nutritional intake or have specialist requirements. The operations manager told us that peoples nutritional needs are reviewed monthly and if any problems or issues are identified then a more accurate and detailed record of their dietary intake will be kept so they can monitored and the appropriate support given. The home do not keep a record of the time people have their breakfasts and when we looked in care plans at we could not see the information about what time people prefer to eat their breakfast. We were informed through surveys that people sometimes have their tea at 5.00pm and then nothing to eat till breakfast the following morning at 8.00a.m. The manager told us that people are offered milky drinks and snacks late evening but because the home does not keep a record of all the residents’ diet they could not evidence that people had been offered or accepted the drinks and snacks. This means that people may be going for long periods of time without a drink or snack. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are confident complaints will be listened to and dealt with appropriately. They cannot be sure they will be protected from all forms of abuse. EVIDENCE: The home has a complaints procedure, which meets the national minimum standards. The complaints procedure is available. Since the last inspection there has been one complaint made directly to the home this has been actioned and resolved. The Commission have directly received three complaints about the service. We referred two of the complaints back to the provider to investigate and one was reported to the local safe guarding team at social services. The manager and organisation has dealt with the two complaints according to the homes complaints procedure and these issues have been dealt with and resolved. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 19 The majority of residents and relatives told us that they feel their complaints are taken seriously and acted on. One relative said “I discuss any concerns directly with the nurse and she sorts things out as soon as a possible”. The complaints, investigations and findings are recorded. The manager told us the information is passed onto staff in meetings so the home can improve its practises. We were told that issues are often raised in family and residents meetings. People said the manager deals with these promptly. They said that this has improved. The home told us that it has policies and procedures relating to safeguarding adults, which staff are introduced to when they first come to work at the home. The majority care staff have received training in safe guarding adults and there is training planned for those who have not yet received it. Staff were able to tell us about abuse and what they would do if they if they suspected or evidenced that someone was not being treated as they should be. Staff told they knew about the whistle blowing policy. There has been one safe guarding adult alert raised since the last inspection visit. The local social services have responded to this. This means that a complaint is being looked at by the local social services safe guarding adults team. A meeting has been held in conjunction with the management of the home. The concerns have been investigated and subsequently the home is developing an action plan, which is being implemented. The management of the home is working pro-actively. The home is being monitored by specialist services to ensure the improvements continue and people are getting the care and support they need. At the time of writing the report the safe guarding adult alert remains open. Specialists who have visited the home generally said that the home is moving in the right direction. They said and standards of care have improved for those who live there. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. The home has policies and procedures in place to assist in and support people to manage their finances. The policies and procedures protect people from financial abuse. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,24,25 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service continues to improve and maintain the environment to provide people with a comfortable, homely and safe place to live. The residents benefit from a clean environment. EVIDENCE: We looked around different areas of the home. We looked at all the communal areas and some of the residents bedrooms. Acacia House is set in pleasant surroundings with large, well-maintained gardens. Since the last inspection Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 21 improvements have been made to the homes environment and the requirements have been met. The manager told us that access to the 2 large ponds is now safe and the gates are secure. Residents who occupy the ground floor have decisions whether they want net curtains on their windows to give them more privacy. The hallway, lounges and dining room are large, decorated and comfortable rooms in which to spend time. The home has a programme for the maintenance and they are working through it. Some carpets have been replaced with new flooring and plaster work has been repaired. There is a new wet room downstairs which allows easy assess for people who wish to have a shower. Bedrooms are in the process of being redecorated and refurbished. Electric strip lights now have secondary covers. Many of the bedrooms are well decorated and furnished and have been personalised by residents and their relatives. Most of the commodes at the home have been replaced and we saw no evidence of unclean or rusty equipment. The laundry room and sluice rooms are well maintained. The laundry room is suitable for purpose and there is adequate equipment in place. Soiled materials are transported through the home safely. The majority of staff have received training in infection control. The person who does the laundry told us that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. Residents said that the laundry service was good and they had no complaints. They say that they do nearly always get their own clothes back from the laundry. The home has two shaft lifts accessing the first floor. However, one of the lifts remains out of action. The manager was unsure when this was going to be repaired but said that she would discuss it this issue with the company’s operations manager Many residents need assistance with mobility. Hoists are used for some residents to help them transfer from bed to wheelchair and wheelchair to chair. The hoists are now stored as safely as possible. People told us that the home is always clean and fresh. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 22 Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is taking steps to make sure there is enough staff with the skills, knowledge and competencies to undertake their roles effectively and safely. Residents are protected by the homes recruitment policies and practises. EVIDENCE: We looked at the staff duty rota and we spoke to residents, relatives and staff. We received conflicting views about the staffing levels at the home. The staff relatives and residents said that at times there are not enough staff on duty to give the people the care they need in a timely manner. The duty rota showed that for the majority of time the home have 2 trained nurses and 5 care staff in the morning, 2 trained staff and 4 care staff in the afternoon and 1 trained and 3 care staff at night. The manager told us that they have recently increased the amount of care staff at night. The comments received from residents stated Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 24 “They need more e staff at weekends. It is a job to find a carer when you needed one”. “Level of efficiency depends on individual member of staff”. “Trained nurses are very reliable but there are not enough of them”. A visiting professional said “Greater number of staff and carers would improve care and speed up responses to care and client’s requests”. Staff said “Sometimes it is difficult to get to people quickly as there is not enough of us. We do our best”. A lot of the people living at the home need two people to assist them. The care staff are divided between the ground floor and first floor. On the first floor when a person requires two care staff to assist them and the nurse is busy doing medication or dressings there is no-one left to respond to people needs. This means that people may to wait for some time before someone is able to support them. We saw this on the day of the visit. The carers did get there as quickly as they could. Since the inspection the manager has informed that they have employed two new care workers. She told that they will be increasing the number of carers in the day by one. During the day, there are other members of staff on duty. They work in the kitchen or do the housekeeping. There is also a maintenance man. We saw that some staff are working at lot of hours to make sure the duty rota is covered. Staff told us they were happy to do this. We discussed the safety aspects of this with the manager. She told us they are in the process of recruiting 2 new carers and 1 qualified staff member plus a new deputy manager. She said that this situation would be resolved within the next few weeks. There are gaps in mandatory training. The manager is aware of this shortfall and is the process of accessing training for staff over the next few months. The staff are also going to receive more specialist training to ensure that they have the skills knowledge and capabilities to care effectively, positively and safely for the residents at the home. The manager has developed a training matrix so gaps can be identified quickly. We were told that all new members of staff receive an induction into the home and have an induction training programe in place. The mangement does not check the competencies of the staff to make sure their jobs effectively and in the best interests of the people who live at the home. The manager told us she will be addressing this issue through supervisions and audits. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 25 Registered nurses do the training required by them to make sure they can reapply for their registration. There is extra training in wound care, dementia, continence and feeding people via a PEG devise and medication. The home has an NVQ programme for care staff and the service told us that they have not yet reached the target of having 50 of care staff with NVQ level 2. But they are working towards it. To make sure the residents are kept safe and are protected the company has thorough recruitment practices in place. We looked at four of the staff files these included 2 of the most recently employed staff. The manager completes a number of safety checks on new care workers. These include things such as confirming their identity, taking up references and doing a police check. (CRB) The CRB’s have been done on those staff employed by the present company, however we did find that one person who has been at the home for some time did not have a police check on file. We were told that this because the previous company kept their records centrally. There was no CRB reference number. The manager told us she would apply for a new CRB immediately. The files had been audited but this check had been overlooked. The manager does keep a record of the questions she asks people at interview and their responses. This makes sure all areas have been explored by the service especially when asking about gaps in employment history. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some shortfalls in the management and quality assurance systems of the service. The required health and safety checks are undertaken. EVIDENCE: The manager of the service has only held this position since the beginning of the year. She was previously the manager of another home. She is a Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 27 registered nurse and started doing a management award in March 2009. She hopes to complete this by September 2009. She has completed her application form to become the registered manager of Acacia House and is presently waiting for the company to process this. The manager does have has an understanding of the key principles and focus of the service but we did identify shortfalls throughout the inspection process with regards the care and support for the service users. This means that some care needs have not been met. These shortfalls should have been identified and addressed by the manager. She is now aware of the shortfalls within the home and told us that these will be addressed. The manager said she will be working to improve the service and provide an improvement in the lifes of the service users. The senior management of the company have told us they will be supporting her to do this. We received feed back from staff and they felt that sometimes they were not listened to. They felt that manager was not aware of some of the things that are happening at the home. This was evidence from the shortfalls that have been identified at the inspection. We also found that staff are not informing the manager in a timely manner about important things that are happening. There are communication problems. This was highlighted in an incident when one of the boilers broke down over a weekend and staff failed to inform the manager and no pro-active action was taken. The manager told us she is addressing these issues through staff meeting and will do this through supervision when it is implemented. Some staff told us that things have started to improved at the home since the new manager took over. The AQAA was completed before the manager came to post. All sections of the AQAA were completed but it did not give a picture of how the service had improved since the last inspection and how they had addressed the shortfalls Information was vague and non-specific. The home has begun to address quality-monitoring issues but this hasn’t progressed since the last inspection. Last year questionnaires were circulated to residents, relatives and other stakeholders so their opinions and views about the service are sought. The information was not collated to identify the strengths and weaknesses of the home. People were not informed of the outcomes following the surveys. The operations manger told us surveys are due to be sent again. The operations manager completes monthly monitoring visits. She looks at what is happening in the home and looks at the progress and shortfalls. She also speaks to resident’s staff and relatives. She told us she will be auditing the care plans with the manager following the shortfalls at the inspection. The Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 28 manager does have resident/relatives meetings, which is a forum to gain feedback about the service. At the time of the inspection the staff were not receiving regular supervision. The manager has organised a schedule to start this as soon as she gets support from the new deputy manager. There are regular staff meetings which staff said they benefit from. Residents and/or their relatives have not expressed concerns in regard to management of monies on their behalf. The Operations Manager stated the home does not act as appointee for any resident. Policies are in place to strengthen safe practices. The home has informed us that all the relevant checks and inspection of equipment and systems have been undertaken. An accident book is maintained. All fire assessments and checks are done at the required intervals. Water temperatures are taken and comply with regulations. Drug cupboard and fridge temperatures were also evidence and were within the stated ranges. The manager is aware of untoward incidences to the Commission under Regulation 37. Containment of Substances Hazardous to Health (COSHH) products are locked away safely. A record is kept of any accidents or incidences. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The manager needs to develop and agrees with all residents /representative an individual support/care plan, which includes all the health, social and personal care required, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations. The plan needs to be implemented and updated to reflect the changing needs of the residents. Risk assessments need to robust and promote independence. Timescale for action 31/08/09 2 OP8 12(1)(a) Daily records need to contain relevant information about the day of the residents and written in conjunction with the care plan. All health care needs of the 31/08/09 residents must be documented, support action agreed and those needs must be monitored closely for improvement or deterioration. Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 31 3. OP9 13 • There needs to be individual guidelines in place for residents prescribed ‘when required’ medication. The effects of pain relief need to be monitored. People need to be supported to take their medication when it is prescribed. 30/08/09 • • 4 OP18 13 Due to lack of developing 30/08/09 implementing and updating care plans some people may e at risk of not receiving the care that they need. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Acacia House DS0000070676.V375730.R01.S.doc Version 5.2 Page 32 Care Quality Commission South East The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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