Inspection on 03/07/07 for Acorn Lodge Nursing Home

This inspection was carried out on 3rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 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 Lodge Nursing Home 13/04/10

Acorn Lodge Nursing Home 07/12/09

Acorn Lodge Nursing Home 04/02/09

Acorn Lodge Nursing Home 06/08/08

Acorn Lodge Nursing Home 07/11/07

Acorn Lodge Nursing Home 10/10/06

Acorn Lodge Nursing Home 29/11/05

Acorn Lodge Nursing Home 14/06/05

Acorn Lodge Nursing Home 12/01/05

Acorn Lodge Nursing Home 06/07/04

Acorn Lodge Nursing Home 11/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Sunny Bank (P.R.S.) Ltd

Ruskin Lodge

Bushell House

Ashwood Court Unit 1

Langrigg House

Parkside

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Acorn Lodge Nursing Home Guido Street Failsworth Oldham Lancashire M35 0AL Lead Inspector Tracey Rasmussen Unannounced Inspection 3rd July 2007 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.V339631.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 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.V339631.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. No more than 45 places to be used for nursing care. 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. 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). 10th October 2006 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. Fees for accommodation and care at the home range from £333 to £594 per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. 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.V339631.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors undertook this ‘unannounced’ key inspection site visit on the 13th March 2007. The home was not told beforehand of the inspection visit. The inspection included a review of all available information received by the Commission for Social Care Inspection (CSCI) about the service provided at the home since the last inspection. This included the receipt of one complaint that was being investigated by the local authority A questionnaire (Annual Quality Assurance Assessment -AQAA) was sent out to the manager at the home about two months before this inspection visit, however this was not completed in sufficient detail, so did not provide enough information to better understand the quality of service provided at Acorn Lodge. The key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices, talking with residents; talking with visitors; interviewing the manager and other members of the staff team. A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. One inspector undertook a special two hour observation (short observational framework for inspection -SOFI ) of care provided to residents with dementia, living on the first floor. The purpose of this was to better understand the experiences of people with dementia. A brief explanation of the inspection process was provided to the manager of the home at the beginning of the visit and time was spent at the end of the visit to provide verbal feedback to the manager of the home. What the service does well: The home offered a comfortable environment that was clean, tidy and generally odour free. Resident spoken with were very pleased with their individual rooms and said that they had “brought in a number of personal possessions, pictures of grandchildren and family and other things that help remind me of places I have been”. Residents spoken with on the ground floor were positive about living in the home and they also said the food was good. Residents said the staff were ‘pleasant and polite’ and ‘they know what they are doing’. Residents also said visitors were welcome. Visitors said they were satisfied with the management of the home. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 6 People know how to make a complaint and said when they do so, they are listened to. Minor concerns were not recorded. Staff received a varied training programme and said they were supported to do their job properly. What has improved since the last inspection? What they could do better: This inspection identified a number of areas of care practice that need improving as a priority. The special two hour observation of care practices on the nursing dementia unit provided a picture of poor care practice for residents with dementia which could be described as institutionalised care. Staff did not take the time to speak to residents about anything. Sleeping residents were lifted into wheelchairs or moved without being woken first. Residents were not offered choices at meal times or informed what food they were being given. Residents were moved without the proper moving and handling equipment, footplates were not put on wheelchairs and a communal bowl of water was used to wash residents’ hands and face in the lounge. These practices did not promote the privacy, dignity or the wellbeing of residents and resident’s health and safety were put at risk. The register manager, is also the unit manager for the nursing dementia unit and he was informed of these concerns. He needs to make sure that he improves care practices for the people living on this unit. Staff training is good, but we observed that some staff do not put what they have learned into practice. The manager needs to reinforce training learned and what is good practice. The manager needs to be clear with staff what he expects them to do. Care planning documentation seen from all parts of the home had not improved much since the last inspection. Assessments undertaken before people move into the home need to be better so that the manager is confident his staff can care for people properly. The manager needs to make sure that anyone coming into the home who needs specialist equipment has this in Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 7 place, before they come into the home. This will ensure that people receive the proper care supported by the right equipment straight away. Records (care plans) for residents provided a general over view of the care to be provided but did not refer to each resident’s individual needs, wishes or preferences. Risk assessments, health assessments and recognition of mental health care needs were limited and did not reflect the specialist nature of the service to be provided. Care plans were not always recorded for each need