Inspection on 20/02/08 for Acacia House

This inspection was carried out on 20th February 2008.

CSCI found this care home to be providing an Poor 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 30/07/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Acacia House Ashford Road St Michaels Tenterden Kent TN30 6QA Lead Inspector Lisbeth Scoones Unannounced Inspection 20th February 2008 09:30 X10015.doc Version 1.40 Page 1 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 Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 2 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 House DS0000070676.V360020.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 vacant post Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability over 65 years of age (0) of places Acacia House DS0000070676.V360020.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 - (PC) 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) Older People with physical disabilities (PD(E)) The maximum number of service users to be accommodated is fortyone (41). This is the first inspection under the new ownership 2. Date of last inspection Brief Description of the Service: Acacia House is a large, detached and extended house set in well-maintained gardens. Car parking is provided. 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. 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 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. The inspection report would be freely available and on display in the entrance hall. Current weekly fees range between £698.00 and £750.00. Additional charges are made for hairdressing, toiletries, newspapers and chiropody. Acacia House DS0000070676.V360020.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 0 star. This means the people who use this service experience poor quality outcomes-. This unannounced visit took place over two days and was carried out by two regulatory inspectors. A pharmacist inspector joined them on the second day and undertook a full medication audit. 1st Choice Care Homes became the registered provider of Acacia House on 22nd October 2007. The inspection process took into account information received prior to and obtained following the visit. The manager completed an AQAA (annual quality assessment and audit) on 30th October 2007. During this inspection all the National Minimum Standards were reviewed. An in-depth discussion was held with the manager who was joined for some of the time by the area manager. The inspectors spoke with many residents, a visiting relative and some of the staff on duty. A short observational framework inspection (SOFI) was carried out by one of the inspectors on the second day. A tour of the building was made and documentation examined. The documentation included the Statement of Purpose and Service User Guide, pre-admission assessments, care plans and risk assessments, medication charts, policies and procedures, financial records, accident book, complaint records, staff files, training records, duty rota and menus. A comprehensive feedback was given to the manager at the end of the second day. At the time of the visit there were 5 residents with residential type needs and 23 residents with nursing needs. Since the new ownership, an incident has been investigated under the Safeguarding Vulnerable Adults procedures. The investigation has since been concluded. What the service does well: The manager and area manager acknowledge that the environment is urgently in need of upgrading. The process of upgrading has commenced. The manager is aware that staff need the training and support to embrace the philosophy of care promoted by the new owners. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 6 The manager is receptive to requirements and recommendations made at this inspection. What has improved since the last inspection? What they could do better: Pre-admission assessments must be more comprehensive and demonstrate how the home can meet the residents’ needs. Information thus obtained would ensure that residents have a person centred care plan from the start. The contents of care plans needs to be reviewed to enable staff to input sufficient information to demonstrate how the care is delivered. Reviews need to clearly evidence that the planned care has been evaluated. If personal care charts are used, they need to be completed to evidence that the planned care has been carried out. Some blank spaces were noted for weights, bathing, oral hygiene and bowel care. Staff must evidence that all residents’ health care needs are met and where necessary that specialist staff such as continence advisors are consulted. Entries in daily records pertaining to GP visits should be cross-referenced to the multi-disciplinary pages, which record GP visits. Staff must ensure that entries in the daily records provide an evaluation of the care provided. The systems for medication administration need to improve to ensure that residents are not placed at risk. The use of pain charts needs to be reviewed. Staff must ensure that residents’ privacy and dignity is respected at all times. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 7 In the absence of an activities coordinator, the manager should ensure that residents are provided with suitable entertainment and stimulation. The manager must ensure that accident records are audited and where appropriate reported to the CSCI and other authorities. In order to provide a clean and safe environment, it is recommended that an infection control audit be carried out. The home must ensure that the environment is pleasant, well decorated, safe and free from hazards. In order to evidence that the home is improving the environment, a time-scaled upgrading and maintenance programme must be prepared. The manager must ensure that staff are aware of and confident in their roles and responsibilities within the staffing structure. The manager must ensure that all care staff receive mandatory training including infection control. Specialist training should include dementia care. Quality assurance systems could be improved by formally including residents and other stakeholders. Care records should be audited and care practices monitored. 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. The summary of this inspection report can be made available in other formats on request. Acacia House DS0000070676.V360020.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.V360020.