Inspection on 04/03/09 for Acorn Grange

This inspection was carried out on 4th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Acorn Grange 20/01/10

Acorn Grange 05/12/06

Acorn Grange 16/01/06

Acorn Grange 29/07/05

Acorn Grange 07/03/05

Acorn Grange 02/09/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Acorn Grange Vicarage Road West Cornforth Durham DL17 9JW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Steve Tuck     Date: 0 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Acorn Grange Vicarage Road West Cornforth Durham DL17 9JW 01740656976 01740656667 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Robert Pattinson t/a Manor Care Home Group Name of registered manager (if applicable) Sharon Mary Louise Sperring Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is 48. The registered person may provide the following category of care: Care home only Code 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 - Code OP. No more than 19 places. Dementia - Code DE. No more than 29 places. Date of last inspection Brief description of the care home Acorn Grange is registered to provide residential accommodation for forty-eight older people including nineteen people with dementia who are over the age of sixty-five. Acorn Grange is not registered to provide nursing care. The home is situated in its own grounds. The grounds include parking spaces and Care Homes for Older People Page 4 of 38 care home 48 Over 65 0 19 29 0 Brief description of the care home colourful borders to the front and side of the building and large lawned areas to the back of the building. Inside the home provides single bedroom accommodation over three floors. A passenger lift enables access to the upper floors. Two bedrooms have en-suite facilities. The home also has two conservatories, two dining rooms and several lounge areas. Acorn Grange is situated off a main street in West Cornforth, providing good access to local shops and social facilities. The weekly fees for living at this home are £382 - £402.50 The costs of newspapers, hairdressing, private chiropody and toiletries are not included in the fees. Additional costs include hairdressing, private chiropody, toiletries and personal items including clothing, newspapers and magazines and door guards. Actual fees paid depend on individual circimstances further details can be found in the homes Service User Guide. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is ONE Star. This means the people who use this service experience ADEQUATE quality outcomes. Before the visit we looked at Information we have received since the last Key Inspection. How the service dealt with any complaints or concerns since then. Any changes to how the home is run. Care Homes for Older People Page 6 of 38 The providers view of how well they care for people. We asked them to examine their own service and write to us with the results. We sent surveys to people who use the home, people who arrange for people to live there, those who visit the home to support people like doctors and therapists and the staff who work in the home to ask what they think about services there. The Visit An unannounced visit was made on 5th December 2008. During the visit we Talked with the people who use the service the staff, the manager and visitors to the home. Observed life in the home. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around parts of the building to make sure it was clean safe and comfortable. Checked on what improvements had been made since the last visit. We told the acting manager what we had found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Plans which show how people are to be cared for must be written in enough detail to show the specific actions staff are to take to support peoples needs, preferences and lifestyle. And care plans must be written in enough detail so that they can be used to co-ordinate the work of staff and show if changes in peoples condition have taken place. This must include how people are supported if they have pressure care needs, if they are at risk of injury or if they are in pain but unable to say so. Where people have dementia, the home must follow current best practice to make sure that peoples plan of care and staff support is relevant to their history and needs. There needs to be better structured meaningful activities for people with dementia and adaptations made to the surroundings so that people can find their way around and remain as independent as possible. The home is in a state of disrepair with urgent attention needed to the building. So that people living at the home can continue to live there in comfort and safety, The premises must be kept in a good state of repair; there must be plans of how urgent and routine maintenance, redecoration and refurbishment is carried out. Care Homes for Older People Page 8 of 38 Peoples rooms and communal areas must be clean and have no foul odours. And that proper materials and equipment must be in place to make sure that the home can be kept clean and odour free. The bathroom facilities must be improved so that they are clean and that furnishings are not damaged. And there must be hot water available at all times. The building needs to be adapted to make sure that people with dementia type illness are supported in an environment which suits their needs and follows current best practice. There must be enough suitably qualified and experienced staff available to meet the needs of people living at the home. This includes people who have been identified as being more vulnerable or need more supervision because they have dementia type illness. Some people at this home need a lot staff support because they are vulnerable or have behaviours which challenge. Where people prefer to keep their bedroom doors open, there must be steps in place which will keep everyone safe if there was a fire in the home There must be a plan in place which demonstrates how the quality of the home is to be improved which is based on the views of the people who use the service. This is to make sure that people living at the home know that their service will be improved by the owners, and will be run in their best interests. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 38 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Trained staff from the home find out and understand the needs of people who wish to live there before they move in. This information helps to make sure that peoples needs can be met at the home and agree the ways in which staff are to support them Evidence: Relatives and people living at the home have information that gives them details which they need to tell them what they can expect. Copies are also available at the reception. Although some of the information is being updated, it tells people who is responsible Care Homes for Older People Page 11 of 38 Evidence: for the home, who to speak to and how they can make a complaint if they are unhappy. People who live at the home have a signed agreement about the purpose of their stay and proposed length of stay. But the fee levels are not included in this agreement making it difficult for people to understand the costs of their service. By looking at the records kept at the home we could see that each persons needs are assessed before they move to the home, either by a local authority social worker, healthcare staff and or the acting manager. This is so that the acting manager can be sure that the home is suitable for meeting the needs of people who are going to live there. The acting manager also finds out the cultural and lifestyle needs of people who wish to move to the home to make sure that these can be met. She does this by asking about their backgrounds and how they expect that the home will meet their cultural needs. The acting manager has completed training so that she is able to carry out these assessments. As a result of these measures, all of the people living at the home at present have been properly placed there and the home is able to meet their needs. One person living at the home said, Talking to people about their lives and experiences helped my mother to get used to the idea of having to live in a home. There are some people at the home who have specialised needs or they are already having treatment. The manager asks for advice and guidance from healthcare specialists to make sure that these needs are best met. Care Homes for Older People Page 12 of 38 Evidence: The home does not provide care for those people who have been admitted on a short-term basis to get special therapy while they recover from injury or hospital treatment. No one has been admitted to the home with these needs. The acting manager was clear about her responsibility only to admit people who can be successfully supported, and about the number and type of care that the home is registered to provide. Care Homes for Older People Page 13 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has an individual plan of care, which should set out in detail their preferences and how their assessed needs will be met. But these do not fully describe the measures which staff are to use therefore making it difficult for them to consistently meet peoples needs. Evidence: All people who live at the home have a plan of care which gives a description of how their needs are to be met. Staff write about some but not all events or what they have seen into these records. As well as, this care plans did not match the actual support and intervention which staff currently carry out. Staff have a variety of knowledge and Care Homes for Older People Page 14 of 38 Evidence: experience of caring for people living at the home but this information is not yet successfully combined in the care plans so that these can be used to consistently provide fully co-ordinated care. All of the staff interviewed could describe peoples needs, preferences and histories, although some have more detailed knowledge than others. However the potential areas of good practice were not generally shared with colleagues nor were these written down in care plans. People living at the home are not generally involved in their care planning and people dont sign them. As well as this care plans documents were not organised in a way that staff or people who live at the home could read through them easily. One relative said, Ive not been shown the plans in the time that my mother has lived here. The home aims to give personal care to support people who have dementia type illness, however some of the care given was not well organised. For example one person had pressure care damage but some staff did not know how often they should be supported, for example, by position changes. Some people with dementia have serious illnesses and are unable to say if they are experiencing pain. But there was no evidence that the home has strategies in place which recognise and monitor when people need pain relief and how much is required. The acting manager agreed that improving care plans and the quality and consistency of Care Homes for Older People Page 15 of 38 Evidence: the support given to people, was one of the objectives for this service. There were some records in place which show that the staff and manager have considered how to protect people from risks however these were not always completed, and some had not been updated in the last 12 months. Staff at the home should help to judge how to support people who are at risk from falls and help them to use equipment which maintains their fitness and independence around the home, but some of these were years out of date. For example one person had an assessment for support with walking in 2006 but action to support them had not taken place. As well as this, the ways that the acting manager makes sure that they are as safe as possible is not always written down in their care plan. For example some people have behaviour which challenges staff and other people who live at the home but this had not been written down and making it difficult for staff to be clear about the actions that they should take. As well as this care planning arrangements for who have become frail and may also have dementia type illnessthese people do not yet reflect current best practice. For example, care plans do not specify how people who have an altered sense of time or reality are to be supported or what their