Inspection on 30/07/08 for Acacia House

This inspection was carried out on 30th July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Acacia House 20/02/08

Similar services:

St Joseph`s

Ridgemount

Wingham Court

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

Extracts from inspection reports are licensed from CQC, this page was updated on 12/11/2008.

CARE HOMES FOR OLDER PEOPLE Acacia House Ashford Road St Michaels Tenterden Kent TN30 6QA Lead Inspector Gary Bartlett Unannounced Inspection 30th July 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.V367004.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.V367004.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 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.V367004.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). 20th February 2008 2. Date of last inspection Brief Description of the Service: Acacia House is a large, detached and extended house set in well-maintained gardens. Acacia house provides personal and nursing care for 41 residents. It the owners’ intention to phase out the residential beds and in due course provide nursing care only. The home is on two floors connected by a passenger lift. It provides mainly single rooms, some with an en-suite. There are three shared rooms. The home provides two lounges, a dining area and a quiet room with views onto the garden. Car parking is provided. The home is located on the outskirts of Tenterden on the A28 and is served by public transport. The nearest local amenities are approximately half a mile away. Current weekly fees range between £ £320.63 and £950. Additional charges are made for hairdressing, toiletries, newspapers and chiropody. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection was conducted by Wendy Mills and Gary Bartlett, Regulatory Inspectors, who were in Acacia House on 30th July 2008 from 9.30 am until 3:30 pm. Ms Fiona Dancer from the Immigration Service also accompanied the Inspectors for the first part of the visit. During the inspection, the Inspectors spoke with some residents, two visitors and some staff. Parts of the home and some records were inspected and care practices observed. The Manager was unavailable on the day of this visit but the Deputy Manager very competently assisted us throughout the day. The Deputy Manager is very new to the home, having only been in post for some seven weeks. The Operations Manager of First Choice Care joined us later in the morning and also assisted throughout the visit. The Care Homes Regulations 2001 and the National Minimum Standards for Care Homes for Older People refer to people who use the service as “service users”. People living at Acacia House prefer to be referred to as “residents”. Accordingly this shall be done in the text of this report. Residents say they are well looked after and that the staff are kind and caring. We found that there had been progress in making improvements to both the environment of the home and the care given. However, strong leadership and more attention to detail are needed to ensure all staff communicate well and work as a team. The Inspectors would like to thank everyone involved for their contribution to the inspection. What the service does well: Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 6 Residents say they enjoy living at Acacia House and are happy here. The staff are kind and caring. Staff treat residents with respect and maintain their privacy and dignity. There is a friendly atmosphere with good interaction between residents, staff and visitors. Residents enjoy the meals. These are of good quality. Family and friends feel welcome and know they can visit the home at any time Staff recruitment process are robust to ensure only appropriate people work at the home. The Deputy Manager demonstrates good leadership and mentoring skills. This means that we can be confident that good nursing and care practice will be promoted in the home. Staff are encouraged to undertake training. What has improved since the last inspection? What they could do better: Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 7 There is a need for stronger leadership with clearer direction and more robust quality assurance systems. Work has already begun on improving the care plans but the home must ensure that service users and their supporters are involved as much as possible in this process. This will help the service users maintain as much independence as possible for as long as possible. The daily records of care need to be more informative and tell the reader what the resident has been doing or how they feel. They need to give clearer evidence of monitoring residents’ specific care needs. Further work is required for risk assessments to more fully encompass activities undertaken by residents. More attention to detail must be paid to several aspects of the safe handling and administration of medicines. In particular, more diligence is required when completing documentation; documentation must be secure; medicines must be disposed of safely; and temperatures of medicines storage must be checked and recorded. It is important that the storage of substances hazardous to health (COSHH), such as cleaning fluids, must be stored securely at all times; fire doors and escape routes must not be used as short cuts for staff to move around the home. More should be done to encourage activities and conversation so residents can have a number of choices about the way they spend their time. Although there are plans for the redecoration and refurbishment of the home until this is done, the quality of life and safety of some residents is adversely affected by required improvements to the environment. Parts of the garden must be made safe. 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.V367004.