Inspection on 20/10/08 for Acorn Lodge Care Centre

This inspection was carried out on 20th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Acorn Lodge Care Centre 30/10/06

Acorn Lodge Care Centre 03/05/06

Acorn Lodge Care Centre 31/10/05

Acorn Lodge Care Centre 05/05/05

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 13/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Acorn Lodge Care Centre 15 Atherden Road Hackney London E5 0QP     The quality rating for this care home is:   three star excellent 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: Peter Illes     Date: 2 1 1 0 2 0 0 8 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. the things that people have said are important to them: They reflect 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 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Acorn Lodge Care Centre Hackney 15 Atherden Road London E5 0QP 02085339555 Telephone number: Fax number: Email address: Provider web address: acornlodge2005@yahoo.co.uk Name of registered provider(s): Name of registered manager (if applicable) Diane Jureidin Type of registration: Number of places registered: Acorn Lodge Ltd care home 98 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: One named service user to be admitted in the Physical Disability Category under the age of 50 One named service user to be admitted in the Physical Disability Category below the age of 50 Total number of beds 98 to be used flexibly amongst the various categories. With the following categories: Old Age, not falling within any other category (OP) either sex Residents 50 years of age with a diagnosis of dementia (DE) either sex Residents 65 years of age with a diagnosis of dementia DE (E) either sex Residents 50 years of age (PD) either sex Residents 65 years of age PD (E) either sex Date of last inspection Brief description of the care home Acorn Lodge Care Home is a purpose built 98 bedded care home situated in a quite residential area of the London Borough of Hackney. The Commission has just reviewed Care Homes for Older People Page 4 of 33 Over 65 77 46 10 0 0 0 Brief description of the care home and changed the conditions of the home to provide more flexibility. The service can now accommodate up to 98 people needing nursing or personal care within any of the following conditions: old age (OP), dementia (DE) and physical disability (PD) without any other conditions. The home is within easy access of local transport and community facilities. The home was opened in 2005 and is a purpose-built four-storey building. All the bedrooms are single with en-suite facilities. En-suite facilities consist of a toilet and wash hand basin and are accessible to wheelchair users. There is a passenger lift to all floors. Information on the service at Acorn Lodge is available in the Statement of Purpose, which is available on request. Fees are currently between £574 and £690 Care Homes for Older People Page 5 of 33 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: three star excellent 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 last key inspection on this service was completed on 30th October 2006. The main fieldwork activity for this inspection took two days on 20th and 21st October 2008. At the time the home had 98 residents and no vacancies. The inspection was undertaken by the lead inspector however, terms such as we, our and us are used where appropriate to indicate that inspection activity is undertaken on behalf of the Commission. The inspection activity included: meeting and speaking with a number of people living on each floor of the home although, because of the nature of their needs, communication was often limited; independent discussion with relatives, friends and a Care Homes for Older People Page 6 of 33 social worker who visited on one of the days; detailed discussion with the registered manager; detailed discussion withe the deputy manager; and independent discussion with nursing, care and support staff. Information was also obtained from: an Annual Quality Assurance Assessment (AQAA), submitted by the home to the Commission prior to the inspection, a tour of the premises and documentation kept at the home. What the care home does well: What has improved since the last inspection? What they could do better: 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 33 Care Homes for Older People Page 9 of 33 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 33 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. The home has a range of information available to help people make a decision about moving into the home. The needs of people are assessed by the home to assist staff to meet these needs when they are first admitted. Staff continue to reassess people’s needs in a range of key areas once people are living in the home to enable them to respond effectively to changing needs. Evidence: The home has a clear statement of purpose, that is kept in the lobby of the home for people to look at. Each resident is given an accessible and pictorial service user guide on admission to the home, the guide having been updated in 2008. Residents that were able to, and visitors spoken to during the inspection confirmed that they had received a range of information about the home when the person was about to move in. Care Homes for Older People Page 11 of 33 Evidence: The files of ten people living in the home were inspected, five of these were for people that had been admitted to the home since the last key inspection. There was clear assessment information on the files inspected included a preadmission assessment undertaken by the registered manager or deputy manager before the person moved in. In addition files contained a post admission assessment, normally undertaken within a few days of the person being admitted. The files also contained a community care assessment undertaken by the statutory authority that had referred the person and additional healthcare assessment information where appropriate. The files indicated that peoples needs are known when they are admitted and that the home is meeting these people’s needs. Once admitted, people’s needs, including in key areas such as skin frailty, overall risk and moving and handling needs, are reviewed on a regular basis by staff to assist them be aware of people’s changing needs. The home does