personal timescales actually are. Care plans, which place the person at the centre of a network of support for their needs and lifestyle requirements, are yet to be put in place. This can be particularly important for people who become increasingly reliant on staff as Care Homes for Older People Page 16 of 38 Evidence: their level of needs increases. Due to their levels of need, people who live at the home are not able to organise their own medicines, and appointed staff therefore help in this area. Staff who are trained in this area administer medication at the home. Medication is securely stored and records are kept which help staff to make sure that people living at the home have the medication that they have been prescribed. The relationships between staff, residents and relatives, were friendly. Care was delivered in private and staff were seen to knock on doors and wait for permission before entering. Care Homes for Older People Page 17 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people who live at the home are encouraged and supported by the staff to lead fulfilling lives. But this could be improved if staff had a better way of supporting the lifestyle needs of people who are more needy or have a dementia type illness. Evidence: The acting manager and staff help people who live in the home to stay in contact with family members and friends. People who are able to get around the home or local community on their own and staff talked about what they do both inside and out of the home. For example visiting their local church. For some of the people who are unable or do not wish to leave the building there are some limited activities which take place. There is an activity co-ordinator and staff do Care Homes for Older People Page 18 of 38 Evidence: spend time with people, talking to them and helping them to fill their time. However the activities co-ordinator does not have a specific programme in place for people who need more support and staff are often busy meeting the care needs of people living at the home leaving them little time to provide all but basic opportunities. The acting manager also acknowledged that it was difficult trying to get people to engage in any type of activity. The home provides for people who have dementia type illnesses. Although staff do spend time talking to people, which is good, there is also little for people to engage in. For example on woman spent an hour in her room with loud music playing when she was clearly not enjoying it at all. A programme of activities, specifically designed to support, interest and help to structure the lives of people with these needs is not yet in place. At present the home is not able to successfully support people who are more needy and require help to have their lifestyle needs met. Staff at the home like to encourage relatives or friends to visit regularly and people living there said that they like it when people visit and make them feel welcome. Information about advocacy is available although no one has used an advocate in the last 12 months. Many of the people living at the home have brought small items with them making their Care Homes for Older People Page 19 of 38 Evidence: rooms homely and reflective of their previous lifestyles, religious beliefs or cultural backgrounds. People living at the home are encouraged to make choices about their diet. Most said that they like the meals at the home and that they are asked what they would like to eat. Staff were seen asking people about their choice of meal and size of portion to make sure that people got what they wanted. Comments from some of the people living at the home were, I have enjoyed that (lunch). Its the best part of the day. Staff are available during meals to offer support and assistance where needed. The cook has a good knowledge of the meals which people living at the home prefer. She understands the benefit of using fresh ingredients to help people to remain healthy. Menus were available which confirmed that a range of meals are provided which give people a balanced diet. Where people need it food supplements are available to help people to maintain their health for example if they have diabetes or have difficulty maintaining their weight. Care Homes for Older People Page 20 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home and their families can make a complaint if they are unhappy, have a grievance or dispute which helps them to have control over their lives and there are measures in place which should protect people who live at the home from being harmed which helps to promote their safety and security Evidence: There is a clear procedure in place at the home which tells people how to complain and the length of time a response will take. Observations of the acting managers and staffs day-to-day practices show that they ask for peoples views and promote choice and decision making. People living at the home and their visitors said that they would feel comfortable about approaching senior staff if they had any concerns, and most were confident that these Care Homes for Older People Page 21 of 38 Evidence: would be dealt with. Whilst there have been no instances where abuse has been shown to have actually taken place, the home has an adult protection procedure which can be used where abuse has been suspected. This has helped to make sure that the people who are vulnerable and living at the home are properly protected. There is a staff guide that gives clear instructions about the actions which they must take if abuse is disclosed or witnessed. All staff spoken to are knowledgeable of these practices and have had training as part of their introduction to the home and National Vocational Qualifications. Care Homes for Older People Page 22 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment which is homely and should promote their privacy, independence and comfort during their stay. But this could be improved if the home was better maintained and designed to meet the needs of people with dementia type illness. Evidence: All communal areas and some of the bedrooms were viewed during the inspection. Acorn Grange is a converted older property which has had a