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Inspection on 04/02/09 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 4th February 2009.

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

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

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

CARE HOMES FOR OLDER PEOPLE Acorn Lodge Nursing Home Guido Street Failsworth Oldham Lancashire M35 0AL Lead Inspector Geraldine Blow Unannounced Inspection 09:30 4 February 2009 th 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.V373987.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.V373987.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 (35), Mental disorder, excluding registration, with number learning disability or dementia (25), Old age, of places not falling within any other category (60) Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To people of either gender whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP (maximum number of places: 60) Dementia - Code DE (maximum number of places: 35) Mental disorder, excluding learning disability or dementia - Code MD (maximum number of places: 25) The maximum number of people who can be accommodated is 85. Date of last inspection 6th August 2008 Brief Description of the Service: Acorn Lodge is a purpose built home situated on a main road close to the Failsworth/Manchester border, owned by Mr Goorwappa. The home provides accommodation for up to 85 people. The majority of bedrooms are single en-suite. One double room is provided people who wish to share. Seven lounge/dining rooms, two quiet lounges and two conservatories offer a variety of settings in which people living at the home 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. Fees for accommodation and care at the home range from £360 to £516 per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This report is based on information gathered by the Commission for Social Care Inspection (CSCI) and supporting information received in the Annual Quality Assurance Assessment (AQAA) submitted by the manager prior to this visit in September 2008. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Staff and some people living at the home were sent comment cards. In September 2008 we received four comment cards from people living at the home. Some of their comments have been included in the body of this report. This visit was unannounced, which means that the manager and staff were not told that we would be visiting. Two Regulation Inspectors and a Pharmacist Inspector carried out the visit. This visit forms part of the overall inspection process and took place on Wednesday, 4 February 2009. This report is an overview of what the inspectors found during the inspection. Since the last inspection visit the investigation undertaken under the safeguarding adults procedure has concluded and the suspension on admissions to the home has been lifted. As part of the visit we (the commission) spent time examining relevant documents and files. We also spent time talking with the manager, several people living at the home and members of staff. A tour of the building was undertaken. Feedback was given to the manager during the course of this visit and on conclusion of the visit. What the service does well: Generally the feedback from the people living at the home and visitors to the home was encouraging. Some comments from people living at the home include: Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 6 I like it here, I have made a lot of good friends. The staff vary but on the whole they are good. You can have as much food as you like and the place is very clean and well kept. I have been here 2 weeks. Its good here, the staff are lovely and the meals are lovely. I like to keep myself to myself and they don’t mind. I go to my room a lot just as I please. Feedback from relatives was encouraging. One relative said that when he visited his mum there was always a member of staff sat with her and he feels his mum is looked after really well. Another relative said that they had no complaints and felt their relative received very good care. They said they have noticed positive improvements lately. One relative said that the staff seem very knowledgeable about his relative and always keep him informed of any issues. A visiting professional said that the staff are always helpful and follow guidance given to them. What has improved since the last inspection? What they could do better: Some areas of the medication administration and the care planning process need further improvements to ensure that all the personal, social, health care needs and personal preferences of people are met. To ensure people are not put at risk an accurate record of fluids must be kept, especially fluids that need to be thickened due to swallowing problems. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 7 Records must be improved so they can show all medicines are accounted for and are given as prescribed. All people must be given their medicines as prescribed. To promote the personal choice and peoples dignity it is recommended that baths or showers, depending on personal preferences are offered on a more regular basis. The complaint procedure should be reviewed and updated to accurately reflect the produce within Acorn Lodge. In addition to avoid confusion there should only be one procedure in place. Also there should be a system in place to monitor and review concerns and complaints to ensure that they are responded to in an appropriate and timely manner and any patterns of poor practice can be picked up at an early stage and appropriately addressed. Some improvements are needed to the recruitment procedure to ensure that the people living at the home are fully protected. The manager should develop monitoring systems, within the home, to review and improve the quality of care provided to people living at the home. 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.V373987.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.V373987.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to make sure that people’s needs are assessed before admission. EVIDENCE: As detailed in the previous inspection report the manager confirmed that admissions are only made to the home after an assessment of the person’s needs has been undertaken. The manager also said that information from the care managers assessment of the placing authority or the funded nurse assessment is obtained in addition to the their own assessment of needs. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 10 The manager said, as recommended in the previous report, that it was his intention to be more involved in the pre admission process of prospective admissions. One person had recently returned to the home following a hospital admission. The manager confirmed that it was not usual practice to reassess a person’s needs following a stay in hospital. To ensure that the home can continue to meet the person’s needs it is recommended that prior to being discharged from hospital a further assessment of needs is undertaken. A recommendation was made in the previous report that the assessment documentation should be further developed to show that people have been consulted about their lifestyle preferences, social interests, how they perceive their care needs and to show that they have been consulted on how they want to be supported. This recommendation had not been met and due to the suspension on admissions being lifter the recommendation is reiterated in this report. A copy of the Service User Guide is available on each unit if anybody requests to see it. Acorn Lodge Nursing Home DS0000025427.V373987.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 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some shortfalls were identified in ensuring that the health care needs of people living at the home were being met. EVIDENCE: Three care plans were looked at during this visit, one form each unit. The manager said that since the last visit the majority of care plans had been reviewed and rewritten. It was of some concern when a member of staff was asked about care needs of a person, who was on the unit where they were working they said they did not know the person’s needs and had not read the care plan. They also said that there were a number of care plans they had not read. The care plan should be used a working document that staff use to ensure they are giving the correct care to meet peoples identified needs. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 12 The manager said that he does review the care plans, although no evidence could be provided to support this statement. To ensure any shortfalls are identified and addressed it is recommended that a formal review system of care plans is implemented. It was of concern that although the care plans looked at had recently been rewritten not all identified care needs had been incorporated into the care plans in all three files and not all of the paperwork had been fully completed. For example in one file the information sheet had not been fully completed. Care plans had not been developed for needs such as oral health care, diabetes, Parkinsons, wound dressing, significant weight loss, pain, confusion and oral hygiene. It was of further concern there was no documented evidence that any of above needs had been met. Some care plans contained contradictory information, for example the required consistency of thickened fluids. Several care plans identified that people required hourly checks overnight, 2- 3 hourly checks during the day and regular pressure relief. No evidence could be found that that these care needs had been met. These shortfalls have the potentional to put people at risk. It one file there was a risk assessment for the use of bed rails. However it was not a thorough risk assessment and did not include the risk of entrapment. To ensure that people are not placed at unnecessary risk the risk assessment for the use of bed rails must be further developed to include the significant risk of entrapment. Care plans were not seen to promote peoples personal choice or preferences. For example all files seen documented that residents were to be offered the chance of a bath or shower at least once a week. The daily evaluation notes did not evidence that baths or showers were regularly offered or given. A comment received from a relative was, I feel mum needs more showers/hair washed. To promote personal choice and people’s dignity it is recommended that baths or showers, depending on personal preferences are offered on a more regular basis. There was a daily evaluation record. However many of the entries were vague and repetitive. From discussions with the manger it was clear that the record did not accurately reflect the actual care given. It is recommended that the daily evaluation reports are written in sufficient detail to accurately reflect the care given. Some people required drink thickeners due to swallowing impairments. However the record of drinks taken did not always evidence that the drinks had been thickened. If unthickened drinks are given to people who require thickener it puts them at significant risk. An accurate record must be maintained of all thickened fluids given. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 13 Three of the completed surveys from people living at the home identified that they always receive the care and support needed and one stated they sometimes did. Some comments included staff very good, very caring I feel I am part of a family. It was of some concern that an unsafe moving and handling practice was observed when a person was being transferred from the armchair using a walking frame. Also staff did not give any verbal instructions or encouragement to the person. This was discussed with the nurse in charge who immediately instructed staff on the correct technique to be used. During the inspection the pharmacist inspector looked at how well medicines were handled to make sure that residents were being given their medicines properly. This was because at the previous inspection medicines had not been handled safely. We also checked to see if the requirements made at the previous inspection regarding medicines had been met. Medication records belonging to a number of residents were looked at together with their medicines. We spoke to two nurses and one senior care assistant who were responsible for administering medicines on the day of our visit. Each unit in the home has their own medicine’s storage room; two of the three medication rooms were very hot. One trolley containing medicines had a thermometer inside it and the temperature shown was above that suitable for storing medicines. Medicines, which should be stored in the fridge, were stored at room temperature and we found