not provide intermediate care. Care Homes for Older People Page 12 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People accommodated benefit from the home continuing to improve its systems to record people’s needs and to give guidance to staff on how to meet these, however further clarity in recording is needed where agreed restrictions to peoples liberty are being implemented. People may also benefit further from staff having additional information about their past life experiences. People are supported to have their health needs addressed, including by accessing a range of healthcare professionals. Effective medication policies and procedures safeguard people living in the home. Staff are working hard to treat people with respect and dignity, which is appreciated. Evidence: At the last key inspection three requirements were made relating to residents care plans. These were in relation to: ensuring they were updated properly after monthly reviews; ensuring that decisions relating to residents are accurately recorded and that monitoring records relating to residents care were accurately maintained. At this inspection ten residents care plans were inspected and evidence seen that these three requirements were being complied with. The plans inspected had a range of assessed Care Homes for Older People Page 13 of 33 Evidence: needs including: personal care, communication, risk management and nutrition. The plans also incorporated specific nursing needs where appropriate for people receiving nursing care, these included wound care and treatment of pressure ulcers. The plans also gave sufficient guidance to staff on how to address the needs identified and staff spoken to were able to give examples of how the needs were addressed in practice. Evidence was seen that care plans were reviewed and evaluated monthly, with evidence seen that plans had been amended as a result of this review and evaluation. Evidence was also seen of management audits of some files inspected. The registered manager informed us that the home was also in the process of reviewing the care plan format for all residents and once this was completed all care plans would be re-written in the new format. This will further improve the way peoples needs and preferences are recorded and how staff should meet these. There was a section on each persons file to record key events in their lives to show a life history to assist staff in being aware of peoples past lifestyles, preferences and wishes. However, the quality of information in these life histories was variable and staff spoken to stated that it was often difficult to obtain such information, especially if the person had no known relatives. While we accept the difficulties some of the information on the life histories where people did have relatives that visited them was still not particularly detailed. A good practice recommendation is made that the home explores creatively ways of obtaining more life history information on residents with a diagnosis of dementia to further assist staff in meeting peoples needs and wishes in a more person centred way. At the last key inspection a requirement was also made that risk assessments were fully completed for all residents and updated if residents could potentially be at risk. A range of risk assessments were seen on all ten residents files inspected and evidence seen that the requirement was being complied with. The files seen all included a general risk assessment and all residents that needed assistance with their mobility had a separate moving and handling risk assessment. There was also good quality information seen on the files inspected in relation to monitoring skin condition, weight, nutrition and other signs of physical well being. Each file inspected also contained a consent form to evidence where agreement had been reached with relatives and other relevant people with regard to taking photographs, use of bedrails, use of lap straps and not using footplates on wheelchairs. However, although these had been properly signed it was not always clear as to which of the above areas the consent was in relation to. This was because the form stated that the areas that consent was not given for should be deleted. None of the consent forms seen had any of the areas deleted but on discussion with staff we were told that most consent forms only related to a single area e.g. consent for photographs. A requirement is made that consent forms must clearly and separately record each specific area the home has sought Care Homes for Older People Page 14 of 33 Evidence: agreement to use with a resident, including photographs, bedrails, lap straps, footplates and any other identified actions, in order to protect that person and promote their welfare and dignity. This requirement is also made for the protection of the staff in the home. The homes annual quality assurance assessment (AQAA) stated that the following healthcare professionals visit the home: chiropodist, optician, dentist and that the home liaises with the local dental screening programme for home visits. The AQAA went on to state that residents are assisted to attend health related appointments outside of the home and transport arranged and an escort provided if required. Evidence to substantiate this was seen from records and confirmed by discussion with staff and some visitors spoken to. It was noted files contained a record sheet where healthcare professionals recorded their visit and the outcome of that visit. However, where a healthcare professional declined to write on the persons file staff were recording the contact and the outcome on the persons file, but not necessarily on the same record sheet. This meant that on some peoples files the record of contact with health care professionals was not all in the same place. A good practice recommendation is made that all healthcare professionals contact with a resident is recorded in the same place on their file to assist staff obtain a clear overview of this contact. There were clear records on the files inspected of what action had been taken where someone had suffered from a pressure ulcer. This included a photograph, a separate element added to the care plan and the involvement of a tissue viability nurse where appropriate. Evidence was seen that appropriate equipment including pressure relieving