large extension added to it so that it can be used as a care home. It is a three storey building although no one was resident on the third floor at the time of this inspection. The building was designed over 20 years ago at which time facilities such as a Care Homes for Older People Page 23 of 38 Evidence: passenger lift and catering style kitchens were installed. The home is surrounded by gardens which can be used by people living at the home in the better weather. Inside the home there are some areas such as the downstairs lounge which show that they are more regularly maintained. There is evidence that decoration has taken place in some areas. The furniture fittings and standard of finish is acceptable but unfortunately this contrasts with the first floor lounges, corridors and bedrooms which have damaged paintwork and soft furnishings which are in urgent need of repair, maintenance and replacement. Since the last inspection, people who have dementia type illness have moved to the first floor of the home. Although this home aims to specialise in supporting people with dementia there were no adaptations in place in this area which help to make sure that current best practice can be followed. For example, changes to signage around the home, the placing of appropriate photographs and creating distinct colour contrasts / schemes to people to find their way around. Research by experts has shown that adaptations like this help to support people with dementia who may become increasingly needy. The layout of the first floor makes it difficult for staff and people living there to cope. Several people who live at the home were constantly pushing each other aside as they passed by each other. Corridors in some parts are narrow and the two communal lounges at opposite ends of the building are cramped when everyone wants to use them Care Homes for Older People Page 24 of 38 Evidence: and staff have to split their time between these rooms which sometimes leaves people unsupervised. There is no dining area on the first floor so people living there must dine on the ground floor. However this provided a break for people from the first floor areas and several people said they liked to come downstairs for meals as the room was very pleasant. Bathroom facilities on the first floor were also noted to be in a poor state of repair. Two bathrooms in particular which are used by most people had odour control problems and no hot water at certain times of the day so they could not be hygienically used. These were run down with chipped enamel on the baths and stained floors and tiling. These areas were brought to the attention of the acting manager who reported that there was a boiler fault which the contractors had not yet been able to mend. The acting manager also confirmed that whilst contractors carried out maintenance, the inside of the home has not benefited from an organised scheme of refurbishment and renewal. There are laundry facilities are in place to make sure that that peoples clothing and linen is hygienically cleaned and the risks of passing on any infections is reduced. Arrangements are in place to make sure that clean clothing is always returned to their owner and mistakes are avoided. Care Homes for Older People Page 25 of 38 Evidence: The home is inspected by the Fire Prevention Authority and the Health and Safety Executive (HSE) to make sure that the building and safety systems are suitable for the protection of those who live and work there. Care Homes for Older People Page 26 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. At times there are insufficient staff on duty to meet the needs of the people who are living at the home. This means that they may not get their needs met and could put them at risk of harm or neglect Evidence: The acting manager was unable to give any evidence of how she or the owner had made calculations about how many staff should be available at the home. There was no evidence that the specific care needs of the people living at the home had been accounted for; and the number of staff needed to support them had been considered. As well as this staff who are taking short term sickness absence or holidays were not replaced. This illustrates that staffing levels at the home were allowed to be arbitrary Care Homes for Older People Page 27 of 38 Evidence: dependant on the good health of staff. At this inspection there were two care staff and senior to support nineteen people on the first floor, five of whom were described as having behaviour which challenged staff because of their dementia type illness. Some people require the support of two staff, for example to attend to their personal care. On these occasions only one staff was available to support the people living in this part of the home. One relative said, Sometimes there doesnt appear to be as many staff (due to illness, etc) as there should be. Maybe the owner should look at having more staff to support the current care staff. The acting manager has made deliberate attempts to recruit staff from similar cultural backgrounds as the people living at the home. In some cases they share the same community and social links which can help people to be confident with the way in which they are supported. Several new staff have been employed at this home in the past 12 months. The acting manager described the recruitment practices which should safeguard vulnerable people from unsuitable workers. There was evidence that not all employment checks had been carried out to make sure that they were suitable to work with vulnerable people. For example one person did not have two references before being employed at the home. Care Homes for Older People Page 28 of 38 Care Homes for Older People Page 29 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The acting manager has attempted to make sure that the home is run properly, and make sure that people living there get good quality care while the Registered manager is absent. But this could be improved if the owners gave better support and resources so that the quality of life for people living there is improved. Evidence: This home usually has a manager who has been assessed in the last 12 