This inspection was carried out on 9th August 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
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.
CARE HOMES FOR OLDER PEOPLE
Acacia Care Centre 12 Sherwood Rise Sherwood Nottingham NG7 6JE Lead Inspector
Mary OLoughlin Unannounced 9 August 2005 - 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Acacia Care Centre Address 12 Sherwood Rise Nottingham NG7 6JE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0115 9621186 0115 9621216 Southern Cross Care Centres Limited Mrs B K Urbaniak Care Home with Nursing 58 Category(ies) of Physical disability (PD) 3 registration, with number Sensory impairment (SI) 1 of places Old age, not falling within any other category (OP) 58 Terminally ill (TI) 2 Dementia - over 65 years of age (DE(E)) 1 Both Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1 2 Named Individuals aged 47 can be included in the registration 2 Within the total number of beds a maximum of one bed for named service user to be used in the category of DE(E) 3 The Manager needs to be fully Conversant with Protection of Vulnerable Adults Policies and Procedures. 4 The Manager needs to be fully conversant with the Regulations and National Minimum Standards. 5 The Manager needs to attend training to ensure practices and procedures are within current good practice 6 To admit named service user in the category of Physical Disability. Named service user aged 54 years at the time of admission. Date of last inspection 22/03/05 Brief Description of the Service: Acacia Care Centre is a purpose built property set in an inner city area of Nottingham. There are limited grounds but a parking facility is available to the rear of the building. A passenger lift offers access to the first floor and a range of specialist lifting equipment is available for service users with dependent needs. The home has two lounges, a quiet / activities room, a designated smoking lounge and two separate dining areas, providing a variety of comfortable seating and occasional tables. The registered provider is Southern Cross/Highfield Care Ltd. Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was conducted unannounced over 3hrs. The manager was attending a training day and the proposed Deputy manager was on duty throughout the inspection. The main method of inspection was to case track residents, this is to determine if the home are assessing and meeting the needs of the residents by reading care plans and examining the outcome for the resident. Residents spoken with all gave positive feedback, they were happy with the care they received and looked well cared for. The deputy manager was very knowledgeable about the residents’ personal, social and health care needs. The home was warm and well maintained. The care planning was comprehensive and demonstrated a proactive approach by the staff at the home to maintain the physical and psychological wellbeing of residents and ensure they maintained their optimum level of functioning in their daily lives. What the service does well: What has improved since the last inspection?
Staff have attended training in adult protection to ensure they are aware of how to deal with any suspicion or allegation of abuse. Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3-6 Documentation provided and assessment of individuals prior to admission ensures that residents and their families are confident that the home will meet their needs. EVIDENCE: The most recent admission to the home had received an assessment of their needs by a qualified person. There was evidence that trained staff had prepared a care plan at the point of admission, which included specific information from all the external professionals involved in the person’s health care at home. This ensured that at the point of admission staff knew how to care for the person and were able to meet their needs. Where the resident required the external professional support during their stay at the home, staff ensuring continuity of the care required had appropriately accessed this. The health care needs of the new admission were fully examined and prepared for by the home. Intermediate care is not provided by the home.
Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-8-9 Comprehensive risk assessment and care planning ensure that the resident receives appropriate care. The management of medicines did not always reduce the risk of error’s to safeguard the resident. EVIDENCE: Four care plans were case tracked on this occasion. Care plans in use were based on a nursing model that included all the activities of daily living for the resident. All four care plans contained the required risk assessments including the assessment of falls risk. Care plans demonstrated that residents and relatives had been involved in care planning on some occasions.
Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 10 One resident had developed a pressure sore following hospitalisation; the care plan clearly demonstrated that the trained staff had accessed the tissue viability specialist for assessment of the wound and guidance on the management. The wound care plan was well written with clear instructions to staff, which ensured that the correct treatment was being provided. Records of dressing changes did not provide a clear account of changes undertaken. The resident had been provided with appropriate pressure relieving equipment on his bed and armchair. The pressure relieving mattress motor was however set at an incorrect level; this was corrected during the inspection. Nutritional assessment and nutritional care plans demonstrated that a thorough assessment with monthly weight records were undertaken for all residents, however, the cook was not fully conversant with the special dietary needs of the residents case tracked which would not ensure that people received the appropriate diet. There were records of visits from the chiropodist, optician and specialist medical and nursing services in all records examined. Medicines were received, stored and administered according to the Medicines Act. The disposal of unwanted medicines is under review and the provider is obtaining an external contract to dispose of medicines in line with the controlled waste regulations. The medicine administration records examined had on one occasion a hand written prescription regarding the dosage of insulin. The corresponding bottle of insulin did not have any instructions as to the dosage or frequency, which does not safeguard the resident from harm. Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-13-14-15 Residents can exercise choice and control over their lives whilst living at the home. EVIDENCE: There was evidence within the care plans of the residents that they had been consulted on their interests and hobbies. There was good emphasis on maintaining the community and family links for the residents. Religious and cultural needs were considered and access to ministers was facilitated. Meals were not seen on this occasion but residents spoke of being happy with the meals provided and they were offered a choice of meals. Residents were seen to be free to leave the home and visit shops following risk assessment. Many had wheelchairs to assist with their mobility and freedom of movement around the home. For those that wished to smoke there is a smoking room with good ventilation. The staff ensured that residents are assessed before deciding that they can be left unsupervised whilst smoking. The Deputy manager was fully conversant with the individual lifestyles and the family links of each resident.
Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Staff are trained in adult protection, which ensures that they respond appropriately to any suspicion or allegation of abuse. EVIDENCE: Since the last inspection the provider has provided adult protection training to a large number of staff at the home. The manager is presently investigating an allegation of abuse following the local procedures and ensuring the safety of the resident. Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-26 A comfortable and safe standard of accommodation is provided for residents. The infection control practices do not safeguard the residents from infection. EVIDENCE: The home was clean and warm. The carpet in the main lounge and corridors was heavily stained but is part of the planned refurbishment. The home is purpose built and suitable for the residents accommodated. There are appropriate laundry facilities in place that meet disinfection standards for washing linen. The main treatment room was found to have a dirty floor and the cupboards were externally dirty.
Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 14 The storage of sterile equipment was being contaminated with hearing aids, spectacles and emery boards etc. The boxes they were held in were full of debris and dust. The clinical equipment such as suction machines and nebulisers had no cleaning or maintenance schedule in place to ensure that they were in good order and in a usable condition in an emergency. The monitoring of blood glucose was being undertaken without devices that provide safeguards to the staff undertaking the procedure. Individual lancet devices are being requested from the diabetic clinic. Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 There is sufficient staff on duty to meet the needs of the residents and ensure continuity of care. EVIDENCE: The numbers of staff on duty was compliant with the National Minimum Standards. Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 The present arrangement around the management of personal monies does not protect the interests of the residents. EVIDENCE: The personal finances of residents unable to manage their own accounts are presently managed by the administrator at the home. All personal allowance is paid into a non -interest bearing, pooled account; the provider is presently reviewing these arrangements to comply with the National Minimum Standards. Receipts of incoming and outgoing payments are held. Secure facilities are provided for the safekeeping of money and valuables. Residents unable to consent or manage their own financial affairs had accrued large amounts of personal monies within the pooled account. There was little evidence that legal or financial referral had been accessed to ensure that the resident was protected.
Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 1 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x 2 x x x Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 18 no Are there any outstanding requirements from the last inspection? 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 26 Regulation 13 Requirement The registered person must ensure that suitable arrangements are in place to control the risk of infection. 1. Record the cleaning and maintenance of clinical equipment. 2. Ensure treatment areas are kept clean. 3. Ensure that staff undertaking procedures involving blood spillage are appropriately screened and provided with protection from blood borne infection such as Hepititis B. The registered person must ensure that where a resident lacks the capacity to consent or manage their own finacial affairs that they are referred for appropriate legal/financial representation. Timescale for action October 30th 2005 2. 35 20 November 30th 2005 Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 8 8 9 Good Practice Recommendations The registered person should ensure that the kitchen staff receive written coonfirmation of the special dietary needs of each resident. The registered person should ensure that the records of dressing changes are held clearly and provide a record of each dressing change. The registered person should ensure that : Medicines are individually prescribed for each service user and are the property of the service user. Staff should ask the prescriber to write full and precise instructions on the prescription. Prescribers should avoid the use of instructions such as as before or as directed. It is important that the written prescription includes the dose and frequency of administration to ensure that the correct treatment is administered and to reduce the risk of errors. When the administration route is other than oral, it is important for the route to be clearly stated. The indication for use of an as required medication should be presented clearly and include the dose, frequency and dosage interval including the maximum daily dose. Hand written instructions must be signed. Acacia Care Centre C53 C03 S26431 Acacia Care V241847 090805 Stage 2.doc Version 1.40 Page 20 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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