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.V367004.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, 3, 4 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides the residents, their relatives and supporters with the information they need so that they can make an informed decision about their choice of home. Acacia House has pre-admission procedures so that residents can be confident the home can meet their needs. EVIDENCE: The home was taken over by First Choice Care Ltd in the autumn of 2007 and registered with the CSCI in October 2007. At that time a new Statement of Purpose and Service User Guide were written for the home. The CSCI registration team approved these as they meet the required standard for the information they contain. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 10 There have been not been any recent admissions. However, there are sound pre-admission policies and procedures in place and discussion with the Deputy Manager showed that she has a clear understanding of the importance of ensuring that the home can meet the needs of the individual service user before offering a place in the home. The Deputy Manager described how a pre-admission assessment is made of each prospective resident. The assessment process includes recording the findings of the assessment, the detail of which then informs the initial care plan. She said prospective residents, their families, advocates, and relevant health care professionals are involved in the assessment process. Specialist advice is sought from external sources when required. Intermediate care is not offered at Acacia House. Acacia House DS0000070676.V367004.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home works to promote the health and personal wellbeing of the residents but more attention to detail would enhance residents’ quality of life. The home liaises with health care professionals to help meet residents’ health needs. Staff treat residents with respect and maintain their privacy and dignity. EVIDENCE: Each resident has a care plan. Five were inspected in detail. These were tracked to the daily record, equipment and maintenance records. The Deputy Manager has initiated a major overhaul of all the care plans. The new format is much better organised with important information about general health care needs more readily accessible to staff help them provide support to people who live in the home. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 12 A significant improvement in the care planning process has been made already but more attention to detail is required. For example, one care plan states that correct positioning in a wheelchair and wheelchair maintenance should be carried out. However, it did not specify how many times a day positioning should be checked, nor did it describe the maintenance that should be carried out and by whom. Tracking to the daily record showed no mention of either positioning or maintenance having been carried out for a period of sixteen days. Inspection of the wheel chair showed it is need of remedial work. Some care plans contain very detailed information about the social history of the individual so that staff have enough information to provide sensitive support to people who live in the home. Some do not and it is not always evident that residents’ families and supporters have been approached for the information that would help staff provide sensitive support. Moving and handling assessments are kept in residents’ rooms so staff have ready access to them. The daily records of care seen generally consist of uninformative notes such as “all care given”. They do not tell the reader specifically what the resident has been doing or how they feel. They need to give clearer evidence of monitoring residents’ specific care needs. This is especially important where there has been depression, for example. The Deputy Manager is aware that records of daily care need to be more informative to comprehensively reflect the service given and is planning to address this by regularly monitoring them and giving staff guidance as necessary. Staff spoken with generally have a good understanding of getting a balance between perceived risks and promoting independence. There have been improvements to the risk assessments, but as with the care plans, further work is required for them to more fully encompass activities undertaken by residents. Recently, there has been a great improvement in the communication between the home and local health and social care professionals. The home is now working much more closely with the district nurses. On the day of inspection a representative from the local hospice was visiting to liaise over the pain management of a resident. The home made the most of this opportunity as a learning experience and the visiting health care professional spoke very positively about joint working with the home. The Deputy Manager is to be commended for the work she has done to promote this. There has been a recent audit of pressure relieving equipment in the home. Following this, old equipment was thrown away and new equipment has been purchased. This means that the residents are now better protected from developing pressure sores if they are confined to bed. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 13 Residents say that the staff are kind and caring. Direct and indirect observation showed that staff speak with residents in an appropriate and respectful way. However, small details of the environment, such as plant pots left in a corridor and a dead pot plant left on the window-sill show that staff are not fully aware of the impact this might have on a resident who may be feeling unwell and has little else to look at. There are sound policies and procedures for the safe handling, administration and disposal of medicines. The monitored dose system is used for most medicines. However, in this area, lack of attention to detail was also seen. An uncovered jug of water was left on an unattended medicine trolley in a corridor. This trolley is stored chained to a wall at the end of a corridor. There is no thermometer to check the temperature of storage and the folder containing the Medicines Administration Record (MAR) charts was left unattended on top of the trolley. This compromises security and confidentiality. There was some evidence of poor recording in the MAR charts. For example, when an “O” signifying “other” was entered, no record was made on the reverse of the MAR sheet to describe what “other” actually meant. This is an omission in recording and could compromise the health and well being of the residents. A tube of cream that was no longer needed was found in a waste bin in an empty bedroom during the inspection. This means that the no account had been made of what happened to it and that the disposal of this cream was unsafe. It was encouraging to note that the Deputy Manager took immediate steps to inform staff and to address the shortfalls. This negated the need to issue Immediate Requirement Notices. Acacia House DS0000070676.V367004.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. More should be done to encourage activities and conversation so residents can have a number of choices about the way they spend their time. EVIDENCE: On the day of inspection the weather was hot and sunny and some residents were spending time out in the garden whilst others were either in their rooms or in the main lounge. Although staff were seen to speak to residents in a kindly and respectful way, there appeared to be little time for them to stop and have meaningful conversations with the residents. Neither did we observe any formalised activities being carried out throughout the time we were in the home. We were told that the post of activities co-ordinator has recently been advertised and the home is now part way through the recruitment process for this post. It is important that the absence of an activities co-ordinator is not seen as a reason for lack of activities. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 15 There are many potential opportunities in and around the home for all staff to involve residents that wish in day-to-day activities. Staff spoken with say there are times when they would like to have more to do. There is little evidence of community contact for the residents. A staff member said a minister visits the home regularly to conduct a religious service. Family and friends feel welcome and know they can visit the home at any time. During the inspection a number of visitors were seen in the home and the visitors book records regular visits by families, friends and others. The design of the home provides seating areas within the communal areas of the home where residents can entertain their visitors. In addition, residents can receive visitors in the privacy of their own room. The dining room is spacious and airy and the tables were nicely laid with tablecloths and laminated menus in attractive menu holders. There is also a white board in the dining room where the day’s choice of menu is written. Most residents and staff use this as their guide to choice of food. However, on the day of inspection, although the menus looked very attractive, they were a little confusing and the choice of lunch menu for the day was different to that stated on the board. It is strongly recommended that the laminated menus that are placed on each table are simplified and that there is a daily check to ensure these are the same as the actual choice. An experienced cook provides good quality meals. An alternative main meal is always available. Residents say they enjoy the food and look forward to mealtimes. For those who eat in the dining room, mealtimes are generally relaxed. Staff are patient and helpful and allow residents the time they need to finish their meal comfortably. Regular drinks and snacks are available throughout the day. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 16 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are systems to protect residents from abuse. Whilst the home records concerns and complaints well, more work is needed to ensure that lessons learnt from complaints are put into practice. EVIDENCE: There are sound policies for managing complaints, concerns and protection. Three minor complaints have been received by the home since the last inspection. It is difficult to track these. The complaints, investigations and findings are recorded well, but because the records of staff meetings are either unavailable or supervision notes do not fully describe the situation, it is not evident that relevant guidance has been passed on to staff. We found evidence that lessons that should have been learned from complaints are not always being put into practice. For example, one complaint was about used cups being left in a room over a weekend. On the day of inspection we found empty plant pots on a corridor floor and pots with dead plants in them on windowsills. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 17 The Deputy Manager and the Operations Manager both agreed they could make significant improvements. They already have plans to increase the number of staff meetings and to improve on the way one-to-one supervision is carried out. The home has a whistle-blowing policy. It is particularly important staff are aware of this as, from observation, some staff may find it difficult to challenge a colleague directly. There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The staff spoken with showed a sound understanding of safeguarding adults’ procedures and say they have had POVA training recently. There have been two Safeguarding Vulnerable Adults alerts in respect of the home since the last inspection. Investigation of one showed there were no abuse or neglect issues and the alert was closed. The second is ongoing. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 18 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 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The quality of life and safety of some residents is adversely affected by required improvements to the environment. EVIDENCE: Acacia House is set in pleasant surroundings with large, well-maintained gardens. It was noted at the last inspection that two large accessible ponds were either inadequately or not fenced off. Large fences have been erected in response to this but it was not thought to make the gates secure and there is still access to the ponds via a pathway. Some residents were seen to be in the garden unsupervised and, especially those with cognitive difficulties, could be Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 19 at risk. The home is not able to produce a risk-assessment in respect of this. The operations manager undertook to make the area safe as soon as possible. It was agreed that residents occupying ground floor bedrooms would be asked if they wanted net curtains fitted to enhance their privacy. The hallway, lounges and dining room are large, nicely decorated and comfortable rooms in which to spend time. Other parts of the home are still in need of redecoration and upgrading. The operations manager said there are plans for refurbishment, such as replacing the worn and stained carpeting and repairing damaged plasterwork. The completion of this is clearly necessary to improve the comfort of residents. Worn décor and damaged plasterwork is not going to help attract new residents to live at the home and Acacia House currently has a high number of vacancies. Some rooms are in the process of being redecorated and refurbished. Windows have been fitted with more effective restrictors. Some parts of the home have electric strip lights, some of which are without the necessary secondary covers. The Operations Manager said she would arrange for all to be fitted with secondary covers as required or be replaced. The replacement of these lights with a type more domestic in character would make the environment more homely. As noted at the previous inspection, none of the communal toilets have raised seats or handrails to assist the residents use these facilities. There has been some improvement to bathing facilities with a Parker bath having been installed. Other bathrooms are being improved but the home must ensure these rooms are kept secure whilst building works are in progress. The operations manager agreed to ensure they are not accessible to people who could be at risk. Staff are not mindful that fire doors and escape routes should not be used as short cuts for them to move around the home, despite large notices on the doors stating the doors should not be left open. The Deputy Manager immediately addressed the issue and reminded staff of their responsibilities to maintain safety at all time. Had she not done so, we would have issued an Immediate Requirement Notification. Likewise, the Deputy Manager also needed to remind staff of the need to maintain infection control. A commode frame is rusted in places and this and others like it must be made good or replaced to promote infection control. The laundry room and sluice rooms are being maintained to a satisfactory standard. The home must improve its systems to ensure all equipment is kept in a good state of repair and stored appropriately to promote the safety of residents and staff. The home has two shaft lifts accessing the first floor. However, one lift has been out of action prior to May 2007. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 20 Many residents need assistance with mobility. Hoists are used for some residents to help them transfer from bed to wheelchair and wheelchair to chair. The home has limited storage facilities and the hoists, with other equipment such as laundry trolleys, are placed in corridors. Whilst staff are being as careful as they can be, this presents a potential trip hazard to people using the corridors. One resident has a wheelchair in which he can propell himself as recommended in his care plan. The covering of the rims is in poor repair making their use uncomfortable at best, a risk at worst. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment processes are robust and offer protection to people living at the home. Staffing levels are sufficient to meet the nursing and care needs of the residents but not to promote and maintain their independence. Staff are kind and caring and their morale could be improved by stronger leadership, more regular and frequent supervision and improved teamwork. EVIDENCE: Staff recruitment policies and procedures are sound. A number of staff files were examined, including those most recently recruited and those awaiting confirmation of pre-employment checks. Recent files all showed that appropriate checks have been made. There was also discussion about the use of agency staff. We were told that agency staff are rarely used and when they are, only those agencies that are inspected under the Care Standards Act are used. It was difficult to ascertain whether overseas staff who have been working in the home for some time had received Criminal Records Bureau Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 22 (CRB) checks. It is possible that this might not be the case as, at the time they were recruited, the check that was required was a police check in their country of origin. The organisation was asked to review the staff files of existing staff to ensure all appropriate checks