and records of social activities and stimulation relevant to each person’s need were not available. This could mean that some people who wish to undertake specific activities or join in activities may be left out as the staff are not aware of their wishes. Medication storage practices on the nursing dementia unit needed to be safer and more secure. The statement of purpose and service user guide which people use to tell them about the home and what it provides need updating so that people have accurate information on which to make a decision about whether Acorn Lodge is the right place for them. Menus offering choices need to be readily available to residents in the home so they know what to expect at mealtimes. The frequency of quality assurance auditing and monitoring undertaken by the owner should be increased in light of the concerns identified at this visit. The owner and the manager need to make sure that when they complete information (AQAA) which we have asked them for, they provide us with more detailed information on what they think the home does well, and what they need to improve upon and how. This will demonstrate that they have a good understanding of the service they currently provide, and how they intend to improve it. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not provided with accurate information to make an informed choice about the services provided. The home’s assessment procedures did not always confirm that they could meet the needs of the resident on admission. EVIDENCE: Information guides telling residents about the home and the services it provides were available in the offices on each unit in the home and in the staff meeting/training room. These had not been up dated since 2002 and contained information that was out date and did not reflect the change in the Care Home Regulations 2001, nor the home’s change in the age of people admitted into the home. This means that prospective residents were not provided with a complete picture of the home and the services it provides. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 10 Many residents were unable to comment on the quality of service provided in the home due to their illness. However, comments from residents who were able were on the whole positive. Four care files were seen and these contained a range of information about the care needs of the residents. Pre-admission assessments were available although the content of information was variable and this resulted in one resident being admitted to the home without the necessary equipment being provided to meet their health care needs. The manager was aware that this equipment was needed, but had allowed the person to move into the home knowing that the equipment was not available. At the time of this visit, the equipment had still not been provided. Care plans to meet identified care needs were not recorded consistently. These contained basic information and did not include information about personal wishes, preferences, and cultural or religious needs. Intermediate care (standard 6) is not provided in the home. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care, support and care records did not always promote the health, safety, respect and dignity of residents. Medication practices were not completely safe so residents were potentially at risk from poor management practice. EVIDENCE: Some residents living on the general nursing unit and ground floor residential unit were able to comment about the service they received whilst living in the home. All residents spoken with had positive comments to say about the home’s regular staff. One resident said staff were ‘pleasant and polite’ and that ‘they know what they are doing’. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 12 A specialist observation tool (SOFI) of care services provided to residents with dementia living on the first floor nursing dementia unit was used at this visit. This involved watching five residents for two hours over a lunchtime period. The result of this observation indicated that residents appeared happy or content for only a short time during the two hours and spent most of the time either asleep or sat quiet and uninvolved or withdrawn. The care provided by staff on this unit was a concern in that residents were treated in a manner that did not respect them or recognise each resident as a person. Examples of practices observed include; two staff took hold of a sleeping resident under the arms and putting her in a wheel chair to take to the toilet. Another sleeping resident had the foot rest of his chair knocked down and was wheeled out of the lounge. Staff did not prepare or reassure either resident with explanations of what they were going to do. Another sleeping resident, had a plate put in front of him and told, ‘dinner it’s in front of you’ and fourth resident was fed by a staff member who did not speak to, nor look at the resident at all throughout the meal time. Another resident tried on several occasions to attract the attention of staff and was ignored for most of the time. The attitude and approach of staff was indifferent and did not reflect a caring approach. At the end of the meal all resident’s hands and face were washed from a communal bowl of water, in the lounge. This is poor practice as it does not promote the privacy, dignity or respect of the residents and potentially puts them at risk from cross infections. This unit is a specialised nursing dementia unit, however the institutionalised practices observed on this unit did not reflect current good practice in dementia care and this must be addressed as a priority. Further unsafe moving and handling practices were observed and wheelchairs were used without footplates. Four care plans were viewed in the home. Some care plans were satisfactory, however many care plans were generalised providing limited information on how to care for each person according to their preference, needs and wishes. Assessments of care needs were not always comprehensive or consistently completed correctly and gaps in information were also noted and this could result in resident’s health care needs not being met. Management plans for identified risks for falls, pressure sore prevention and chest infections were inadequate. Care plans explaining how to respond in the event of