mattresses were used for people with vulnerable skin. Evidence was also seen of nutritional assessments, involvement of a dietician and healthcare guidance to assist with people who may have difficulty swallowing. Residents are registered with a GP and evidence was seen that the GP undertakes three visits to the home a week and that GP cover is available 24 hours a day from the GPs out of hours service. Nursing staff on each floor of the home are responsible for the safe administration of medication to residents on that floor. Medication and medication administration records were inspected on three of the four floors for selected residents. These were satisfactory and indicated that residents were being protected by the homes medication procedures. Each floor inspected had an up to date medication policy and procedure, including a clear section in relation to homely remedies that nursing staff spoken to were familiar with. Medication was being properly stored, each floor having a controlled drugs cupboard although none of the residents on the three floors inspected were currently being prescribed controlled drugs. The controlled drugs register on one floor was sampled and showed clear and satisfactory records relating to previous administration of controlled medication. Satisfactory records of medication Care Homes for Older People Page 15 of 33 Evidence: being received into the home and of being disposed of by the home were also seen. Many residents received personal care throughout the inspection and their privacy and dignity was being maintained. Nursing and care staff were observed throughout the inspection talking to residents in an appropriately friendly and professional manner. A number of relatives spoken to throughout the inspection gave positive feedback about the staff, including their caring attitude. One relative told us that they were made welcome at the home every day and stated that staff were nothing but kind to him, referring to the person they were visiting. Care Homes for Older People Page 16 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from different activities being available within the home and within the community to meet their needs and preferences. Families and visitors are made welcome at the home, which they and people living there appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. People are also served good quality and appetising meals that they enjoy. Evidence: At the last inspection a requirement was made following the Inspector that undertook that inspection observing both the television and the radio being on at the same time in one of the lounges for people with dementia. This requirement was being complied with at this inspection. The annual quality assurance assessment submitted to us prior to this inspection stated that the home has a planned programme of activities to suit the abilities of residents. Outings to local events are organised where appropriate. There are regular opportunities available for residents to go out, including to the local shops, out for tea and cakes at the local Salvation Army and to the local pond to feed the ducks. Care Homes for Older People Page 17 of 33 Evidence: Evidence to substantiate this was gathered from observation, records inspected and staff, resident and visitors spoken to. The home employs two activities coordinators that were both spoken to. They work with the staff on each floor to provide a range of activities, both within the home and in the local community (as described above). They organise a daily programme of activities within the home that includes groups playing bingo, board games, art work and sing a long. They also provide one to one sessions for people that cannot, or do not want to, take part in group activities. One of the coordinators told us that for some people with complex needs that may just include sitting, chatting and holding their hand in their room. Individual activity records are kept for each resident and some of these were sampled. These showed what the person liked and did not like and the activities they had participated in. The records also showed peoples personal preferences e.g. whether a person smoked so this could be accommodated where possible. Residents come from a range of ethnic, cultural and religious backgrounds and the home was working hard to meet peoples needs and preferences in these areas. Care plans seen included some for residents whose first language is not English. An example on one plan gave examples of the sorts of areas a person may be able to understand in English, listed a number of staff employed who could speak that persons first language and identified other more complex areas where the persons relative should be consulted. The homes AQAA stated that the home has Church contacts with residents who are Roman Catholic, Church of England and Jehovah Witness and is working hard to develop an effective contact for residents that are Jewish. Residents who have other religions are mainly supported by relatives to attend their place of worship e.g. Mosque or Temple, or are given the quiet and privacy to undertake religious observances within the home. We were also pleased to see that the home works hard to provide a sensitive service to meet peoples differing sexual orientation. In discussion with the registered manager and deputy manager they indicated that this was an area they had identified as important and told us of how they had worked with an individual resident and people that were important to that person to provide a more sensitive service to meet their particular needs and preferences. We left a copy of the Commissions recently published equality prompts with the managers and indicated that a recent Age Concern resource pack called The Whole of Me, may help staff further in this area. The resource pack gives suggestions and guidance as to how care homes can more effectively meet the needs of older lesbians, gay men and people that are bisexual. We were impressed with the way the registered manager and her deputy are endeavouring to promote the equality and diversity agenda within the home. Care Homes for Older People Page 18 of 33 Evidence: We spoke to a number of relatives and visitors to the home and received positive comments about the home, the care offered and the managers and the staff. One relative, who