are in place. An officer from the Immigration Service accompanied us during part of this visit. The reason for this was that the home employs a significant number of overseas staff and there was concern that there had been some anomalies in the way overseas nurses were employed whilst undertaking the adaptation period to enable them to practice as registered nurses in this country. No evidence of poor practice in the employment of overseas staff was noted. We were told that since the new owners had taken over, adaptation periods are no longer being offered to overseas staff. Staff rosters showed that there are sufficient staff with an appropriate range of qualifications and skills on each shift. A registered general nurse is rostered on each shift. The Deputy Manager is also a registered general nurse. There are staff vacancies and the home is in an area where recruitment is difficult. Existing staff have been very loyal and have supported the home by taking on extra shifts. This means that some are working very long hours for several days at a time. The rosters show that there are sufficient days off in between these long days but it is likely that staff are getting tired and this can lead to minor issues becoming major irritations. There was discussion about how this could have been contributory to a report of a staff incident noted during the inspection. The Deputy Manager is aware of the risks of staff working long, consecutive shift patterns and, when she has been able, has tried to minimise this occurring. Staffing structures are clear and there is a good range of skills, qualifications and experience of staff working in the home. However, encouragement for the team leaders to show stronger leadership could improve team working. There is good evidence that staff training and mentoring is starting to take place as well as statutory training such as infection control and health and safety. Specialist training is also going on and staff have recently received training in the Protection of Vulnerable Adults and in Dementia Care. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 23 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, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a need for stronger leadership with clearer direction and more robust quality assurance systems. EVIDENCE: On 15th July 2008, Kent County Council wrote to the provider informing him that they have decided to place a Poor Practice Risk Level 3 Sanction on the contract for the home. The decision had been reached because it had been evidenced by all Agencies involved with Acacia House that recommended planned actions are not carried through because of weaknesses in the management and leadership within the home and organisation. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 24 We were told that the Registered Manager for the home has resigned and that her last working day would be two days following this visit. On the day of inspection the interim management arrangements for the home had not been agreed. The Operations Manager said that she would be arranging to advertise the post and that, in the interim, the Deputy Manager would look after the day-to-day running of the home. The Operations Manager also said that she herself would be based at the home on a daily basis until a new registered manager is recruited. The Deputy Manager is a registered general nurse who has many years experience in the NHS as a nurse manager. She is clearly competent and has maintained her continuing professional development. She had only been in post for just over seven weeks at the time of this visit. Conversation with her showed that she already has a clear vision for the direction that the home needs to take. She has begun work in some of these areas already. For example, she has carried out an audit of pressure relieving equipment and plans to carry out another on the wheelchairs being used in the home. Although it was said there are regular staff meetings and supervision, there are not records to provide evidence of this. The Deputy Manager has improved mentoring and one-to-one supervision of staff within the limitations of support and resources available. The organisation has some quality assurance systems in place. The Operations Manager makes regular visits to the home to inspect the environment, talk to staff and relatives and to support the manager, in accordance with Regulation 26. However, we found that some environmental concerns and lack of attention to detail have been missed during these visits. A requirement was made fro the home to send the CSCI the reports of the Regulation 26 visits for the next six months. The Operations Manager told us that a questionnaire has recently been sent to the residents and their relatives. At the last inspection of 20th February 2008, it was noted that external stakeholders who visit the home were not included in the quality assurance process. To date, this has not changed and a stakeholder questionnaire to find out what the visiting health and social care professionals and others think of the home has yet to be sent out. Residents and/or their relatives have not expressed concerns in regard to management of monies on their behalf. The Operations Manager stated the home does not act as appointee for any resident. The records seen are kept in a manner that maintains confidentiality. Some records, such as staff files need to be better organised to make information more readily accessible. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 25 An example of very poor practice in keeping hazardous substances secure was observed. The Deputy Manager took immediate action in regard to this. This meant we did have to issue an Immediate Requirement Notice. Staff spoken with have a sound understanding of emergency procedures. The Operations Manager stated that all records of maintenance and safety checks are up to date. These were not inspected on this occasion. Acacia House DS0000070676.V367004.