aggressive incidents were inadequate, not personalised and referred to the home’s restraint policy. The Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 13 home’s restraint policy required a more detailed care plan to be recorded than was available. Evaluations of care plans were also not good enough in that they consisted of a review date with no information about the effectiveness of the care delivered or the progress achieved with the resident. Medication practices were briefly seen on two of the units. Records were seen and these were on the whole satisfactory. Handwritten additions had not been consistently signed or dated by the person writing the medication sheet. Storage of medication on the dementia nursing unit needed improving. The drugs trolley was stored in a room where staff stored their personal possessions and so was very untidy. Unboxed prescribed medication was seen left out in view in this room. Two different care staff tried to walk into the medication storage area, but found it locked. One staff member commented that the room ‘wasn’t always locked’ and both staff members checked the desk drawer for the keys to the room. This suggests that the access to medication on this unit is relatively easy and therefore not as secure or safe as it should be. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Not all residents’ social needs were met. Mealtimes did not provide a fulfilling social experience or promote dignity for some, and choices were not offered. Visitors were welcome. EVIDENCE: Observations in the home particularly on the dementia care units did indicate that there was little social stimulation being provided and care planning records did not record the social preferences or the types of stimulation residents responded to. During the two hours spent observing a group of residents on the nursing dementia unit most residents spent a large part of the time either asleep or staring into space and there was little going on to interest or stimulate them. Staff did not interact with the residents. (See Health and Personal Care) Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 15 It was reported that a person was employed to provide activities on Tuesdays, however at this visit the activity person was absent. The walls in the larger lounge on the ground floor residential unit were decorated with displays of ‘artwork’ the residents had made. One resident said she enjoyed doing the arts and crafts. Information in care files indicated that on the whole social histories and assessments had been undertaken, however this information was not reflected in care plans and daily records did not show if the resident had joined in a activity or not. Records of activities on the general nursing unit were limited to information recorded in a diary. At this visit staff were playing table skittles with residents on the nursing unit. In the afternoon on the ground floor residential unit bingo was played and residents were very lively, however on the other side of the residential unit, no activities were being undertaken and staff stood chatting to each other in the corridor. Visitors were welcome in the home and one resident said visitors could come when it suited her. The lunchtime meal service was observed as part of the two hour observation on the nursing dementia unit. Menus were not available on the unit. The pureed meal arrived first and staff served this to residents without asking their preference or seeking any confirmation if they wanted what was provided. Staff proceeded to assist a number of residents with their meals. Staff did not speak with residents and nor did they explain to the resident what they were eating. One resident’s meals was plated up and left to go cold before the resident was fed. Similar practices were observed when the ‘normal’ lunch arrived – food was put in front of residents or fed to residents without being offered a choice or an explanation. These practices do not promote rights and personhood of the residents living in the home. Residents on the residential unit said the food was good. A visit to the kitchen identified that a three week menu rota was available but this only offered one option. The chef did say alternatives were provided but records were not available. Menus were not available on the units so residents could not make informed choices or express a preference regarding their meals. The chef said he went out to speak to residents to check how the food was but he was not aware if the manager of the home consulted residents and relatives about the quality of the food. Kitchen cleaning rotas and health and safety records were available and up to date. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were confident that complaints would be listened to, taken seriously and acted upon. Appropriate systems were in place to protect residents from abuse. EVIDENCE: The home has a complaints procedure, which was displayed on the notice board in the entrance area and included in the Service User Guide (although this did need updating). Staff interviewed were familiar with the procedure. Residents and relatives knew who to speak to if they had a complaint but said that matters were usually dealt with straight away so there was no need to complain. These smaller issues were not recorded. The manager may wish to do so for monitoring purposes. The CSCI have recently been notified of a complaint about the home and at the time of the inspection the Local Authority Social Services department was investigating the matter. The policy and procedure used by the home for the Protection of Vulnerable Adults (POVA) was the Oldham Inter-agency procedure. A whistle-blowing procedure was also in place and staff interviewed showed their understanding Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 17 of it. The manager knew and understood the reporting procedure, which he had appropriately used in the past. All staff had received POVA training and residents spoken with felt safe living at the home. Staff have received Adult protection training and demonstrate an awareness of the content of the policy and know the immediate action to take, and who to refer to. Feedback from relatives and others associated with the home state that they are very satisfied with the service provision, feel very safe and well supported by the home, which has the protection and safety of residents as a priority. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. The home has a planned maintenance and renewal programme for the redecoration and refurbishment of the home to ensure residents live in a comfortable, homely and safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On each floor of the nursing and dementia care units are lounge/dining areas. These areas are nicely decorated and furnished with good quality items, providing residents with attractive, accessible and safe garden areas where they can sit. A large care park is situated at the side of the home. The home is suitable to meet the needs of residents. Specialist equipment is provided including grab rails, a call bell system and assisted bathing and toilet Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 19 facilities. The home is well laid out and accommodation is clearly signed so that residents can identify their own rooms. A tour of the home confirmed that the home was well maintained, clean and generally free from any offensive odours. Ramped access was provided to the front door and level access throughout each of the floors. A passenger lift was provided and handrails fitted to corridors throughout. Everyone spoken with thought the home was a safe place to live and work in. Grounds were seen to be safe, tidy and accessible. Residents said they looked forward to sitting outside in the good weather. Four residents spoken to were very pleased with their individual rooms and said that they had “brought in a number of personal possessions, pictures of grandchildren and family and other things that help remind me of places I have been”. Residents said staff kept the building clean and odour free, inspection of the premises supported this view. Discussion with the domestic staff verified that sufficient staff and equipment were provided to ensure the home was maintained in a clean and hygienic condition. An infection control policy was in place and training was provided in this area. Staff spoken with described safe infection control practice. Satisfactory practice was in place with regard to disposal of clinical waste. The laundry was sited away from the food preparation area and was seen to be clean and orderly. Sufficient and suitable equipment was provided and laundry was attended to efficiently. Three residents said that they were satisfied with the laundry system at the home and that there was a quick turn around on the clothes sent for cleaning. To aid residents with a dementia in recognising toilet areas, further improvements are required in order that residents living with dementia have a supportive environment, such as improved signage. For example toilets could show a picture of a toilet. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff deployment, staff training and competencies meet residents needs, however some care practices are poor. The home’s recruitment procedures are robust and these provide safeguards for the protection of residents. EVIDENCE: Examination of the duty rotas and a discussion with staff and residents showed that there was enough staff on duty to meet the care needs of the residents. On the nursing units 24-hour nursing care continues to be provided by qualified nurses. Suitably trained care assistants support them. Senior care assistants who have achieved their NVQ Level 3 in Care, manage the residential unit and suitably trained care assistants support them. The overall management of both units remains the responsibility of the Registered Nurse Manager. The Inspector examined staff files and found that they contained all the information required, confirming that the recruitment procedures had been followed. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 21 A newly recruited care assistant said she had been given an induction to the home and spoke about the content of the programme and the support she had received. The care assistant felt the induction process was well organized and thorough enabling her to get to know the residents in the home as well as becoming familiar with the way the home was run. Training is high on the agenda and comprehensive records are kept of the training undertaken by staff. Staff spoken to informed the Inspector of the training that they had done, including care of residents with dementia. They stated that they are encouraged to attend courses and given the time and support to do this. The home has approximately 50 trained to at least NVQ Level 2 with 3 more staff working towards the qualification. Staff spoken to said that they were clear about their role and work well as a team to ensure the individual and collective needs of the residents are met. However despite the good levels of training provided by the home, care practices observed on the nursing dementia unit did not reflect good dementia care practice and residents health and safety was put at risk from poor moving and handling and infection control practices. This means that residents living on the dementia do not get a good service. The manager needs to put systems in place which ensure that training provided results in good quality care that respects and protects each resident regardless of their illness. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32, 33, 35 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The management of the home does not fully promote the health, safety and wellbeing of all residents, however there is evidence that they are consulted about the service provided. EVIDENCE: The manager is a qualified nurse who has many years experience in caring for residents and possesses a management qualification. Throughout the inspection the Inspector was able to observe the professional, capable and approachable manner in which the manager undertook his role when dealing with residents, staff and visitors. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 23 Residents, relatives and staff spoke well of the management team and the care and support that they give. Staff said that the manager provided a clear sense of leadership. Feedback was provided to the manager at the end of the inspection visit. The registered manager is also the unit manager for the nursing dementia unit. This is the unit where a number of concerns were identified regarding care practices. Discussion with the manager indicated that he had little awareness that practices undertaken on the unit could be considered institutionalised and did not reflect current good dementia care practice. Further the manager was informed about the poor moving and handling practices observed. A quality assurance system is in place and a survey that includes residents and relatives’ opinions. The manager audits all of the services offered in the home annually and any areas that do not meet the homes standards are addressed within a reasonable time scale. Given the concerns identified in the Health and Personal Care section of this report regarding care planning documentation, medication storage and care practices the registered person should consider evaluating the effectiveness of the home’s quality assurance systems so that service quality improves. Staff meetings are held regularly to share information and also to listen to people’s views about the service that is offered. Staff spoken to had a clear understanding of their role and what was expected of them. The Inspector saw documentation that confirmed that staff received regular supervision and annual appraisal. Residents, relatives and staff spoke well of the management team and the care and support that they give. The Inspector was able to witness their approach to the residents and staff and confirm that comments made. Information provided by the manager and examination of the records, confirmed that all safety equipment is regularly serviced. However as stated previously some health and safety practices put residents at risk. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 2 x x x 2 1 Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14, 15 Requirement The registered person must ensure that the pre-admission assessments makes certain that care services and equipment provided in the home are appropriate to meet the needs of new residents. This ensures that all aspects of the health, personal and social care needs of the resident are met. The registered person must ensure that assessments and care plans are accurate and comprehensive so that the right care can be provided to each resident in a timely manner. The registered person must ensure that risk management plans are recorded for each resident and these explain the necessary interventions staff are to undertake to reduce the identified risk to resident. The registered person must ensure that medication is stored safely in a dedicated storage area that is maintained locked and secure. The registered person must DS0000025427.V339631.R01.S.doc Timescale for action 31/08/07 2. OP7 15 15/08/07 3. OP8 13 15/08/07 4. OP9 13 31/07/07 5 OP9 13 31/07/07 Page 26 Acorn Lodge Nursing Home Version 5.2 6 OP10 12,14 7 OP38 13,18 ensure that prescribed medication is kept in the original dispensing boxes and this held securely in a dedicated locked storage cupboard. The registered person must ensure that care practices undertaken in the home promote the privacy and dignity of the residents. The registered person must ensure that resident’s health, safety and welfare is protected by ensuring the risks of cross infection are minimised, moving and handling practices are safe and wheelchairs are used with footplates. 31/08/07 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The registered person should ensure information guides such as the Statement of Purpose and Service User Guide are maintained up to date, reflect current legislation and detail how the home meets the individual and specialist care needs of people living in the home. The registered person should ensure that care plans reflect the personal wishes, preferences and choices of the residents. The manager should ensure specialist care needs such as dementia have care plans recorded in accordance with current good practice in dementia care. The registered person should ensure that handwritten medication details on the medication administration records are signed and dated by the person writing the record. Social activities and stimulation in accordance with wishes, preferences and needs should be provided to each resident and a record of this maintained in the resident’s care plan DS0000025427.V339631.R01.S.doc Version 5.2 Page 27 2 3 4. OP7 OP8 OP9 5 OP12 Acorn Lodge Nursing Home 6 OP14 7 OP15 8 9 10. OP15 OP16 OP19 11 OP32 12 OP33 13 OP33 14 OP36 The registered person should ensure that management and care practices reflect current good practice for example dementia care so that practices promote the resident’s right to choose and to be involved in decisions that affect him or her. The registered person should ensure that meal times offer a pleasant social experience where residents receive assistance with dignity; are offered choices and individual preferences are recorded. A menu that offers a choice at each mealtime should be available to residents on a daily basis. The Registered person should ensure that a record is maintained on each unit of concerns or complaints that are received In order that residents living with dementia have a supportive environment, the Registered Manager should ensure that there is improved and adequate signage, for example toilets could show a picture of a toilet. Management practice in the home should be reviewed to ensure care services are reflective of current good practice in dementia care so that person centred and dignified care is provided. The owner of the home must prepare a written report each month on an unannounced visit he has made to the service. He must interview, with their consent and in private, people who use the service and their representatives and staff working in the home. The report must include an inspection of the home, its record of events and records of any complaints. The manager should review and improve the quality assurance systems implemented in the home to ensure standards are monitored and improvements made when required. The registered person should ensure that staff care practices are monitored, so that the effectiveness of training provided could be evaluated and poor practices stopped. Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Acorn Lodge Nursing Home DS0000025427.V339631.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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