visits the home most days, confirmed that they knew who their persons named nurse was, received quality assurance questionnaires and were invited to reviews at the home. The service user guide states that visitors are welcome to the home and the visitors book evidenced that many visitors attended the home each day. The majority of residents have complex needs that mean they are not able to control their own finances. The home has a very robust system for dealing with residents finances that was seen and this is described further in the Management and Administration section of this report. Residents are allowed to bring personal possessions with them to the home. At the last inspection a requirement was made that fridges in the satellite kitchens on each floor are kept clean and that residents are given a choice at meal times. Both of these requirements were being met. Fridges in satellite kitchens were sampled and seen to be clean. Residents were also seen to be offered a choice of meals. Residents are supported to choose meals but they make the choice the day before, this is then recorded to allow the main kitchen to provide the chosen option. However, as the majority of the residents have dementia not many of them can remember what they have chosen. A good practice recommendation is made that table menus are provided to assist residents remember what the choice of meal is. We were offered lunch with residents on one floor during the inspection. The meal was tasty, nutritious and well presented; residents were seen to enjoy their meal. We also noted that staff took time to assist those residents that needed one to one help and the atmosphere was calm and pleasant throughout the meal time. The meals are prepared in the homes main kitchen and bought to each floor in hot trolleys. The chef on duty in the main kitchen was spoken to and confirmed that the home could cater for a variety of special diets and for a range of needs and preferences in relation to religion and culture. The kitchen was well organised, clean, had up to date health and safety record and the chef and her staff presented as being very competent. Care Homes for Older People Page 19 of 33 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. Residents and relatives have any concerns they raise taken seriously and acted upon appropriately. However, they may benefit further from more accessible information about how to make a complaint being displayed in the home. The home has clear policies and procedures for protecting people from abuse that staff are aware of. Evidence: The home has a clear complaints policy that was seen. It was noted however that the complaints procedure was in text and not particularly accessible. A good practice recommendation is made that the home produces a pictorial or easy to read summary of the complaints procedure and displays this on all floors of the home so that the procedure is more accessible to residents and visitors. Since the last key inspection two complaints had been recorded at the home and seven concerns, i.e. more minor issues raised that did not constitute a formal complaint. Records of these were inspected and indicated that they had been dealt with in accordance with the home’s procedures. The Commission had received an anonymous concern that carers talk back to residents and can be a bit abrupt with them, no other information was received about which staff or resident this may have referred to. This concern was discussed with the registered manager at the time. At this inspection were were pleased to see documentary evidence that the registered manager had taken this seriously and had undertaken a range of work with all staff. This had included raising the concern with all staff at a staff meeting and reinforcing the need for staff to treat Care Homes for Older People Page 20 of 33 Evidence: residents with respect and dignity thorough the homes staff supervision system. People and relatives spoken to indicated that they were confident that any issues they raised with staff or managers would be properly dealt with. No other complaints or concerns had been received by the home or by the Commission since the last key inspection. The home had a copy of the L.B. of Hackneys safeguarding adults policy and a satisfactory in-house procedure. Staff receive training in safeguarding issues and staff spoken to were aware of how to respond should an allegation or disclosure of abuse be made to them. There had been no disclosures or allegations of abuse made to the home since the last key inspection. There had been one anonymous allegation received by the Commission about the provider organisation since the last inspection. This was properly investigated through a multi-disciplinary investigation led by one local authority and was found to be unsubstantiated. Care Homes for Older People Page 21 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a modern, purpose built home that is well equipped, well decorated, well furnished, well maintained and that meets their needs. The home was clean and tidy throughout creating a pleasant environment for people accommodated, staff and visitors. Evidence: The home was purpose built and opened in 2005. It is well furnished, well decorated and well maintained and meets the needs of people that live there. Accommodation at the home is on four floors. The ground floor has twenty one places for nursing care for people with physical disabilities. The first floor has thirty one places for nursing care for older people. The second has thirty one places for residential care for older people. The third floor has fifteen places for nursing care for older people with a diagnosis of dementia. The home’s main kitchen, laundry facilities and staff facilities are situated in the basement and the managers office and administrative office are situated on he ground floor by the main entrance to the home. All floors are linked by two flights of stairs and a passenger lift. The home also has a conservatory, garden and car parking area. Each of the four floors that people live on have satellite kitchens, dining room and two lounge areas and suitably adapted toilets and bathrooms. The home also has a range of suitable specialist equipment Care Homes for Older People Page 22 of 33 Evidence: such as hoists and grab rails to meet people’s needs. Communal