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Inspection on 18/10/05 for Acacia Lodge Nursing Home

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

This inspection was carried out on 18th October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

What the care home does well

The atmosphere in the home was friendly and relaxed, and staff were welcoming. Any body wanting to make a complaint has easy access to the complaints procedure, and a record is kept of all complaints. The complaints policy is a corporate one and is not specific for Acacia Lodge. Staff demonstrated a good understanding of the residents` needs and were seen to relate well to the residents. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 6A varied and interesting menu is planned for the residents, and identifies that there is a choice offered to all residents. Meals that are liquidised are served in an appetising manner, and each component is liquidised separately. One relative was helping her husband to eat his meal. Residents were moving freely within the confines of the home. There are security systems in place to ensure safety for the residents with dementia. Appropriate graphic signage is displayed to enable residents with dementia to access lavatories, bathrooms and their own personal room.

What has improved since the last inspection?

Some limited improvement has been made to the care plans and the risk assessments since the last inspection. All areas of the home have been assessed so that a detailed refurbishment and redecoration programme can be developed. In response to previous requirements health care professionals in the form of dieticians have been contacted and a specialist in Huntingdons Disease has provided guidance and advice. On going information and advice is being given from the diabetic nurse and continence advisors. Wheelchairs had in place the footplates, and the maintenance man has a system in place to ensure regular checking of wheelchairs is undertaken. A Bain Marie has been purchased so that the food transferred to the first floor remains at an acceptable temperature.

What the care home could do better:

Currently there is no person responsible for arranging activities. The residents with dementia were receiving minimal stimulation from the staff, with the staff standing around and seemingly not knowing what to do. A number of residents are very active and would benefit from being offered a range of appropriate activities. A number of bedrooms were not personalised and did not have bedside lights in place. The beds had not been made properly and the floors of the en-suite facilities had a residue of cleaning agent resulting in the floors being sticky. A number of wheelchairs were in need of attention in that when the breaks were applied the wheelchair could still be moved. The wheelchairs were showing signs of wear and tear and were `tatty`Although some work has been made on the residents` care plans and risk assessments since the last inspection they are still inadequate in being able to inform staff in how each individual`s care is to be delivered. Currently the information recorded by the staff in the resident`s files is not consistent resulting in essential information being left out. The result of this poor practice is that there is little evidence to show that individual identified care needs are being met. Important information is being omitted that could potentially put the residents at risk of harm. Residents, wherever possible, should be involved in the development of their plan of care and resulting risk assessments. Fundamental information such as their choice of where to sit in the home and how they wish to spend their day; what sort of food they want to eat and where they want to eat it; whether they want a key to their room are all central to ensuring that each resident is treated as an individual with rights as to how they want their care to be provided whilst they live at Acacia Lodge. The current practice undertaken by staff when aiding resident`s with their meals did not promote dignity and respect. All new staff receives induction training. However the manner in which this information is delivered should be reconsidered to ensure that all staff have understood the information that has been given before new subjects are introduced. The Inspector is aware that a detailed assessment of all areas of the home has been undertaken. This action is long overdue because the condition of the home is beginning to look very tired, with a number of areas in need of repair and redecoration to bring the home up to an acceptable standard. Toiletries, creams and ointments are left in open containers in a number of the en-suite bathrooms. Any resident with dementia is at potential risk of harm.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Acacia Lodge Nursing Home 15 Wellingborough Road Irthlingborough Wellingborough Northants NN9 5RE Lead Inspector Mrs Judith Sansom Complaint Visit 18th October 2005 12:00 X10029.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 Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 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 and Care Homes for Adults 18 – 65*. 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 Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Acacia Lodge Nursing Home Address 15 Wellingborough Road Irthlingborough Wellingborough Northants NN9 5RE 01933 651660 01933 652948 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) Bupa Care Homes (AKW) Ltd, Central and West Mids Regional Office Vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (5), of places Physical disability (18), Physical disability over 65 years of age (18), Terminally ill over 65 years of age (5) Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2005 Brief Description of the Service: Acacia Lodge is owned by BUPA Care Homes Ltd and is registered to provide nursing and personal care for service users with a variety of needs. The majority of service users are over 65 years of age. Acacia Lodge is a home situated on a main route within the small town of Irthlingborough in Northamptonshire. The home is within walking distance of Irthlingborough town centre where community resources include churches, shops, pubs and restaurants. Accommodation to the service users is provided across two floors, there are 30 single rooms and 5 double rooms with a majority providing en-suite facilities. The first floor is used for the service users with dementia. Located on this floor is a dining room and lounge area. On the ground floor there are lounge areas and a dining area. There is access by a passenger lift to the first floor. Gardens and car park are located at the front and side of the home with disabled access to the home. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for residents and their views of the service provided. The methodology of case tracking is used to find out if the care being provided to the residents is of an acceptable standard and meets their individual needs. ‘Case tracking’ involves the review of resident’s records, meeting with them and talking with the care staff that provide the personal care to the selected residents. The inspection also includes a review of the homes’ procedures and processes to ensure that all practices carried out by the staff protect the residents. This inspection was carried out on an unannounced basis and was in response to a complaint that had been received by the commission. The Inspector carried out the inspection in the home on an unannounced basis and was in the home from late morning until late afternoon. Compliance by the manager to action previous requirements placed was reviewed as part of the inspection process. The areas of complaint were varied but primarily covered poor care practices, staffing numbers, condition of some furniture and aids, and the changes that are being introduced into the home. To ensure that all areas of the complaint were reviewed the Inspector undertook the following process: ‘case tracking’ which involved selecting 3 residents and tracking the care they receive through review of their records, discussion with the residents, the care staff and observation of care practices. The Inspector undertook a selected ‘walk’ of related areas of the home, and a detailed review of relevant records that are held in the home. The topics of the complaint are addressed throughout the report. The requirements and recommendations placed at the conclusion of the report reflect the findings of the complaint inspection. What the service does well: The atmosphere in the home was friendly and relaxed, and staff were welcoming. Any body wanting to make a complaint has easy access to the complaints procedure, and a record is kept of all complaints. The complaints policy is a corporate one and is not specific for Acacia Lodge. Staff demonstrated a good understanding of the residents’ needs and were seen to relate well to the residents. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 6 A varied and interesting menu is planned for the residents, and identifies that there is a choice offered to all residents. Meals that are liquidised are served in an appetising manner, and each component is liquidised separately. One relative was helping her husband to eat his meal. Residents were moving freely within the confines of the home. There are security systems in place to ensure safety for the residents with dementia. Appropriate graphic signage is displayed to enable residents with dementia to access lavatories, bathrooms and their own personal room. What has improved since the last inspection? What they could do better: Currently there is no person responsible for arranging activities. The residents with dementia were receiving minimal stimulation from the staff, with the staff standing around and seemingly not knowing what to do. A number of residents are very active and would benefit from being offered a range of appropriate activities. A number of bedrooms were not personalised and did not have bedside lights in place. The beds had not been made properly and the floors of the en-suite facilities had a residue of cleaning agent resulting in the floors being sticky. A number of wheelchairs were in need of attention in that when the breaks were applied the wheelchair could still be moved. The wheelchairs were showing signs of wear and tear and were ‘tatty’. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 7 Although some work has been made on the residents’ care plans and risk assessments since the last inspection they are still inadequate in being able to inform staff in how each individual’s care is to be delivered. Currently the information recorded by the staff in the resident’s files is not consistent resulting in essential information being left out. The result of this poor practice is that there is little evidence to show that individual identified care needs are being met. Important information is being omitted that could potentially put the residents at risk of harm. Residents, wherever possible, should be involved in the development of their plan of care and resulting risk assessments. Fundamental information such as their choice of where to sit in the home and how they wish to spend their day; what sort of food they want to eat and where they want to eat it; whether they want a key to their room are all central to ensuring that each resident is treated as an individual with rights as to how they want their care to be provided whilst they live at Acacia Lodge. The current practice undertaken by staff when aiding resident’s with their meals did not promote dignity and respect. All new staff receives induction training. However the manner in which this information is delivered should be reconsidered to ensure that all staff have understood the information that has been given before new subjects are introduced. The Inspector is aware that a detailed assessment of all areas of the home has been undertaken. This action is long overdue because the condition of the home is beginning to look very tired, with a number of areas in need of repair and redecoration to bring the home up to an acceptable standard. Toiletries, creams and ointments are left in open containers in a number of the en-suite bathrooms. Any resident with dementia is at potential risk of harm. 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 Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3, Standard 6 does not apply to Acacia Lodge. Although the home has an admission process that includes the completion of an assessment form this format limits the amount of fundamental information that is sought and recorded prior to any admission which is elemental to the development of the initial care plan and related risk assessments. In the absence of this essential information there is no assurance that the potential resident’s individual care needs can be met. EVIDENCE: Placed in some resident’s rooms is a copy of the Service User’s guide. This document would benefit from being reviewed to ensure that it is written in a manner that residents easily be read and understood. Currently this document is not service user friendly. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 10 A pre-formatted template is used as a tool to aid the pre-admission assessment and enables the assessor to gain some basic information concerning the potential resident prior to them coming into the home. This document/tool would benefit from being reviewed to ensure that sufficient information is detailed so that the initial care plan and risk assessment can be developed prior to admission. This is especially important when admitting persons with dementia. Due to the level of dementia of the residents on the first floor the Inspector was unable to ascertain whether they had been involved in the decision making process prior to coming into the home. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 10 Minimal progress has been made since the last inspection to develop the care plans and risk assessments to ensure that the health care needs of the residents are identified and met. These shortfalls have the potential to place residents at risk. EVIDENCE: The residents’ care plans contain limited information. There is no robust system in place to ensure that all relevant information is consistently recorded. This shortfall means that the reader could have difficulty in making significant Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 12 and important decisions about the care of the resident. This is especially important when residents have fragile skin and are prone to marking when touching hard surfaces or when being touched by the staff when personal care is being given. The daily notes identified that once the care staff had identified a health need for one resident health care professionals were consulted in a timely fashion, resulting in antibiotics being prescribed and given. In response to previous requirements each file contained risk assessments. The risk assessments included such assessments as manual handling; nutrition and falls. However there was no evidence to show that life style risk assessments pertinent to each individual resident had been developed that was in line with promoting independence and choice and maintaining previous life styles. Where a risk has been identified there is no instruction or guidance for staffing in the management of the specific risk. For example the risk of choking was identified for one resident; no guidance or instruction was given in managing the situation other than to try to ensure that the resident was sitting up. For residents who present challenging behaviour possible triggers were not identified or recorded. There was no evidence of detailed instructions for staff to follow in how to how to manage the situation. For residents who have fragile skin no guidance is given. These shortfalls have the potential of putting the residents at risk of harm Care plans and associated risk assessments should be developed with input from the resident and significant others when the resident is unable to understand the process. There was no evidence of involvement by the resident at any stage of the development of their plan of care or risk assessment. A number of residents suffer with continence problems and require specific care. The manufacturers of continence aids used in the home have given advice and guidance that instructs staff in how to use the products. This information is detailed and displayed in the office for the staff to use as an aide memoir. However the manager is encouraged to continue seeking advice from external continence advisors to ensure that the residents are receiving the appropriate continence advice and subsequent aids. Residents’ care plans must provide instruction and guidance for staff in the management of each individual’s continence needs. All staff should receive training and guidance that is relevant to the continence care provided to each resident. Records show that residents are checked regularly during the day and night to ensure that pads are changed frequently and appropriately. Due to problems with new suppliers, at times there have been insufficient quantities of shampoo and shower gel for the residents to use. This problem has now been solved and the stock cupboard contains sufficient quantities. Due to their levels of dementia residents on the first floor were unable to make Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 13 meaningful comments in relation to their care and how the staff look after them. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 There is limited information recorded in the care plans that identify previous hobbies, interests and life styles and how the resident want these past interests included into their everyday life. With the vacancy of an activities organiser there is danger that residents holistic needs are not being met. EVIDENCE: Information recorded in the care plans does identify goals and aims for the residents. However these goals and aims are not reflective of past interests, hobbies, preferences and choices but are limited to health needs. Religious interests and needs are not identified. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 15 During the inspection a number of relatives/friends were visiting the home. A number of relatives were observed undertaking tasks for the resident. One relative was sitting with her husband in the lounge area helping him to eat his meal. Each resident is asked on a daily basis what he or she would like to eat. The menu identifies a wide selection and choice for the breakfast meal, dinner and tea. A record is maintained of the alternative food eaten by the residents. A Bain Marie has been purchased so that foods being transferred up to the 1st floor retains its’ heat and enables staff to serve the meals upstairs. Currently meals are pre-plated in the kitchen. This practice is being reviewed to assess whether an alternative method can be found. Information and guidance has been sought from the diabetic nurse in relation to those residents who suffer with diabetes. The current practice is for all residents with diabetes to be offered the same meals as the other residents. Caution is to be taken when offering some foods, for example if a pudding has a ‘sugar-icing top’. Care staff should be advised whether it should be removed when served to a resident with diabetes. In relation to puddings in general, a smaller helping is offered; this follows the advice given. The cook is aware of this guidance, but at times will provide diabetic custard to go with the pudding on offer. The cook is not aware that residents’ with diabetes are restricted to three puddings a week. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The complaints process and procedure in the home must be written in a manner to ensure that all residents are able to understand how to make a complaint. Failure to address this could result in residents not knowing how to make a complaint. EVIDENCE: To enable residents and visitors to the home to make a complaint about the service they are receiving there is a copy of the complaints procedure displayed in the main foyer. Contained in the Service User’s guide is guidance in how to make a complaint. The way in which this is written does not aid those residents who have difficulty in reading or understanding the words for example those with the early stages of dementia. Some information is omitted from this corporate complaints policy. The complainant needs to know that they have the right to contact the commission to make a complaint at any time or stage of making a complaint and the complainant should be aided to make this contact by ensuring that the commissions’ local contact information is detailed. This shortfall should be addressed to promote residents rights to complain. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 17 A complaints file contains complaints made about the home. A number of shortfalls were identified: currently the log does not record how the complaint was addressed, the necessary information in relation to the outcome of the complaint and whether the complainant is satisfied with the outcome. All complaints should be responded to in a timely fashion and the complainant advised that their complaint is being attended to. Steps have been taken by the management of the home in relation to an allegation of abuse. The situation is currently ongoing. However the management must undertake a review of the home’s POVA (Protection of Vulnerable Adults) policy and procedures to ensure that any allegation or suspicion of abuse is dealt with in a timely fashion and appropriately. Staff were clear about their responsibility to ‘whistleblow’ on any staff member that is seen or heard acting inappropriately towards any resident. These issues are detailed within the induction training for all new members of staff. However all staff would benefit from their knowledge base being updated through further training. The local area office of the commission has received a complaint about the practices at Acacia Lodge. The complaint issues were related to staffing, management care practices and the environment. Where the complaint topic is upheld relevant requirements and recommendations have been detailed at the conclusion of the report. There will be ongoing monitoring to ensure compliance to the requirements. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 & 26 The environment provides safe comfortable surroundings but attention must be paid to the necessary refurbishment and redecoration of the home. Failure to address these identified shortfalls means that the residents’ home is not maintained to an acceptable standard. EVIDENCE: To enable the residents to move about freely and safely in the home over both floors some security systems have been put in place. There are gates at the Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 19 top of the staircases that cannot be opened without the use of a security code. This action enables those residents who have dementia and are continuously active to walk the ‘floor’ without being at risk. There are plans being discussed that would secure areas of the garden to enable the residents to enjoy being able to access the garden safely. A number of areas in the home are showing distinct signs of wear and tear. The plans to refurbish and redecorate must be finalised so that a detailed programme can be developed to ensure that the environment does not fall below the standards any further. A maintenance person is employed to undertake the everyday repairs as needed in the home. For example one dining room table had become wobbly and unsafe to use. This has been repaired. No other dinner tables were found to be wobbly. A review of the residents’ bedrooms must take place to ensure they are personalised, homely and residents are offered all items of furniture as detailed in the National Minimum Standards. It is the responsibility of the manager to provide bedrooms that are welcoming and homely, this is especially important for any residents who do not have any items to being with them when they move into the home. The home was clean, pleasant and hygienic. A dedicated group of staff are responsible for maintaining an acceptable level of cleanliness and hygiene. These staff members have received COSHH (Control of Substances Hazardous to Health) training. Protective clothing is provided for staff to ensure personal safety when managing bodily fluids and to ensure that infection control is maintained. Staff are encouraged not to wear gloves when giving personal care unless there is an identified risk. Some staff are not happy with this directive from the management and feel that they should wear gloves for all tasks including the washing of resident’s face and hands. Discussions relating to this topic are ongoing, and further training on infection control is being considered for the staff. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Recruitment for new staff is ongoing due to a number of staff having left their employment at the home. Staff morale is low due to a number of changes being implemented. However the staff are committed to ensuring that the residents are well looked after and are working to improve the resident’s whole quality of life. EVIDENCE: Due to a number of staff having recently left the home further selection and recruitment is being undertaken. Some staff are taking on extra work and shifts to cover the gaps. All new staff are given a detailed induction period with specific training that is in line with the TOPPS foundation training. New staff are monitored and work alongside a senior and experienced member of staff until deemed to be capable of lone working. The amount of information that all new staff are expected to take on board is daunting and can be confusing, Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 21 especially if the new recruit has no previous experience in the care field. The registered persons should consider a method of reviewing the current system to ensure that the staff are retaining the information. There were sufficient staff on duty during the inspection. Staffing levels are being constantly reviewed taking into consideration of the changing needs of the residents. An increase in night staff is currently being considered, as a number of residents who suffer from dementia are very active during the night hours. The shift pattern that is currently being used is being reviewed and changes are planned to commence in November. These changes have not helped to boost the morale of the staff. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 38 In the absence of a registered manager the senior team alongside the acting manager carry the everyday running of the home. The senior team is giving leadership and guidance to the staff, however it is the registered persons responsibility to proactively monitor the situation to ensure that the residents receive consistent quality care. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 23 EVIDENCE: The senior team and acting manager have the everyday responsibility of running the home. A number of management decisions have been made to endeavour to improve the service being provided to the residents. The acting manager has been in post for a number of months, the commission has not received an application for the position of Registered Manager. This shortfall should be addressed to bring stability to the management structure to the home. The acting manager was not available for the inspection and to provide information relating to the issues detailed in the complaint received by the commission. However the deputy manager was able to identify a sound knowledge of the needs of both the staff and residents. Although the ‘maintenance person’ monitors the condition of the wheelchairs, and carries out repairs as necessary, the brakes on a number of wheelchairs were ineffective. A number of rubber covers on levers were not in place and wheelchair footplates would not stay in position. The condition of the wheelchairs has given cause for concern since the inspection of June 2005. Other areas relating to the health and safety of the residents have been addressed through this report. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 24 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 2 X 3 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 2 21 X 22 X 23 X 24 2 25 X 26 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 X 34 X 35 X 36 X 37 X 38 2 Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 25 YES 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 OP7 Regulation Reg 15 Requirement The care plans for each resident must be reviewed to ensure that they contain sufficient information and instruction for staff in the provision of care. Each resident must be involved in the development and review of their care plan. There must be written evidence to evidence the involvement of the resident. Resident’s individual risk assessments must be developed that give sufficient guidance and instruction to staff in how to manage and minimise the identified risk. Resident’s records must demonstrate that health care professionals have been consulted and are involved in the identification of individual’s care needs. All residents must be given the opportunity of living a lifestyle that is in keeping with their expectations, preferences and choices providing them with holistic care. The current Protection of DS0000029163.V260054.R01.S.doc Timescale for action 30/12/05 2 OP7 Reg 15 30/12/05 3 OP7 Reg 13 & 15 30/12/05 4 OP8 Reg 12 & 15 30/12/05 5 OP12 Reg 12 30/12/05 6 OP18 Reg 13 30/12/05 Page 26 Acacia Lodge Nursing Home Version 5.0 7 OP18 Reg 13 8 OP19 Reg 23 9 OP38 Reg 13 & 16 10 OP38 Reg 13 & 16 Vulnerable Adults Procedures must be reviewed to provide comprehensive and accurate information to all staff. Outstanding from 27/02/04 All staff must receive the appropriate training instructing and guiding them into the actions that must be taken when an allegation or suspicion of abuse has been made. A comprehensive and detailed refurbishment and redecoration programme must be developed and submitted to the local area office of the commission. The condition of all wheelchairs must be reviewed to ensure that they are all of an acceptable standard and in good working order. Detailed risk assessments must be developed that incorporates the individual identified needs of the residents and of the environment. 30/12/05 30/12/05 30/11/05 30/12/05 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 OP1 OP3 OP13 OP16 Good Practice Recommendations The Service User guide should be written in a manner that can be easily understood by the reader. The pre-admission assessment tool should be developed further so that sufficient information is sought prior to admission to enable an initial care plan to be developed. Further development must be undertaken to ensure that cultural and religious needs of the residents are maintained, and includes involvement with the community. The complaints processes and procedures should be reviewed to ensure that all complainants are given the courtesy of having their complaints addressed in a timely DS0000029163.V260054.R01.S.doc Version 5.0 Page 27 Acacia Lodge Nursing Home 5 6 OP19 OP24 7 OP27 8 OP31 fashion and manner. Further work should be undertaken to ensure that all residents have the opportunity of enjoying the external grounds of the home. Further reviews should be undertaken to ensure that the home provides each resident with a room that is homely and welcoming and contains the items of furniture as detailed in the National Minimum Standards. The review of staffing levels should be ongoing to ensure that there is sufficiently skilled staff on duty to meet the individual needs of the residents during the day and the night. The registered persons should be ensuring that sufficient oversight and input is being offered to the management team of Acacia Lodge in the absence of a registered manager. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI. Acacia Lodge Nursing Home DS0000029163.V260054.R01.S.doc Version 5.0 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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