Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 29/11/05 for Acorn Lodge Nursing Home

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

This inspection was carried out on 29th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

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

What the care home does well

Acorn Lodge is very clean, bright and spacious, and residents were complimentary about the standards of hygiene within the home and the laundry services. One resident said staff were helpful and supportive. Another said "you couldn`t have a better place even in a hotel". One visitor said "staff are lovely".

What has improved since the last inspection?

Since the last inspection the ongoing programme of redecoration has continued with a number of areas around the home having been painted.

What the care home could do better:

Work is still required to ensure that care plans are developed to address all the residents` needs. More care needs to be taken to make sure that residents` needs are documented clearly so that all staff know what they need to do to look after and monitor the residents properly and to demonstrate that advice and instructions given by other health care professionals has been followed. Pre-admission assessments contained little information about residents` social care needs and few residents had social care plans in place. Opportunities for social stimulation were limited and not very specific to individual residents` interests and needs. Interaction between staff and residents could be improved especially on the dementia unit. Additional support is needed to promote residents independence and choice.

CARE HOMES FOR OLDER PEOPLE Acorn Lodge Nursing Home Guido Street Failsworth Oldham Lancashire M35 0AL Lead Inspector Mrs Fiona Bryan Unannounced Inspection 29th November 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Acorn Lodge Nursing Home Address Guido Street Failsworth Oldham Lancashire M35 0AL 0161 681 8000 0161 688 8088 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Aneerood Goorwappa Mr Goinden Kuppan Care Home 85 Category(ies) of Dementia (25), Dementia - over 65 years of age registration, with number (25), Mental disorder, excluding learning of places disability or dementia (30), Old age, not falling within any other category (40), Physical disability (20), Physical disability over 65 years of age (20) Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. No service user aged under 55 years to be admitted to the home. 1 RMN to be on duty throughout the 24 hour period. One Registered Nurse to be on duty throughout each 24 hour period plus one additional Registered Nurse for 12 hours per week. No more than 45 places to be used for nursing care. Service users to include 25 DE, up to 25 DE(E), up to 40 OP, up to 30 MD, up to 20 PD and up to 20 PD(E). 14th June 2005 Date of last inspection Brief Description of the Service: Acorn Lodge is a purpose built home situated on a main road close to the Failsworth/ Manchester border. The home provides personal care for up to 40 service users accommodated on the ground floor. In addition the home provides general nursing care for up to 20 service users and specialist care for up to 25 service users with dementia. Service users requiring nursing care are all accommodated on the first floor. The home is owned and operated by Mr Goorwappa and a manager who is also a registered nurse assists him in the management on a day-to-day basis. The majority of bedrooms are single en-suite. One double room is provided for couples or service users who wish to share. Seven lounge/dining rooms, two quiet lounges and two conservatories offer a variety of settings in which service users are able to receive visitors, socialise and participate in activities. The home is on a main bus route with a bus stop outside. There is ample parking for visitors cars. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by two inspectors who spent time talking to residents, visitors and staff. The needs of six residents were looked at in detail, with a particular focus being their experiences in the home from their admission to the present day. This was the second inspection of the year. At the last inspection in June 2005 the home was performing satisfactorily in many areas so the purpose of this inspection was to review progress in the areas that were identified as needing improvement. This was mainly related to how care plans were developed and reviewed and the provision of social activities for residents. Four other key standards, which have to be assessed at least once year were not examined at the last inspection, and were therefore considered at this inspection. These standards included how the home dealt with medicines, staff recruitment, residents’ personal finances and the qualifications of the manager and the care staff. A selection of documents was examined including residents’ care files, medicine records, and personal finance records, staff personnel files and duty rotas and training records. This inspection concentrated on just two of the three units within the home – the unit for people requiring personal care only (the ground floor) and the unit for people with dementia. Standards which were not assessed at this inspection, were considered to be satisfactory at the last inspection. For further information about how the home met these standards please refer to the report of the inspection on 14th June 2005. What the service does well: Acorn Lodge is very clean, bright and spacious, and residents were complimentary about the standards of hygiene within the home and the laundry services. One resident said staff were helpful and supportive. Another said “you couldn’t have a better place even in a hotel”. One visitor said “staff are lovely”. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 The pre admission assessment process requires more rigour to ensure that the social care needs of residents are identified so that residents can be assured their needs can be met. EVIDENCE: Examination of residents’ care files indicated that community care assessments had been obtained for most of the residents and staff at the home had undertaken their own assessments too. The content of the community care assessments was often quite limited whilst the home’s own assessments provided a better overview of residents’ needs. However, in the majority of cases no social history was provided for residents. One member of staff was asked to describe residents’ needs and found this difficult as English was not their first language. The registered person should ensure that staff employed at the home can communicate effectively with prospective service users. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The residents’ care plans do not always set out all of their health, personal and social care needs, leading to the potential risk that needs may not be met. Procedures for dealing with medicines were generally satisfactory. Residents’ privacy is observed. EVIDENCE: Examination of a selection of care plans indicated that no real improvement had taken place in the development of care plans to address residents’ needs. Some important care needs were not addressed adequately. For example the care plan for one resident with diabetes contained no details about the potential long term effects of diabetes and plans for annual checks by the optician and regular treatment from the podiatrist and did not state how often or in what way their condition should be monitored. Some care needs were not addressed at all, for example one resident who was presenting management difficulties due to aggression did not have a care plan in place in relation to this. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 10 The majority of residents had no social care plans and there was no reference to social stimulation or activity in the daily records. Although it was recorded that care plans and assessments had been reviewed monthly some were not reflective of the actual situation. For example, the risk management plan for one resident stated that they were at low risk of falls and needed occasional supervision but the accident records indicated that the resident had sustained a significant number of falls in August and November 2005. On the unit for people with dementia risk assessments had not always been reviewed monthly. In some care files there was no evidence that advice and instructions from other health care professionals had always been implemented, for example the dietician had prescribed dietary supplements for one resident but it could not be evidenced that the plan was being followed and one of the carers was not aware at interview that the resident had specific nutritional needs. The wound care plan for one resident contained a record of treatment and progress. The resident had been seen by the tissue viability nurse. The care plan did not contain specific details about the type of mattress required for the resident. This should be included together with the pump setting so that staff can ensure the mattress is working effectively. Records indicated that residents had been seen by dentists, opticians, podiatrists and GP’s. Residents were generally well presented, clean and tidy. Two visitors said their relatives were always presentable when they visited. One visitor said she was happy with the care her relative was receiving. Another visitor stated that staff kept her informed regarding changes to her relatives condition. Medicine administration procedures were generally satisfactory. A risk assessment had been undertaken for one resident who wished to administer their own insulin and consent had been obtained from their GP. A new medicines fridge had been purchased on the unit for people with dementia and the temperature had been checked daily and recorded. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 The home does not meet all the residents’ social and recreational needs. The means by which residents’ choices and independence are maintained need to be reviewed. EVIDENCE: As stated previously, the majority of residents did not have a care plan to address their social care needs and no records were available regarding what social stimulation residents were receiving. Although one of the carers stated that one of the residents was very sociable and liked to chat their care file recorded that they had no hobbies or social interests. One resident said there was “nothing to do. I do get fed up”. Another resident also said there was not much to do. One visitor agreed but said residents occasionally went on trips out. One resident on the unit for people with dementia said he liked to walk around but was not allowed to – staff told him to sit down and would not let him walk. This resident also said that he had to go to bed at 8.30pm and the television was switched off in the lounge at 8pm. In one of the ground floor lounges the television was on but no residents were watching it. Two members of staff could not really describe how residents liked Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 12 to spend their day other than watching television and both said the residents mainly fell asleep. On the unit for people with dementia a member of staff was always in attendance in the lounge but very little interaction with residents took place. Interactions tended to be task focussed, for instance instructing residents when they were taking them to the toilet. It was observed that staff immediately told residents to sit down if they tried to stand up and walk around. This was discussed with the deputy unit manager who stated that staff were trying to preserve the safety of residents and diminish the risk of falls. However, maintaining the safety of residents has to be balanced with fostering their independence and promoting quality of life and at least two of the residents appeared quite frustrated at being curtailed in what they were trying to do. It was reported that a member of staff organises activities for some residents for a few hours per week. However it was the inspectors’ opinion that a designated activities organiser is essential in a home of this size in order to meet the requirements of this standard. The key worker system was not fully operational and the development of this role and improved assessment and care planning would help to meet the social needs of the residents. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Some practices within the home need to be reviewed to ensure that residents’ rights are upheld and they are not subject to abuse. Staff need further training in the prevention of abuse. EVIDENCE: Two staff reported that they had received some training in prevention of abuse, whilst two said they had not had training in prevention of abuse. One carer was very unsure about the procedures to follow if abuse was suspected and was concerned that staff would be offended if they were reported. This member of staff had not seen the whistle blowing policy. One carer who had commenced employment at the home two weeks previously could not demonstrate what her understanding of what abuse was. As previously stated, on the unit for people with dementia it was observed that residents were constantly told to sit down when they attempted to get up from their chairs. One resident kept trying to get up but was prevented from doing so by a member of staff. This type of action constitutes restraint. One resident said he liked to walk around but staff were always telling him to sit down and he was not allowed to walk. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the standards in this section were assessed. EVIDENCE: Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 29 The home is on course to meet the standards for the percentage of care staff who have completed NVQ training. Suitable procedures are in place for the recruitment of staff. EVIDENCE: Just under 50 of staff have completed NVQ training and further staff are undertaking training. Examination of three staff personnel files confirmed that two references had been obtained for each prior to employment. All also contained proof of identity. As none of the senior management team were on duty the disclosure certificates from the Criminal Records Bureau were not available. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38 The manager needs to provide evidence that care provided on the unit for people with dementia is in line with current best practice. Financial procedures ensure that residents’ interests are safe guarded. Further training is required for some staff in health and safety procedures. EVIDENCE: The manager has previously achieved a BA(Hons) in Practitioner Leadership. This standard will be reassessed at the next inspection, as the manager had not undertaken any training recently to provide evidence that his skills and knowledge were being updated. Examination of residents’ financial records showed that receipts had been retained for all transactions, however as identified at the last inspection, two signatures were not consistently recorded for all debits. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 17 When asked to explain the home’s procedures in the event of fire, two carers gave conflicting information. One carer said he would run out of the nearest fire door, whilst another said they would assemble in the designated area and evacuate the residents if possible. Given this conflicting understanding of the home’s fire procedures urgent attention must be given to ensure all staff receive appropriate fire safety training. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 X 28 2 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3OP4 Regulation 14 Requirement The registered person must ensure that pre-admission assessments include information relating to residents’ social care needs. The registered person must ensure that residents care plans and risk management plans set out in detail the action which needs to be taken to ensure that all aspects of the health, personal and social care needs of the residents are met. (Timescales of 28/2/05 and 31/07/05 not met). The registered person must ensure that residents’ care plans and risk assessments are reviewed at least once a month and updated to reflect their changing needs. The registered person must ensure that an accurate record is maintained of advice and treatment ordered by other health care professionals. The registered person must ensure that a programme of activities is arranged that DS0000025427.V263928.R01.S.doc Timescale for action 28/02/06 2 OP7 13, 15 28/02/06 3 OP7 15 28/02/06 4 OP8 13 28/02/06 5 OP12 16 28/02/06 Acorn Lodge Nursing Home Version 5.0 Page 20 6 OP14 12 7 OP18 13 8 OP18 13 9 OP38 23 provides facilities for recreation for all residents including those that are more dependent and those with dementia. (Timescale of 30/08/05 not met). The registered person must ensure that so far as practicable residents are able to make decisions about the care they receive and their health and welfare. The registered person must ensure that residents are not subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of the resident and there are exceptional circumstances. On any occasion where a resident is subject to restraint a record must be made of the circumstances including the nature of the restraint. The registered person must ensure that all staff receive training in the prevention of abuse and local adult protection procedures. The registered person must ensure by means of suitable training, fire drills and practices that all staff are aware of the procedure to follow in case of fire. (Timescale of 31/07/05 not met). 28/02/06 31/01/06 31/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 21 1 2 OP4 OP8 3 OP12 4 5 6 OP28 OP31 OP35 The registered person should ensure that staff employed at the home can communicate effectively with prospective service users. The registered person should ensure that care plans include specific details about the type of pressure mattresses being used and the pump settings if applicable so that staff can ensure they are working properly. The registered person should consider the appointment of a designated activities organiser and the extension of the role of the key worker in order to meet residents’ social care needs. The registered person should continue to support staff to undertake NVQ training so that this standard can be achieved. The registered person should ensure the manager undertakes training to ensure that care within the home is based on best practice and up to date research. The registered person should ensure that all transactions made on behalf of residents are witnessed by two signatories. Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Acorn Lodge Nursing Home DS0000025427.V263928.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!