areas were bright and airy and the home has purchased a tropical fish tank for each of the main lounges on each floor that are attractive and, we were informed by the deputy manager, can have a therapeutic effect for some people. All the bedrooms are en-suite and those seen during the inspection were comfortable and had been personalised to the taste of the person living in them. There are a range of signs and pictures on doors to bedrooms and to other communal areas to assist people to find where they want to go and the building meets the needs of people living in it. At the last inspection requirements were made that identified offensive smells were dealt with and that dining rooms were cleaned following meal time. During this inspection no offensive smells were noted and the dining rooms were being kept clean. The home has appropriate laundry facilities and the systems for looking after peoples clothes appeared robust. The registered manager informed us that in March 2008 the home had voluntarily participated in a pilot infection control audit instigated by the local Primary Care Trusts Infection Control Committee and that the homes infection control procedures were considered robust. Good quality infection control procedures were in place at the time of this inspection and staff spoken to were aware of these. Care Homes for Older People Page 23 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by a staff team with sufficient numbers to address their needs and who have a range of competencies. People accommodated are protected by the robust home’s recruitment procedures. Staff have access to a wide range of training opportunities to assist them keep their skills and knowledge up to date. Evidence: Staffing at the home is deployed as follows: ground floor, people with physical difficulties, nursing, 1 nurse and 3 or 4 care staff during the day and 1 nurse and 1 carer at night; first floor, nursing, 2 nurses and 4 carers during the day and 1 nurse and 2 carers during at night; second floor, residential, 1 nurse and five carers during the day and 1 nurse and 2 carers at night; third floor, people with dementia, nursing, 1 nurse and 2 carers during the day and 1 nurse and 1 carer at night. In addition, the home employs a range of support staff including domestics, kitchen staff, laundry staff and maintenance staff. This staffing level was judged to be satisfactory for the needs of the residents at the time on this inspection. A requirement was made at the last inspection that staff do not work long shifts without reasonable breaks. Rotas were seen on each floor and this requirement was judged to be complied with. A requirement was also made at that inspection that residents receive one to one care when requiring assistance with feeding. During meal times observed at this inspection Care Homes for Older People Page 24 of 33 Evidence: the requirement was being complied with. The homes annual quality assurance assessment (AQAA) showed that approximately 80 of staff had achieved or were working towards the national vocational qualification (NVQ) level 2 in care. Records sampled and discussions with the registered manager and a number of staff confirmed this. It was also noted that a number of these staff were also undertaking NVQ level 3 in care. Recruitment documentation and staff files sampled showed that the home was operating a robust recruitment procedure. This included: proof of identity, including a recent photograph; a clear employment history, with dates, that was included on the application form; two written references including a last employer reference, with evidence that these had been verified and an enhanced criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check, that had been obtained by the home before the person had commenced work there. We also saw evidence that nurses registration is also checked with the Nursing an Midwifery Council (NMC) before appointment and six monthly checks undertaken after that. We were impressed overall with the management systems in place to monitor recruitment procedures, an example of this was an electronic system for keeping track on staffs entitlement to work in the UK where appropriate. This was linked to an electronic calendar and sent a reminder e-mail to the homes administrator when a work permit was nearing expiry. The registered manager stated that the home endeavoured to recruit staff locally and had agreed this with the L.B. of Hackney. It was noted from records seen and from staff spoken to, that for a large home, the staff turnover had been very low since the home was opened in 2005. It was judged that this contributed significantly to the continuity of care for residents. Evidence was seen from the AQAA and from records sampled, including an electronic training matrix that was modelled on Skills for Care standards, that the home offers staff appropriate training. The administrator produces regular monitoring reports for the registered manager regarding staff training and when core subjects need to be refreshed of individual staff. Evidence of in-house training undertaken since the last inspection from the spreadsheet included: safeguarding residents from abuse; infection control, moving and handling; first aid and food hygiene. Evidence was also seen on the system of other external training being provided including: wound management; dealing with pressure ulcers; continence, managing PEG feeding, managing continence and safe administration of medication. Registered nurses are ultimately responsible for keeping their training up to date and the registered manager stated that nurses individual training needs were also monitored through supervision. Nursing and care staff spoken to throughout the inspection confirmed that they received regular training and that it was useful to them. Care Homes for Older People Page 25 of 33 Care Homes for Older People Page 26 of 33 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 excellent 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 benefit from the service being managed by a competent, qualified and experienced registered manager and her management team. People are regularly consulted to promote and monitor the quality of the service they receive and clear action taken to act on this. People’s financial interests are safeguarded while living in