months by the Commission for Social Care Inspection as being sufficiently skilled, trained and competent. However the manager has been on extended leave for a period of 3 months Care Homes for Older People Page 30 of 38 Evidence: and the deputy has been appointed as acting manager on a temporary basis. The acting manager is a trained nurse and has worked at the home for over 2 years. The acting manager has the skills and aptitude to manage the home on a temporary basis. However although she recognises that the home needs to improve, the owners have not given their full support to the acting manager. For example, areas which are out of the control of the acting manager, such as maintenance of the building, staffing levels and repairs to the heating system, have not been carried out despite requests to do so. Although the acting manager has done her best to improve services at the home and there is a questionairre which is sent to people who livwe at the home and their relatives once per year, theris not a system in place which measures the quality of the service or a plan in place which describes how this is to be improved. There is no management plan for the home which would describe how the quality of life for people is to be met. The overall management approach lacks clear vision. Staff at the home help people who live there to manage their money. Detailed records are kept of peoples day-to-day finances and where staff have supported them to make purchases. Care Homes for Older People Page 31 of 38 Evidence: There are many fire doors at the home, these are mostly peoples bedroom doors and there are safety procedures in place to make sure that people remain safe if there is a fire. However, there are many people at the home who prefer to keep open their bedroom doors which means that the homes procedure to keep people safe if a fire occurs would not work and people would be at risk. The home is also subject to inspections by the Fire Authority and the Health and Safety Executive (HSE) to make sure that the home is safe for people to live and work there. Care Homes for Older People Page 32 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 The person responsible for the home must make sure that all support for people with dementia follows current best practice and this is recorded in each persons care plan. This is to make sure that people who have dementia at the home are supported in ways that are most suitable for them.This is a new Requirement. 01/05/2009 2 7 15 The person responsible for the home must make sure that all care plans must have enough detail to show the specific actions staff are to take to support their needs preferences and lifestyle. This must include how risks are to be managed. Reviews must reflect the progress towards those goals. 01/06/2009 Care Homes for Older People Page 34 of 38 This is to make sure that staff plan and review how they work with people and that they write this down so that everyone in the home works in the same way. This is a new Requirement. 3 8 12 The person responsible for 06/04/2009 the home must make sure that arrangements are in place to successfully support people who require pain relief particularly if they are unable to say so because of dementia type illness. And that routines are recorded and understood by all staff. his is to make sure that people who cannot say so are not suffering from pain.This is a new Requirement 4 8 12 The person responsible for 13/04/2009 the home must make sure that arrangements are in place to successfully support people who have pressure damage. And that routines are recorded and understood by all staff. This is to make sure that people who have pressure care needs are properly supported at the home.This is a new Requirement Care Homes for Older People Page 35 of 38 5 19 23 The person responsible for 01/06/2009 the home must make sure that the premises are of a sound construction and kept in a good state of repair. This includes all communal and private rooms, corridors and bathrooms. The hot water system must work properly. This is so that people who live in the home have an acceptable level of comfort, hygiene and safety.This is a new Requirement 6 27 18 The person responsible for 06/04/2009 the home must make sure that there are sufficient suitably qualified and experienced staff available to meet the needs of people living at the home. This is to make sure that there are enough staff to meet the care needs of people who live at the home.This is a new Requirement. 7 38 23 The person responsible for the home must make sure that people are not at risk by keeping bedroom fire doors propped open. This is to help prevent dangers if there is a fire at the home.This is a new Requirement 06/04/2009 Recommendations Care Homes for Older People Page 36 of 38 These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 The person responsible for the home should make sure that the details of the fees that people are to pay is included in their residency agreement. The person responsible for the home should make sure that adaptations to the home are in place that support people with dementia and follow current best practice. This is to make sure that people with dementia are supported in an environment which best suits their needs. The person responsible for the home should make sure that adaptations to the home are in place that support people with dementia and follow current best practice. This is to make sure that people with dementia are supported in an environment which best suits their needs. The person responsible for the home should make sure that odour control is improved in all rooms and corridors identified at this inspection.This is to make sure that the home is kept in a hygienic and pleasant condition. The person responsible for the home should make sure that plans are written down about how the home is to be run and improvements made.This is to how how the home responds to service users comments and tells people about the measures that will be put in place to improve the quality of the service. 2 12 3 19 4 26 5 33 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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