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Inspection on 02/06/10 for Acorn Lodge Nursing Home

Also see our care home review for Acorn Lodge Nursing Home for more information

This is the latest available inspection report for this service, carried out on 2nd June 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home offers support to people with diverse needs. The atmosphere in the home was relaxed and friendly and staff were very polite and sensitive.This was noticeable when visiting the home and watching how staff interact with residents. The health care of people living there is well managed and care plans identified residents care needs and what action is needed to meet them. People living at the home enjoy the food provided one person told us,"I have never had to ask for something different,I like the meals". There is a stable staff team who work well together and clearly know the residents well. Residents were aware of the complaint procedure and who they would speak to if they had any concerns. One resident told us,"I would speak to the boss" indicating the manager. Residents spoke positively about the care they received. Resident and relative questionnaires indicated that staff supported them and listened to them. One resident told us, "service is very good and staff are very friendly,caring and helpful". During the visit the atmosphere in the home was welcoming and friendly. Staff and residents took an active part in the inspection visit. Relatives said the home has an improved atmosphere which is nice.

What has improved since the last inspection?

We undertook an inspection in April 2010 to to look at how well medicines were handled to make sure that people who live in the home were being given their medicines properly and their health was protected. This was because at the previous inspection there were concerns that medicines were not always given properly or handled safely.Following our inspection visits in November and December 2009 an action plan was sent to us outlining the improvements which would be made to ensure the safe handling of medication. During that inspection we found that major improvements had been made and that residents were given their medication properly and medication was handled safely.Overall there were significant improvements in all areas of medicines handling and residents health and well being was protected and they were safe from harm.No requirements about medication were made as a result of that inspection and all previous requirements in relation to medication had been met. To provide safeguards to residents and staff and to comply with regulations. The requirement to ensure all staff have a criminal record bureau disclosure before they start work at Acorn Lodge has been met. Newly appointed staff files now include all the details listed in Schedule 2 to ensure the recruitment procedure protects residents and to comply with regulations.The registered person now notifies the Commission of events in the home that affect the health safety and wellbeing of residents as defined in regulation 37. A lot of training has been arranged since our last inspection which supports staff to do there job well and maintains the health, safety and wellbeing of residents. To promote the dignity of residents and prevent the risk of cross infection residents have their own toiletries which are now kept in their bedrooms. To promote residents privacy, respect or dignity whilst in bed, the arrangements for having residents bedrooms doors open has been reviewed. To ensure care staff have the knowledge and skills when serving food, and understand the procedures for food safety. Staff have attended food hygiene training or updates to make sure they know what they are doing and keep residents healthy and safe. To ensure that people are not put at unnecessary risk safeguarding adults training has been provided to members of staff team who had not previously received this training.

What the care home could do better:

There are requirements and recommendations which are identified on this inspection which when addressed will further develop and enhance the service available to residents.

Key inspection report Care homes for older people Name: Address: Acorn Lodge Nursing Home Guido Street Failsworth Oldham Lancashire M35 0AL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kath Oldham     Date: 0 2 0 6 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Acorn Lodge Nursing Home Guido Street Failsworth Oldham Lancashire M35 0AL 01616818000 01616888088 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Aneerood Goorwappa Name of registered manager (if applicable) Mr Goinden Kuppan Type of registration: Number of places registered: care home 85 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To people of either gender whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP (maximum number of places: 60) Dementia - Code DE (maximum number of places: 35) Mental disorder, excluding learning disability or dementia - Code MD (maximum number of places: 25) The maximum number of people who can be accommodated is 85. Date of last inspection 35 25 0 Over 65 0 0 60 Care Homes for Older People Page 4 of 33 Brief description of the care home Acorn Lodge is a purpose built home situated on a main road close to the Failsworth/Manchester border, owned by Mr Goorwappa. The home provides accommodation for up to 85 people. The majority of bedrooms are single en-suite. One double room is provided for people who wish to share. Seven lounge/dining rooms, two quiet lounges and two conservatories offer a variety of settings in which people living at the home are able to receive visitors, socialise and participate in activities.The home is on a main bus route with a bus stop outside. There is ample parking for visitors cars.Fees for accommodation and care at the home range from GBP360 to GBP516 per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit was unannounced, which means that the owner,manager, staff and residents were not told that we would be visiting, and took place on 2nd June 2010 commencing at 8:40am. The manager and senior management were available on the visit and provided us with information and records,in addition to the support from staff on duty during our visit and residents. The