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 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 2 2 2 X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 2 2 Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 14(2)(b), 15(2), 17 Schedule 3, Schedule 4 Requirement “The registered person shall maintain records as specified in Schedules 3 and 4. The registered person shall keep the service user’s plan under review” in that service users’ individual plans and records must be more comprehensive and specific in detail of information required. Timescale for action 30/11/08 2. OP9 13(2) It is acknowledged good progress has been made. All service users must have a comprehensive care plan by the given timescale, if not sooner, which is thereafter maintained. “The registered person shall 30/08/09 make arrangements for the recording, handling, safekeeping, safe administration of medicines” in that: 1. The home must ensure all medicines are stored in accordance with current Royal Pharamaceutical Society guidelines. 2. The Medication Administration Record charts must be a true and accurate record of the DS0000070676.V367004.R01.S.doc Version 5.2 Page 28 Acacia House medication administered to the service users. 3. All medicines must be disposed of in an appropriate manner. To be completed by the given timescale, if not sooner and maintained thereafter. “The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated, in that residents must not be at risk from unsafe access to hazardous areas such as the nearby ponds. 3. OP19 13(4) 15/08/08 4. OP19 23(2)(b) 5. OP22 23(2)(c) To be completed by the given timescale, if not sooner and maintained thereafter. 30/10/08 “The registered person shall, having regard to the size of the care home and the numbers and needs of service users ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally”, in that a detailed plan of refurbishment and redecoration that includes timescales must be received by the Commission by the given date if not sooner. “The registered person shall 30/09/08 having regard to the number and needs of the service users ensure that equipment provided at the care home for use by service users or persons who work at the care home is maintained in good working order”, in that the rim covering of wheelchairs used by residents that can self-propel must be in good repair. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 29 6. OP26 13(3) 16(2)(j) To be completed by the given timescale, if not sooner and maintained thereafter. “The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home”, in that: 1. Rusted commode frames must be made good or replaced. 2. Lifting hoists with damaged paintwork must be made good or replaced. To be completed by the given timescale, if not sooner and maintained thereafter. “The registered provider shall supply a copy of the (Regulation 26) report to the Commission”, in that a copy of the report of each monthly visit conducted from this date must be provided to the Commission until the Commission notifies otherwise. 30/11/08 7. OP33 26 30/07/08 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. 2. 3. 4. Refer to Standard OP8 OP12 OP13 OP15 Good Practice Recommendations It is recommended the risk assessments be further developed to include service users’ daily lifestyles/activities. It is strongly recommended more meaningful activities are provided by staff trained to do so. It is recommended stronger links with the local community are developed and maintained in accordance with service users’ wishes. It is recommended that the laminated menus that are DS0000070676.V367004.R01.S.doc Version 5.2 Page 30 Acacia House 5. 6. 7. 8. 9. OP16 OP22 OP22 OP22 OP27 10. 11. OP27 OP29 12. OP33 13. 14. OP36 OP38 places on each table are simplified and that there is a daily check to ensure these are the same as the actual choice. It is recommended the home is better able to show how relevant guidance that is resultant of complaints has been passed on to staff. It is strongly recommended the communal toilets be fitted with aids such as handrails to assist residents with mobility difficulties. It is strongly recommended the shaft lift that has been out of action prior to May 2007 is made operable. It is strongly recommended hoists and other equipment is stored in designated areas that do not compromise the safety and convenienceof service users and staff. It is strongly recommended staff do not work long consecutive shift patterns that may lead to fatigue and compromise their competency, thereby placing others at risk. It is strongly recommended staffing levels are increased so as to promote and maintain service users’ independence It is strongly recommended a review of staff files be undertaken to ensure all appropriate checks are up-todate and to ascertain whether Criminal Records Bureau (CRB) checks have been received for overseas staff who have been working in the home for some time. It is recommend that a comprehensive quality assurance system be developed which includes obtaining the views of stakeholders and professionals and is incorporated into future planning for the service linked to an understanding of modern practices in care. It is recommended the recent improvements in staff supervision be furthered to include all staff members and that staff meetings are held more frequently. It is recommended environmental risk assessments be undertaken more frequently and that staff be trained in this. Acacia House DS0000070676.V367004.R01.S.doc Version 5.2 Page 31 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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