the home. Staff supervision is provided to support staff meet the needs of people accommodated and to assist in their own development. A range of effective health and safety procedures protect people living in the home. Evidence: The registered manager is a registered nurse who is well qualified and experienced to undertake her role. She has been in post since the home was opened in 2005 and evidence seen, and reflected throughout this report, show that she is competent and has continuously strives to improve the home and the care offered to residents since that time. Evidence to substantiate this include: robust management systems in place to ensure that staff recruitment remains robust; a commitment to equality and Care Homes for Older People Page 27 of 33 Evidence: diversity; continuous improvements to the care planning system including a current review and revision of how care plans are written to further improve guidance to staff; evidence of ongoing management audit of residents files; operating a pro-active quality monitoring system for the home; a commitment to staff training and an open door management style. The registered manager is assisted in her role by a competent and effective staff team including a very well qualified and experienced deputy manager and a competent administrator and housekeeper. The home monitors the quality of care it provides in a number of ways. An annual quality monitoring survey is undertaken, responses from the last survey undertaken in September 2008 were sampled and evidence seen that the responses were evaluated and an action plan compiled and implemented. An example of this was that during the inspection a handy-person was placing new white boards on each floor to show the activities on offer to residents on the day. This was as a result of comments received from the September questionnaires. Evidence was seen that the home holds regular meetings for relatives, this was confirmed by relatives spoken to although one told us that because of personal commitments they would only be likely to attend if there was a problem. The person went on to say that at this time they did not have a problem and were very happy with the home and the care offered to their relative. At the last inspection a requirement was made that the responsible individual must ensure that monthly visits are conducted to the home and reports are made available for inspection. This requirement was being complied with. The homes electronic systems for dealing with residents finances was sampled and found to be robust. Evidence was seen that residents money was held in a bank account that was solely used for that purpose and that interest earned from that account was credited to individual residents on an equitable and proportionate basis. The system for looking after cash held for residents was also sampled and found to be robust. Clear and up to date records were sampled and the cash for one resident, picked at random, was checked with the administrator. The individuals cash record was sampled and found to be up to date. Each residents cash was seen to be securely stored in an individual plastic wallet and the cash for the resident whose record was inspected was checked and the amount corresponded to the record. At the last inspection a requirement was made that all staff in the home be appropriately supervised at least six times a year and that supervision records must be maintained. At this inspection the requirement was being complied with. When a member of staff receives supervision a record of this is kept. In addition a monitoring record of the session is sent to the homes administrator. She in turn enters the date of the supervision session on an electronic database to allow managers to monitor that supervision takes place regularly. The registered nurses on each floor supervise the care staff and the nurses in turn are supervised by the registered manager or her Care Homes for Older People Page 28 of 33 Evidence: deputy. The registered manager also holds monthly meetings with the registered nurses and topics discussed include policies and procedures as well as general issues regarding the smooth running of the home. There are also general staff meetings where relevant issues are discussed. As noted in the Complaints and Safeguarding section of this report, following an anonymous concern earlier in 2008 a specific agenda item was discussed at a staff meeting reinforcing the need for staff to treat residents with respect and dignity. Staff spoken to during the inspection confirmed that they received regular supervision and they found this helpful. A range of satisfactory health and safety documentation was seen. This included: gas safety certificate, electrical installation certificate, portable appliance certificate, water tank maintenance to minimise the risk of legionella and fire safety. Care Homes for Older People Page 29 of 33 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 30 of 33 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 13 The registered persons must 21/11/2008 ensure that where a resident is subject to physical restraint the circumstances must be recorded, including the nature of the restraint. Therefore consent forms must clearly and separately record each specific area the home has sought agreement to use with a resident, including photographs, bedrails, lap straps, footplates and any other identified actions. This requirement is made to protect the resident, promote their welfare and dignity and also to protect staff in the home. Recommendations 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 7 A good practice recommendation is made that the home Page 31 of 33 Care Homes for Older People explores creatively ways of obtaining more life history information on residents with a diagnosis of dementia to further assist staff in meeting peoples needs and wishes in a more person centred way. 2 8 A good practice recommendation is made that all healthcare professionals contact with a resident is recorded in the same place on their file to assist staff obtain a clear overview of this contact. A good practice recommendation is made that table menus are provided to assist residents remember what the choice of meal is. 3 15 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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