inspection of Acorn Lodge included a look at all available information received by the Care Quality Commission (CQC) about the service since the last key inspection which was held in December 2009 and the pharmacy inspection in April 2010. Every year the owner,person in charge or manager is asked to provide us with written information about the quality of the service they provide.Some weeks before our visit the manager filled in a questionnaire,called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. This helps us to determine if the management of the Care Homes for Older People Page 6 of 33 home see the service they provide the same way that we do. We considered the responses and information the manager provided. Acorn Lodge care home was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. We got our information at the visit by observing care practices, talking with people staying at Acorn Lodge talking with the manager, senior managers and staff.A tour of Acorn Lodge was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Acorn Lodge was meeting the needs of residents and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to four residents was looked at in detail to help form an opinion of the quality of the care provided.We call this case tracking.This is a way of inspecting that helps us to look at services from the point of view of the people who receive a service. We track residents care to see whether the service meets their individual needs. The term preferred by people consulted during the visit was residents. This term is, therefore, used throughout the report when referring to people living at Acorn Lodge. A brief explanation of the inspection process was provided to manager at the beginning of the visit and time was spent with the manager and senior manager on conclusion of the visit to provide verbal feedback. We have not received any complaints or safeguarding matters about this service. References to we or us in this report represents the Care Quality Commission(CQC). Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? We undertook an inspection in April 2010 to to look at how well medicines were handled to make sure that people who live in the home were being given their medicines properly and their health was protected. This was because at the previous inspection there were concerns that medicines were not always given properly or handled safely.Following our inspection visits in November and December 2009 an action plan was sent to us outlining the improvements which would be made to ensure the safe handling of medication. During that inspection we found that major improvements had been made and that residents were given their medication properly and medication was handled safely.Overall there were significant improvements in all areas of medicines handling and residents health and well being was protected and they were safe from harm.No requirements about medication were made as a result of that inspection and all previous requirements in relation to medication had been met. To provide safeguards to residents and staff and to comply with regulations. The requirement to ensure all staff have a criminal record bureau disclosure before they start work at Acorn Lodge has been met. Newly appointed staff files now include all the details listed in Schedule 2 to ensure the recruitment procedure protects residents and to comply with regulations. Care Homes for Older People Page 8 of 33 The registered person now notifies the Commission of events in the home that affect the health safety and wellbeing of residents as defined in regulation 37. A lot of training has been arranged since our last inspection which supports staff to do there job well and maintains the health, safety and wellbeing of residents. To promote the dignity of residents and prevent the risk of cross infection residents have their own toiletries which are now kept in their bedrooms. To promote residents privacy, respect or dignity whilst in bed, the arrangements for having residents bedrooms doors open has been reviewed. To ensure care staff have the knowledge and skills when serving food, and understand the procedures for food safety. Staff have attended food hygiene training or updates to make sure they know what they are doing and keep residents healthy and safe. To ensure that people are not put at unnecessary risk safeguarding adults training has been provided to members of staff team who had not previously received this training. What they could do better: 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. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides sufficient information for people to make a decision about moving in and has systems in place to make sure that peoples needs are assessed before admission. Evidence: We saw the Statement of Purpose and Service User Guide. This gave prospective residents and their families information about the home. One resident who was on respite stay at the home told us,I came here because I couldnt manage but I have improved a lot and I want to stay they are all very nice. We saw that a pre admission assessment form is in use. This was used to develop a care plan.The manager visited prospective residents in their own home or in hospital to carry out an assessment before admission.This is done to make sure that people are only admitted on the basis of a full assessment. Residents placed by the local authority had a care managers assessment of needs. Care Homes for Older People Page 11 of 33 Evidence: The home does not provide an intermediate care service. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs are met by the home and medication practices safeguard residents. Evidence: We saw that each resident has a care plan which sets out how his or her needs are to be met and that this document is reviewed regularly. We saw a sample of care plans. They included information on nursing assessments, moving and handling risk assessments, care managers assessment, oral care, religious and cultural needs, daily life and social activities, pressure area risk assessments, dietary needs, likes and dislikes and allergies. Of the four care plans looked at all contained the correct information. However, more detail about service users personal preferences and preferred way they wish to receive support would ensure that the individuals needs were recognised and made known to care staff. We made a requirement last time to ensure that the health and welfare of residents are fully met, they receive the care and support they need at a time and frequency that is Care Homes for Older People Page 13 of 33 Evidence: needed a detailed plan of care, which includes residents personal choice and preferences, must be implemented for each identified care need.The requirement has been achieved however more detail does need to be included in the care plans. Residents require differing degrees of support in aspects of daily living. This was evident from observations of direct intervention and support provided by staff. We were told that residents preferences are addressed and, where this is not practicable due to mental health, then the relatives are able to contribute to their cared for residents preferred needs from their knowledge of that person. When talking with residents, they gave us positive feedback about the home. They confirmed that staff listened to what they said and attended to their needs appropriately. It was observed that the care and attention to detail was paid to residents. Residents looked clean and tidy and attention was paid to ensure hair, nails and the appearance of residents was promoted. Residents we spoke to said they were, being well looked after. Examination of the daily reports, which are used by staff to record the support and intervention and the development of residents contained on some residents limited information. This limited information would not help the manager if an investigation into a residents care was needed. In order to gain consistency, the manager should review the daily recordings periodically and discuss any problems that some of the staff may be having with recording, during their supervision. We spoke to residents who told us they were happy with their care and that staff respected their dignity.A relative told us, they take care of people that are there and take time out to speak and listen. Another told us,most of the staff are good with my relative they are fed well and always look nice and clean. We overheard staff speaking to residents about their own children and how they were doing,what they have been up to. There was a friendly atmosphere in the home. We observed staff treating residents with respect in a dignified and sensitive manner. Relatives told us,the staff are very caring people and are always there to help. Nothing is too much trouble. Residents told us,staff are lovely. We issued a requirement when we last inspected Acorn Lodgethat to ensure residents Care Homes for Older People Page 14 of 33 Evidence: are not placed at unnecessary risk,the risk assessment for the use of bed rails must be further developed to include the risk of entrapment.We were told that this was now in place and reference made to the risk of entrapment. We served a Statutory Requirement Notice on 10th September 2009 as the home were in breach of the regulation relating to medication. To make sure that they were aware of the areas of serious failings within their service which could lead to service users receiving their medication wrongly or not as prescribed and they were required by 7th October 2009 to comply with the medication requirements issued. In November 2009 the pharmacist inspector completed another unannounced inspection of the service to make sure they had complied with the requirements detailed within the Statutory Requirement Notice in relation to the safe handling, management and administration of medication. The outcome of that inspection was that the registered providers had not met all of the Statutory Requirements detailed within the Statutory Requirement Notice. The pharmacist inspector at that time identified that the home had failed to meet fifty percent of the notice and it was the most important part of the notice they had not complied with. Because of this the registered providers were invited to attend an interview with us as part of our regulatory and enforcement procedures. Following our inspection visits in November and December 2009 an action plan was sent to us by the owner of the home outlining the improvements which would be made to ensure the safe handling of medication. The pharmacy inspector returned to the home in April 2010 to look at how well medicines were handled to make sure that people who live in the home were being given their medicines properly and their health was protected. During the pharmacy inspection in April 2010 we found that major improvements had been made and that residents were given their medication properly and medication was handled safely.Overall there were significant improvements in all areas of medicines handling and residents health and well being was protected and they were safe from harm.No requirements about medication were made as a result of that inspection and all previous requirements in relation to medication had been met. On this inspection we looked at the medication administration records.We saw that medication was dispensed into a monitored dosage system and was stored correctly.We saw that the receipt and disposal of medication was being recorded and Care Homes for Older People Page 15 of 33 Evidence: that records were generally kept well. There was a photograph of residents on the Medication Administration Record sheets to enable staff to recognise residents and minimise the risk of administration errors.We saw a list of staff responsible for administering medication; this included a sample of their signature and initials.There was a medication fridge and temperatures were taken daily. We were told that staff with responsibility for administering medication had received appropriate and up to date training.The home now has a system in place to evaluate staff practice when administering medication to ensure they are confirmed as continuing to be competent to administer medication. We saw that the receipt and disposal of medication was being recorded and that records were kept well. One resident told us,The staff help me when I take my medication. We saw that district nurses and chiropodists visited the home and the tissue viability nurse is also consulted to advise on good pressure area care.Staff were aware of the need to support all residents in the same manner, which ensures their dignity and respect, regardless of the residents ability to understand and or communicate. Acorn Lodge told us that they work closely with health professionals to ensure that residents health care needs are met. Domiciliary visits from opticians and podiatrists are arranged as required. The home feels they have a good professional relationship with outside agencies such as district nurses, social workers and GPs. The managers said they strive to respect residents privacy and dignity at all times. The NVQ training, which some of the staff team have completed and others are working through, reiterates this important area. Residents were seen to be spoken with discreetly when discussing personal care support and staff were observed knocking on doors before entering. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are provided and residents are able to maintain contact with family and friends. Residents have a choice of varied and balanced meals. Evidence: Throughout the morning of this visit residents were occupying themselves by reading or watching TV.Some residents havent the ability to do this and were seen sleeping or sitting in a quiet room with nothing much going on.In order to ensure that activities can be tailored to suit the needs of individuals, social assessments should be in place that identifies past, hobbies and interests, preferences then and now, remaining abilities and skills.There was information displayed about what activities were planned for each day. Residents told us they have an activities organiser who works full time in the home. A record is kept of what residents take part in. We had a look at these records and for some residents it recorded that they hadnt taken part in activity as they were sleeping or were in the shower. These residents werent recorded for long periods as having had any stimulation or interaction. We were told that staff spend time talking with residents and interacting with them on a one to one basis but there was no record that this was taking place. We did see staff sitting chatting with residents on Care Homes for Older People Page 17 of 33 Evidence: our visit. Alternative activities or stimulation should be provided to residents who are not able to take part in organised events. Aromatherapy may be beneficial to those residents cared for in bed who are unable to take part in other activities.In one residents care plan it detailed that they liked colouring and painting. There was nothing recorded that this was taking place. Staff were seen welcoming visitors into the home.There is an open visiting policy and residents were able to see visitors in one of the lounges or in their bedrooms if they preferred. One resident told us their visitors were always made to feel welcome and can visit at any time.Other residents said that they were able to have friends and family visit when they liked.We saw that staff encouraged residents to maintain contact with family and friends. Ministers from local churches visited the home.The manager told us that arrangements would be made to support residents from other religious backgrounds as and when required. Residents told us they enjoyed the meals and confirmed that they were offered a choice of food at meal times. One resident told us,they come round in the morning and ask what we want to eat. Another resident told us, at the meal time they ask us what we would like to eat and give us a couple of choices. In the residential unit there is a white board with the details of the main meal and choices available to residents. Serviettes were not on the table, which would further promote residents dignity.Residents told us that they could have drinks when they wanted and just had to ask staff if they wanted a drink in and between the regular drink times. We saw one member of staff sitting in a residents bedroom helping them to eat their meal. We saw this was done with sensitivity and respect. The member of staff was sat close to the bed leaning towards the resident and was overheard speaking to the resident all the time. One resident told us,we get choices you know,they always ask us what we wantanother said,oh yes they will make you something different if you want. This was confirmed during the visit when we overheard staff asking residents what they would like for lunch. The cook told us that any broken or damaged equipment was replaced. Food was Care Homes for Older People Page 18 of 33 Evidence: purchased from a cash and carry or local shops. The cook said that there was always a good supply of food. This was confirmed on the day of the visit when we saw the delivery man bring a large food order to the home.Environmental health department had in January 2010 awarded a four star certificate at the home for food. We were unable to evaluate the actual meals served to residents as this detail is not currently maintained by the home as it should be. There were records of what some residents had drank or eaten but this was for residents who are poorly. A record should be made of food served to residents so someone is able to make a judgment if the diet individual to the resident is correct in relation to nutrition or otherwise. Residents meetings are arranged to enable residents to exercise their right to choice. Food and meal times are regular agenda items discussed at these meetings. We saw some notes from these meetings when residents had made suggestions and variations to the meals they have. When we looked at the menus we couldnt see these requests and variations included on the menu. We were told that the comments received from residents about the meals had been taken into account. We were also told that the home plan to review the menus.Acorn Lodge feels they encourage residents comments on improving the standards and service they deliver. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has policies and procedures in place to safeguard residents from abuse and people are confident that their complaints will be acted upon. Evidence: A complaints record was in place. No complaints had been recorded since the last inspection and the manager said that no other complaints had been received. We saw that a number of compliment letters and cards had been received. Residents told us of comments they had made about what they thought about things which werent right and what had been done to put these things right. The detail of these comments were not recorded in the complaints book.The registered manager should have a system in place which records all comments,concerns and complaints to ensure that any patterns of poor practice can be identified at an early stage and fully addressed. Discussion with residents demonstrated that they were clear about how and who to make a complaint to.One resident told us,I will speak to the manager or one of the girls. Another said,I would speak to the manager or nurse on duty. Care staff at the home told us they had received training on how to recognise and report abuse. We spoke to staff that were aware of the action to be taken in the event of an allegation of abuse. One member of staff told us,I would make sure the resident was OK and then report it to the manager. Care Homes for Older People Page 20 of 33 Evidence: We looked at two new staff files and saw that both staff who had started work at Acorn Lodge since we last inspected had a Criminal Records Bureau (CRB)disclosure before they started working at the home. The manager had a copy of the local adult protection policy and procedure. This was in the office and accessible to all staff. They had a policy directing staff to the Oldham local authority safeguarding procedures. They told us that further safeguarding training was planned that is linked to the local safeguarding policy and procedure. We were provided with a list of training and the date that staff attended. The training list indicated that almost all of the staff working at Acorn Lodge had taken part in Abuse and Neglect training. We were told that this is completed in house. It would be good for staff to also experience external training. We discussed this with the registered manager on our last visit to provide an opportunity for staff to receive training through the local authority with regards to the Protection of Vulnerable Adults.Since we last visited the registered manager and a unit manager have attended this training. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standards of cleanliness and hygiene provide residents with a clean place to live. Evidence: A visitors book is placed in the hall and visitors to Acorn Lodge are encouraged to sign in and out of the home. This is to ensure that in an emergency situation, everyone in the building is accounted for. A number of rooms are looking tired and would benefit from redecoration, new carpets and furnishings.Some bedrooms were personalised, with items brought from residents homes. Some had a television and chose to spend time in the privacy of their rooms when they wished. A passenger lift is available to support residents getting upstairs to bed and to use other areas of the home. All communal areas, bedrooms and toilets were fitted with a call system.This enables residents to call for staff assistance or support. Maintenance contracts are in place and the manager said Acorn Lodge meets the requirements of Health and Safety, Fire and Environmental Health regulations. Care Homes for Older People Page 22 of 33 Evidence: We saw containers of sanitising hand gel being used to prevent the spread of infection. Protective aprons and gloves were provided in a variety of sizes to meet the individual needs of staff and minimise the risks of infection.These were also seen to be being used. Aids and adaptations were provided to assist in moving residents safely, including hoists. We commented on the last inspection that one of the lounges on the ground floor had an unpleasant odour which needs to be addressed by the registered manager.We were told in the action plan provided by the home that,the odour in the downstairs lounge had been eliminated. We were also told of the actions taken to ensure the lounge has no odours. However when we looked around the home the odours were still obvious. Further steps need to be taken to eliminate these odours. This may be by thorough cleansing,ongoing and continual cleansing or the replacement of carpets or and furnishings.We were told that residents are offered a choice of colour scheme when their bedrooms are being decorated. When we looked round the home we identified that a lot of the toilets and bathrooms either didnt have a lock in place or the lock on the door didnt work properly. To maintain and support peoples dignity and privacy when using these rooms the locks on the doors need some attention. The carpet in the corridor outside the shower room was heavily stained and needs replacement as do other carpets in the home. As we mentioned earlier some of the rooms look bland and institutional in the colour and decoration. In some of the lounges the chairs are around the perimeter of the room with little or no personlisation or colour. Thought needs to be given to the layout of the room and the provision of interest and stimulation for residents. The registered manager told us that they had tried having smaller layouts of chairs in the lounges in the past and this hasnt worked due to the mobility needs of some residents. Residents told us that the conservatory in the warmer weather was uncomfortable due to the heat. Residents also told us that the windows had been measured for blinds some months ago and that was all that had happened. We also saw these comments in relative and residents comment cards and the conclusion by management that, consideration will be given towards the installation of venetian blinds in the conservatory.We were told when we asked on the inspection that by the end of July 2010 these blinds would be in place.This will aid and promote the comfort and respect of residents who choose to spend all there day in the conservatory. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are adequate numbers of staff on duty with the skills and knowledge to meet residents needs and the recruitment procedures protect residents. Evidence: We reported on the last two inspections in February and December 2009 that there were some shortfalls in the recruitment process in relation to references and the lack of staff photographs or proof of identity. A requirement was issued that all staff files must include all the details listed in Schedule 2 to ensure the recruitment procedure protects residents. Recruitment and selection procedures should be in place to safeguard residents and offer a degree of protection to them. It is essential that the regulations be followed to promote this. We were told that two staff have commenced employment in the last six months being when we last inspected the home.We looked at these two staff files.They were well maintained and contained all the necessary CRB and POVA checks. Staff files had copies of documents to verify the persons identity. Staff at the home sign the photocopy to indicate that they have seen the original documents.As is best practice. The two staff files we looked at contained two written references which were recorded Care Homes for Older People Page 24 of 33 Evidence: as having been received before staff started work at Acorn Lodge. Best practice would be to follow up by a telephone call to the referee prior to confirmation of employment. The home use a pre printed reference request form that was sent to the referee. It is recommended that references be either followed up with a telephone call,requested on letter headed paper or contain a company stamp to show that they are genuine. The admin manager told us that all staff were checked against the POVA list before they started work and that staff members working with just a POVA check,pending receipt of a CRB,do not work unsupervised. Staffing rotas showed that there was enough staff to meet residents needs. Staff spoken to told us that they had access to training. Training covered manual handling, medication, fire safety, first aid, and Protection of Vulnerable Adults. A member of staff told us,I have just achieved my NVQ level 2 and would like to go on to do my level 3. The manager reported that regular staff supervision was provided and all staff completed an induction period. The management team supports staff and there was evidence of an ongoing supervision programme for staff. This ensures that senior staff monitor the performance of staff and any training needs are identified. There was evidence on staff files to show that staff received a copy of their job description detailing their roles and responsibilities. The home completed its own induction, which appeared to be of a good standard, staff also attend induction training issued by Skills for Care, which supports continuing professional development, including helping prepare workers for entry onto the appropriate Health and Social Care National Vocational Qualification (NVQ).We were told that all staff who have commenced employment in the last twelve months will complete skills for care induction training to enable them to do their job well. We asked to look at the training record for staff since we last inspected. We wanted to see this as a lot of staff hadnt had essential mandatory training. We wanted to check out if they had all received this. When we looked at the record it appeared that not all staff were recorded as having received this training. We provided verbal feedback at the end of our inspection in relation to this. The senior manager was surprised and said he thought all staff had received all the training. We asked that this information is checked out. The managers were asked to respond within 48 hours of the inspection to confirm this detail. Care Homes for Older People Page 25 of 33 Evidence: We received a response from the manager when we asked for it. We were told, Qualified Staff (Nurses)It was not brought to our attention by CQC that nurses should have training /updates on food hygiene/ first aid/risk assessment.For good practice we will arrange training to be undertaken during the next two weeks.We will forward the record of completion. Staff training. From the training records,you identified a few staff have not completed some of the mandatory training.We will arrange training programme to ensure that all staff will complete all the mandatory training within two weeks time. The records we looked at didnt confirm that nurses had received training in areas such as wound care, promoting continence, care of the dying or stoma care training.We had identified this as a shortfall on the last inspection. This training does need to be arranged to ensure that staff have the skills, knowledge and expertise to care for residents properly.We were told in the action plan that wound care, continence promotion and nutrition diabetes and dementia care that the home was waiting for the new training calender from Oldham Primary Care Trust. Staff were caring and approached residents in a polite and respectful manner. Residents made comment about the staff and told us, they are lovely,the very best, very kindand they are so kind to me. Nursing and care staff meetings are arranged which provides staff with an opportunity to influence how Acorn Lodge is run and contribute to its effectiveness.This doesnt extend to housekeeping, laundry and cooking and kitchen staff having regular meetings. This development would ensure all staff have an opportunity to comment on the development of the service provided at Acorn Lodge. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is safe and run in their best interests. Evidence: We made a recommnedation on the last inspection that the manager should be considering further training options to enhance and keep up to date his skills, knowledge and continued development.We were told the manager will continue to attend refresher training to enhance and keep up to date his skills, knowledge and continued developmnet. We were told the manager had recently attended training on taking safeguarding further arranged by Oldham PCT and Social Services. The manager is a qualified nurse and has experience of running a care service for older people. He had a good understanding of the conditions and illnesses that are associated with old age and was able to address such issues, benefiting residents. They told us that funded care nurses and care managers carried out reviews of residents care needs as and when required. Where the needs of people receiving Care Homes for Older People Page 27 of 33 Evidence: personal care only alter, district nurses carry out an assessment. This makes sure that residents changing needs are met. The manager was aware