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose and Service User Guide have been reviewed and provide prospective residents with the information they need to make a decision about moving into the home. Residents moving into the home do not have a comprehensive pre-admission assessment for the home to judge if it is able to meet his or her needs and do not give sufficient information on which to base a care plan. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 10 EVIDENCE: The statement of purpose and service user guide have been reviewed to reflect the new ownership of the home and both documents contain all that is required under Schedule 2 of the Care Homes Regulations. Pre-admissions assessments do not contain sufficient information from which to generate a care plan. Whilst the assessment tool is comprehensive, staff had mainly ticked boxes with ‘one word’ answers. As a result, residents cannot be assured that the home can meet all their needs. The manager said that the pre-admission tool is being reviewed to provide more space for staff to include detail such as the correct equipment needed”. New contracts are being drawn up with the new company’s logo. Two contracts were seen. Information is clear and states what is and what is not included in the fee. For those residents who are self funding, the document explains how the RNCC contribution is to be deducted from the fee. All residents will be provided with a new contract, which they would sign. The home does not provide intermediate care. Acacia House DS0000070676.V360020.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are not consistently providing staff with the information they need to satisfactorily meet the residents’ needs. There was insufficient recording to evidence that residents’ health needs were met. The systems for medication administration need to improve to ensure that residents are not placed at risk. Personal care is not always offered in a way to protect the residents’ privacy and dignity. EVIDENCE: Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 12 The manager advised that the care-planning format is to be revised. Currently care plans are not always completed to reflect the physical, personal and social care needs of the residents. Whilst care plans are reviewed monthly, there is no evidence that the care needs are evaluated. Many reviews reported ‘no change’. There was no evidence within the care plans that residents have agreed to their plan of care or have been party to developing their care plans. None of the care plans were signed by the residents or their representatives. There was no evidence in the care plans to suggest that staff carry out specific hygiene tasks such as oral care, checking tissue viability, checking nails, hair care, skin care, whether the residents have received a bath, shower or strip wash. The home relies on checklists seen on display on both floors. These were incomplete and did not serve the purpose to evidence that all aspects of personal care had been given. Whilst the care plan identifies the level or risk of skin breakdown, there were no clear guidelines for staff to follow to ensure the level of risk was reduced. From a tour of the bedrooms it was noted that some residents are supplied with pressure relieving mattresses, but this is not stated within the care plans. At the time of this inspection one resident had a reported pressure ulcer. Good wound care evaluation recording was noted. The home has forged a good relationship with the GP’s, districts nurses and PCT nurse specialists. Some care plans evidenced that residents have access to a chiropodist, optician and dentist. The home employs a physiotherapist for one day a week. There was however no information within the care plans to indicate whether he continence nurse had been consulted when a continence management issue had been identified. There was evidence in one care plan that a resident had received a visit from a psychiatrist, but no follow through, so no one would be aware what the follow through was or what should be happening to this resident. Nutrition screening is usually undertaken monthly but there were some gaps in the care plans viewed. Weight loss is not always acted upon. There was no evidence within the care plans that residents are enabled to take part in meaningful exercise routines. New detailed medicine policy and procedures were available to staff, although intended training on these had not yet happened. A medication audit had identified that continued improvement was needed in ordering of medicines Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 13 before they ran out. One medicine had run out on the day of inspection and a nurse said that a further prescription had been ordered. Medicines were stored securely for the protection of people using the service. A new medicines fridge had been ordered. People received their medicines from nurses or trained senior carers. Records were kept of medicines coming into the home, given to residents and the disposal of unwanted medicines. Nurses delegated the administration of creams to carers who made separate records. The manager agreed to review this to ensure carers had adequate training for all tasks that were delegated. Nurses were aware that the pain assessment forms kept with medication records were not always completed. The manager said that this was being addressed. It was recommended that medication records be supplemented by information that clearly described the circumstances when ‘as required’ medicines are to be given. It was observed that staff respect residents’ privacy and dignity when carrying out personal care. However, an incident was observed which compromised a resident’s dignity. Staff call residents by their names, but there was no evidence within the care plans as to how the resident wished to be addressed. From a SOFI observation carried out during the lunch on the second day of visit interaction between the staff and residents was poor. One member of staff assisting a frail elderly resident with her lunch repeatedly said in a loud voice to the resident ‘There’s a good girl.’ Residents are able to see visitors as and when they wish in the privacy of their own bedrooms. The home is in the process of reducing its shared rooms. Currently there is one such room in use. The care plans include a section on residents’ wishes in respect of death and dying. These had been well recorded in most cases. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities in the home need to be improved to ensure they meet the interests of the residents, with particular attention being paid to those residents who are confined to their bedrooms. Links with the community are limited for the residents, although residents are able to have visits from relatives at any time. Residents are able to make choices in regard to their private lives, but this needs to be reflected in the residents’ care plans. The home has made some progress to improve the provisions of a varied menu, but people who need liquidised diets are not able to exercise choice as to how these meals are delivered to them. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 15 EVIDENCE: The home used to employ an activities co-ordinator, but she left on the Friday prior to this inspection. Residents said that they miss her. Two residents said that the home did not provide sufficient activities that were of interest to them. From the activities programme the activities on offer are: Chatting one to one; doing hobbies, crossword puzzles, playing games, armchair exercises, reading newspapers and magazines, choosing library books, music. There was no evidence of any activities taking place during the two days of this full inspection. The manager said that until a replacement has been recruited, a designated carer would provide activities. Outside entertainment is provided once a month. Residents are provided with a newsletter. There appears to be very little community contact for the residents. On the first day of the visit, the local Church of England visited the home in the afternoon to carry out communion. There is an open visiting policy in the home. Residents said that they were able to see visitors in their bedrooms at any time. All residents have a private arrangement with their relatives or solicitor concerning their own personal finances. The home does not act as appointee for any of the residents. From a tour of the building both inspectors noted that residents are able to bring personal items into the home from their own homes to reflect their personalities and interests. The manager said that residents are able to have access to their own personal care plans if they wish to do so. One resident said that she knew she could view her care plan but has no reason to do so. The inspector viewed the four-week rotating menu. Meals on offer were varied and nutritious. Two residents said that if they did not like what they were offered they were given a choice. During observation in the dining room of day two of the inspection, one resident said to another resident that she did not like pastry, but staff insisted on giving it to her. From observation of two residents who required liquidised meals, the inspectors noted that while these meals have food liquidised separately, the care staff mixed the food together before giving it to the residents. There was good interaction between residents during the lunchtime. Interaction between staff and residents was not good all the time. Those Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 16 residents eating in the main dining room were unhurried. The cook said that he is able to cater for specialised diets as and when required. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints policy and procedure in the home need to be improved to ensure that residents know their complaints will be listened to and acted upon. While residents are able to access their rights to voting, more information needs to be available in the home relating to advocacy services. Staff have knowledge of adult protection issues which goes some way to protecting the residents from abuse. However, the manager must ensure that all incidents/accidents, which may be construed as abuse, are referred without delay to the appropriate authorities. EVIDENCE: The complaints policy and procedure is displayed in the main entrance hall but it is out of date and does not reflect the new ownership of the home. The complaints file was examined. This provided adequate detail that the issues were investigated and resolved. Six residents spoken with said that they would know how to make a complaint, but this was sometimes difficult if they did not see the manager, as they were not sure that if they complained to Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 18 some staff their complaint would receive attention. A resident said that she had no reason to complain but would see the manager. All residents take part in postal voting. Residents spoken with were not aware what would happen if they were unable due to illness. Residents were not aware of any advocacy service within the home. The homes policies and procedures in relation to safeguarding vulnerable adults and whistle blowing had not been reviewed. Neither document reflected the new ownership of the home. Two staff said that they had received POVA training. They also said that they were aware of all the ways in which abuse could be perpetrated. An accident involving equipment had not been reported to the Commission or other authority. It had not been referred to the Safeguarding Vulnerable Adults team. A referral was made retrospectively. See also standard 38. Residents are protected by good employment procedures, which include CRB and POVA first checks prior to being offered employment in the home. Good records are kept of all expenditures made on the residents’ behalf. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of the décor, infection control, and refurbishment within the home is poor. There is evidence that the new providers are undertaking and planning future maintenance. At present the home does not present as a homely, safe and comfortable environment for the residents. EVIDENCE: The manager demonstrated a good awareness that the environment is in urgent need of upgrading. Several rooms are being redecorated and refurbished. A programme of maintenance and renewal of the fabric is a requirement of this inspection to ensure that improvements are made in a time-scaled manner. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 20 The gardens are currently not safe for residents to use. Both areas have large accessible ponds that are either inadequately or not fenced off. The manager said that she had received a quote regarding the fencing off of the front pond. All pathways to the home especially from the public car park are in a bad state of repair. A small covered patio area to the side of the home has dangerous paving in situ and the covered Perspex roof is in a poor state of repair. With exception of the three communal lounges and main entrance hall the home in general was in a poor state of maintenance and repair. The home provides three pleasant well furnished lounges for the residents. These are however are used infrequently as residents prefer to stay in their own rooms. The manager is aware that the bathroom facilities are in need of an urgent review. Currently there is only one usable bathroom in the home on the first floor. This bathroom was in a poor decorative order. In a bathroom on the ground floor, the bath hoist was broken and laid on the floor. Large bolts protruded from the floor, which present a hazard both to the residents and any member of staff who might be using this bathroom. Hot water into the bath was being delivered at over 50ºC. This bathroom was in a poor decorative order with mould around the sealant at the top of the bath. While the manager said that this bathroom was not in use, there was evidence that it had recently been used, as there were fresh bubbles left in the bottom of the bath. Some bedrooms have en-suite facilities. None of the communal toilets have raised seats or handrails to assist the residents. There was no staff guidance regarding the use of bedrails. Following an accident involving the use of bedrails, the risk assessment had not been completed until after a week of this accident occurring. See also standard 38. The home has two shaft lifts accessing the first floor. However, one lift has been out of action prior to May 2007. The manager is contacting the previous owners to address this issue. All vacant rooms had broken furniture and aids belonging to the NHS stores department. The manager said that an audit is being carried out with a view to returning unwanted Zimmer frames, bed rails and wheelchairs to the NHS loan stores. Hoists and trolleys with laundry were placed in corridors presenting a potential danger to residents who might be using the corridors. Aids such as hoists and wheelchairs were in a dirty condition and could present an infection risk. All vacant rooms were unusable due to miscellaneous clutter and furniture, and poor state of decoration and repair. Two bedrooms were in the process of being re-plastered and re-decorated. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 21 All bedrooms are in need of redecoration and review of quality of furnishings and furniture. New curtains and blinds are on order. Profiling beds have been purchased and arrived on the first day of inspection. One communal toilet on the first floor did not have a working light and the lampshade had a burn hole. Whilst all bedrooms have radiator covers, some are unsuitable as they were made up of a wooden frame covered with chicken wire. The risk of burning was high as the wires were very hot. One bedroom did not have a working radiator. A freestanding heater had been supplied that was operating at a very high temperature. Although a risk assessment was place in respect of the resident, it posed a risk to any staff or visitors entering the room. Hot water temperatures had not been recorded regularly. There was evidence that some hot water outlets delivered water at above 50ºC while other hot water outlets just delivered cold water. In conversation with the maintenance man, it became apparent that not all the thermostatic control valves were operating effectively. He said that some valves had been replaced but no record kept. There was no recorded evidence of regular water temperatures being taken. The laundry room has two industrial washing machines with a sluicing/disinfecting facility and two new industrial tumble driers. The floor was impervious to water and red alginate bags are used for foul laundry. Both sluice rooms were malodorous. The manager said she had called in the plumber to sort the problem out. However, this should have been arranged prior to inspectors picking this up. A room used for storage was also malodorous. For infection control purposes, it was recommended that a review of bins be carried out. None of the bins were foot operated. In view of the infection control issues identified, the inspectors recommended that the manager contact the Kent Protection Agency to request that an infection control audit be carried out in the home. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager needs to keep rotas for nursing, care staff and ancillary staff under constant review to ensure the needs of the residents are being met. Residents cannot be assured that they are in safe hands at all times when staff are unsure of their role and responsibilities. Residents are protected by the home’s recruitment policy and practices Staff training needs to be further developed to ensure that all staff have received mandatory training as well as work related training so that the diverse health, personal and social care needs of residents are met. EVIDENCE: The duty rota reflects the number of care staff on duty. These appear to be sufficient for the number and dependency of the residents at the time of the inspection. Lines of accountability within the home are not clearly defined. Eleven members of staff hold the ‘title’ of senior carer. A senior carer was asked what Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 23 the role involved. He replied that he would give medication to residents requiring residential care. The carer was not sure whether other roles and responsibilities might be attached to the status of ‘senior’. See also standard 31. In addition to nursing and care staff, the home employs administrative, domestic, laundry, maintenance and catering staff. The manager needs to keep the level of domestic staff under review to ensure the home is kept clean and weekend cover adequate. There are some newly employed staff in the home. A registered nurse was shadowing another and a newly employed carer was in her induction period. The manager will be supported by a deputy from May 2008. All staff receive regular supervision. See also standards 30 and 36. The manager confirmed her commitment to achieve a minimum of 50 NVQ qualified staff and has made contact with a training company for that purpose. However, many of the overseas staff currently employed do not qualify for free training. The manager confirmed that she is keen to develop specialisms in the home and several nurses have shown an interest in taking on a link role. Link roles under discussion relate to wound care, syringe driver, nutrition, continence management and infection control. The above 2 initiatives are at an early stage of implementation. A sample of staff files was examined and demonstrated that good recruitment procedures are in place. Separate training files are maintained. Information in the training matrix identified serious gaps in the provision of mandatory training: Moving and handling 90 Adult Protection 90 Fire Safety 59 First Aid 46 Medication 31 Food Hygiene 7 Infection Control 0 1 cook has Food Hygiene at Level 3 1 cook has Food Hygiene. See also standard 38. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home at present is not well managed and could have a detrimental effect on the residents. Quality assurance systems within the home need to be developed further to ensure that the home is offering a quality service to its residents. Staff receive regular supervision. Records need to be reviewed to ensure they meet with relevant guidance and legislation and relate to the new owners. Health and safety issues including staff training must be addressed to ensure that the residents and staff are not placed at risk. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager is in the process of applying to CSCI for registration. She is a qualified nurse, who has management experience in a large caring company. At the present time there is evidence to suggest that relationship between the registered manager and qualified nurses and care staff could be improved upon. There were many instances of the manager not being aware of what is occurring in the home. One of the inspectors witnessed an incident, which should have been better managed. A disagreement took place between a carer and the manager in a corridor on the ground floor on the first day of the visit and could be heard clearly in a lounge area of the home. This incident could have been avoided by good management practice. In relation to responsibilities and accountability, the role of ‘senior carer’ should be clarified. See also standard 27. Whilst the views of the residents and their relatives are sought, currently consultation with external stakeholders who visit the home such as G.P’s, district nurses, chiropodists, opticians, dentists, care managers, hairdressers, and people supplying entertainment to the home, are not included. Regularly recorded audits of all systems used in the home are currently not carried out. Such audits should include care planning, care plan reviews, medication, cleaning, presentation of meals, competencies of staff after training, infection control measures. A regular health and safety and fire risk assessment has not been carried out for all rooms in the home, including communal rooms and the external premises and grounds. A report of the whole quality assurance audit must then be published on an annual basis. Serious gaps were identified in the provision of mandatory training thereby not safeguarding the residents. Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 26 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 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 1 2 1 2 3 2 2 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 x 3 3 2 1 Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 OP3 Regulation 14 (1) (a) (b) (c) (d) Requirement The registered person shall not provide accommodation to a service user at the care home, unless the needs of the service user have been assessed by a suitably qualified or suitably trained person The registered person shall prepare a written plan as to how the service user’s needs in respect of health and welfare are to be met Timescale for action 30/06/08 2 OP7 15 (1) (2) (a) (b) (c) (d) 30/06/08 3 OP8 13 (1) (b) The registered person shall make 30/06/08 arrangements for services users to receive where necessary, treatment, advice and other services from any health care professional The registered person shall make 30/06/08 suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users The registered person shall DS0000070676.V360020.R01.S.doc 4 OP10 12 (4) (a) 5 OP12 16 (n) 30/06/08 Version 5.2 Page 28 Acacia House OP13 (m) consult with service users about (a) their social interests and make arrangements to enable them to engage in local, social and community activities (b) the programme of activities arranged by or on behalf of the care home The registered person shall establish a procedure for considering the complaints made (relating to the current owners) 30/06/08 6 OP16 22 (1) 7 OP19 23 (2) (d) (0) The registered person shall 30/06/08 ensure that: (a) all parts of the care home are kept clean and reasonably decorated (b) external grounds are provided for residents which are suitable and safe The registered person shall provide sufficient numbers of baths and showers with a hot and cold water supply The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety The registered person shall (a) make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home (b) keep the care home free from offensive odours The registered person shall ensure that that the persons employed by the registered person to work in the care home receive the training appropriate DS0000070676.V360020.R01.S.doc 8 OP21 23 (2) (j) 30/06/08 9 OP22 OP25 13 (4) 30/06/08 10 OP26 13 (3) 16 (2) (k) 30/06/08 11 OP30 OP38 18 (1) (c) (i) 30/06/08 Acacia House Version 5.2 Page 29 to the work they are to perform 12 OP38 13 (4) c The registered person shall ensure that unnecessary risks to health and safety of service users are identified and so far as possible eliminated The registered person shall give notice to the Commission without delay of the occurrence of any serious injury to a service user 30/06/08 13 OP38 37 (1) c 30/06/08 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 Refer to Standard OP9 Good Practice Recommendations That the use of pain management tools be reviewed and medication records be supplemented by information that clearly describes the circumstances when ‘as required’ medicines are to be given That residents and their relatives are informed of how to contact external agents (e.g. advocates) who will act in their interests 2 OP14 Acacia House DS0000070676.V360020.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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