of the Mental Capacity Act 2005 and its implications in relation to helping residents to make decisions that affect their lives. It is recommended that the homes policies, procedures and working practices be reviewed to reflect the implications of the Mental Capacity Act 2005. We saw a copy of the fire risk assessment. Health and Safety checks take place to make sure people are kept safe and records are kept of these. Fixed Gas and Electricty appliances had been regularly maintained and a periodic test of portable appliences and lifting equipment had been carried out. This was to make sure equipment was safe for residents and staff to use. Fire drills had been carried out at regular intervals. Staff spoken to were aware of the procedure to be followed in the event of the fire alarm sounding. We saw that accident reports were completed and stored in line with the Data Protection Act 1998.The accident book detailed accidents, incidents and occurrences experienced by residents.The manager audits the accidents and incidents that are reported at Acorn Lodge. An analysis is in place and needs further development to identify action taken as a consequence to the analysis and any additional risk assessments or intervention put in place if required. The manager told us that, in general, residents families assisted with finances although they do hold the personal allowances for some residents. Where personal monies were held records were kept of transactions carried out on behalf of the resident. To comply with the recommendation from the last inspection to put in place a quality assurance system that seeks and acts upon the opinions of residents in terms of their day to day experiences and improvements that could be made. We were told ,a system is in place to ensure satisfaction survey questionairre is collected from residents, relatives and visitors. A quality assurance system has been introduced. Residents and their relatives or representatives were sent questionnaires as part of the quality assurance process.The results of the survey will be used to improve the service. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 Provide all grades of nursing 31/01/2010 and care staff with training and updates to training which supports them to do there job well and maintains the health, safety and wellbeing of residents. Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 18 Provide all grades of nursing 14/07/2010 and care staff with training and updates to training which supports them to do there job well and maintains the health, safety and wellbeing of residents. To ensure staff do their jobs properly and keep residents safe Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 To ensure that the health and welfare of residents are fully met, residents receive the care and support they need at a time and frequency that is needed a more detailed plan of care, which includes residents personal choice and preferences, must be implemented for each identified care need. Include in residents individual plans of care details of their personal choice, preferences and social care needs. 2 7 Daily records should reflect their daily life within the home, Page 30 of 33 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations residents achievements and individuality as well as cares staffs individual support. 3 12 Additional thought and time needs to be given to the stimulation some residents receive by providing imaginative ways of occupying residents and looking at them as individuals, how they can interact and be stimulated in the day to see what can be provided for them. The detail of the evaluation needs to be recorded in the care plan and the stimulatiion provided to them also documented. Maintain a record of food served to residnets in sufficient detail that anyone looking at the record can judge if the individual residnets diet is sufficient in relation to nutrition or otherwise. Review and update the menus taking into account the suggestions and comments made about the menu by residents. 5 16 The registered manager should have a system in place which records all comments, concerns and complaints to ensure that any patterns of poor practice can be identified at an early stage and fully addressed. Consideration needs to be given by the registered manager for staff to attend external Protection Of Vulnerable Adults training through the local authority to support and continue staffs development. Eliminate the odours in the downstairs lounge. To maintain and support residents respect, dignity and privacy when using toilets and bathrooms repair or replace the locks on the bathroom and toilet doors so they are operational. Review the decoration and layout of the lounges particularly the ones upstairs and the smaller of the two downstairs lounges to ensure the layout of the room isnt institutional in its appearance, that the lounge offers some colour and stimulation and the room is personlised to offer residents stimulation, interest, respect and comfort. Install blinds in the conservatory to promote the comfort of residents who use the conservatorys 4 15 6 18 7 19 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 8 29 To provides all staff with an opportunity to influence how Acorn Lodge is run and contribute to its effectiveness arrange regular staff meetings with cooking, kitchen, housekeeping, maintenance and laundry staff. Maintain notes or minutes of these meetings. It is recommended that references be either followed up with a telephone call, requested on letter headed paper or contain a company stamp to show that they are genuine. Record all grades of staffs attendance to training to support for the future planning of updates and refreshers and to demonstrate staff have received training appropriate to do there job well To take into account the implications of the Mental capacity Act it is recommended that a formal agreement between residents or their representatives that staff can access peoples personal monies to purchase personal items be developed. The registered manager must further develop the analysis of accidents to include the action taken to minimise occurrences and keep residents safe. 9 29 10 30 11 35 12 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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