medicines in the fridge, which did not need cold storage. It is important that medicines are stored at the correct temperatures to make sure they work properly. We found that excessive quantities of dressings were stored in the home. Some of the dressings were not in use and had not been required by the person for whom they had been prescribed for some months. Dressings should not be held as stock when the person for whom they were supplied no longer need them. Arrangements for their disposal should be made. At the last inspection creams and ointments were stored in communal areas of the home. At this inspection creams and ointments were stored in residents rooms, however no check had been made to make sure it that was safe to do so, nor were any of these residents applying their own creams. All types of prescribed medicines should be locked away safely so that they are not mishandled. Controlled drugs, powerful medicines which could be misused, must be stored in special cabinets which are secured to the wall. The type of cabinet used and the way they are fixed to the wall is set down in legislation. We found that the home had bought cabinets, which met the current legislation however one of Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 14 the cabinets was not fixed to the wall. It is important that these drugs are stored in accordance with the law, to prevent mishandling. We found that the records about medicines had improved, especially on the dementia care unit, and there were some good examples of record keeping where the records showed that medicines had been given properly and could be accounted for properly. However we found numerous examples of poor record keeping on all units. At the last inspection it was identified that there was no system of recording how much medicine was carried over from the previous month, this was still the case. We also found that quantities of medicines were not always recorded when they were delivered and the records of medicines awaiting collection for destruction, when they were no longer needed, were poor and incomplete. We found that medicines such as Promazine and Warfarin could not be accounted for. If medicines cannot be accounted for they may be misused and people’s health could be at risk. The records also failed to provide evidence that medicines had been given properly. We found that most medicines that were supplied in the monitored dose system were given properly. We found that there was not always enough information recorded about how to give medicines which were prescribed as required or when there was a choice of dose. We also saw that there was no information as to where to apply creams. When staff do not have enough information on how to give medicines people’s health could be placed at risk. Some medicines were not given as prescribed because staff failed to follow the doctors directions. One person had been prescribed a strong analgesic patch, for pain relief. The patches contain sufficient medication to allow them to be worn continuously for 7 days, after which time the patch must be replaced with a fresh one to ensure a continuous supply of medication. We found that one person had not had their patch replaced for 14 days, potentially leaving them without pain relief for a week. If medicines are not given as prescribed this can place people’s health at risk. The manager told us that he audit checked, that medicines were being handled safely but did not fully record his findings. It is important that the findings of audits are recorded together with the actions taken to ensure that the standard of handling medicines is improved and people’s safety is promoted. The manager also told us that training on the safe handling of medicines had been arranged for both qualified nurses and senior care staff. As many of the concerns were found on the residential unit it is essential that the staff that handle medicines receive training to support them to handle them safely. They must also be assessed as competent to handle medicines to protect the health of people in their care. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 15 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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities are provided and people are able to maintain contact with family and friends. EVIDENCE: Since the last inspection visit an activity coordinator has been employed and the unit manager of the residential unit said in addition to the activities arranged by the coordinator, on her unit they provide activities as part of their day-to-day routine. Staff on the nursing unit said they hoped the appointment of the coordinator would improve and extend the activities offered to residents in the home. There is a my life story in care files, which includes details of people’s hobbies and interests. This had not been completed in one of the files looked at. The unit manager of the residential unit kept a record on each person, which documents leisure interests and lifestyle preferences. It also records any activities that each person has participated in. The unit manager told us that she had got plans to develop activities further and to support individual people to develop a lifetime history scrapbook. She recognised the importance of Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 16 obtaining relevant permissions and where possible involve relatives and advocates. Information in the received comment cards from people living at the home varied with regards to activities from there are always activities in the home to there are sometimes activities. During this visit people were spoken to about their lifestyle experiences in the home. People on the residential unit told us that there were plenty of activities available, such as entertainers, visits from the local church and art and craft. During this visit, a game of bingo was in progress. The activity was well attended and people seemed to be enjoying themselves. One person told us that she had enjoyed a recent visit from some gospel singers and that everybody seemed to join in. As already stated in this report the care planning process needs to include more emphasis on peoples personal choice and preferences. There was little evidence that people were actively encouraged to exercise choice and control over their day-to-day lives. The meal served during this visit appeared wholesome and well presented. People are offered a choice of meals and staff confirmed that if people did not want what was on the menu then every effort would be made to offer alternatives of their choice. Information received in the comment cards from people living at the home varied from they usually liked the meals to they sometimes did. One comment was meals could be better, lack of variation and imagination. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 17 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems need improving to fully protect people and enable them to raise complaints and concerns. EVIDENCE: There is a complaint procedure on display in the entrance of the home. However during the course of the visit we were shown three different procedures. One was dated 2005 and was not personalised to the home and did not have any time frames. The other two were not dated and were also not personalised to the home. It is recommended that the complaint policy is reviewed and updated to accurately reflect the procedure within the home and to avoid confusion only one procedure should be in place. We were shown a complaint folder, which had documentation to record complaints. The file was empty and the manager said that they had not received any concerns or complaints. The importance of recording any concern or complaint received was discussed with the manger, including and the need to keep records of all correspondence, investigations, any staff statements and a conclusion of the concern or complaint. Also there should be a system in place to monitor and review concerns and complaints to ensure that they are responded to in an Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 18 appropriate and timely manner so that any patterns of poor practice can be picked up at an early stage and appropriately addressed. Residents who were spoken to told us that they felt confident in raising any issue of concern with the manager and staff. This finding was reflected in the views of relatives who said that they felt well informed by staff, and they know they could always talk to them if they had a worry or concern. One relative said, “I feel confident that I could approach the staff with concerns. There was a copy of the Oldham and Manchester Local Authority Adult Safeguarding guidelines and the manager said they were available on each unit for staff to access. Records demonstrated that staff had attended safeguarding adult’s training. However, there were varying levels of understanding of the adult protection procedures which must be followed in the event of an allegation of abuse. To ensure that people are not put at unnecessary risk it is recommended that refresher training be provided for those staff who are not fully aware of the correct procedure. Since the last inspection visit there has been an investigation using the local adult safeguarding procedure due to an allegation of abuse being made. The investigation had recently been completed and the allegation had been upheld. Following the investigation various strategies have been put into place to monitor the service being delivered. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 19 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A clean, pleasant environment is provided. EVIDENCE: A tour of the building was undertaken as part of this visit. The home was clean and appropriately furnished and many of the bedrooms were seen to be personalised. It was noted that the standards of cleaning had improved since the last visit and the home was clean, tidy and free from offensive odours. There was evidence on staff training files that ancillary staff had received training in infection control in 2008. Information received in the returned comment cards from people living at the home varied from the home is always clean and fresh to it is usually clean and fresh. People spoken to during the visit were positive about the environment. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 20 There was evidence of a rolling programme of decoration and refurbishment, and the requirement to fit restrictors to the windows over the stairs had been addressed. Since the last inspection visit the ground floor corridor and several bedrooms had been redecorated and new carpets had been fitted. Bathrooms and cleaning store cupboards contained a selection of protective clothing and disposable gloves. Staff were seen wearing appropriate protective clothing during the day. Some bathroom areas were being used inappropriately for storing large amounts of continence pads and communal toiletries for service users to use. The storage of these supplies was causing a hazard as staff were unable to access both sides of the bath, and the communal toiletries raised concerns about the risk of cross infection, and privacy and dignity issues in sharing communal resources. This was addressed at the time of the visit, and items were removed from this area to make it safe. People should have their own toiletries to promote their dignity and to prevent cross infection. During the last visit come of the garden furniture was unsafe for use. The manager told us that the unsafe furniture had been removed, and said that there were plans to develop and improve the outside seating areas before summer. However there was a requirement in the previous report that a risk assessment must be undertaken of uneven patio area to ensure that a safe environment is provided for any people wishing to use this facility. This had not been met and has been reiterated in this report. Specialist equipment is provided to meet the needs of people in the home. For example, grab rails, nurse call systems and a ramped access is provided to the front door. One visitor told us that her relative had recently received a visit from an occupational therapist and had been assessed for a special chair to meet his individual needs. She said this was due to be delivered in the next few weeks. This shows that specialists assessments are requested when appropriate and that people are provided with equipment to improve their comfort and safety. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to the recruitment procedures to ensure people are fully protected. EVIDENCE: From reviewing the duty rota and from observations during the visit there were sufficient staff on duty to meet the needs of the people living there. On the nursing unit, one visitor told us that he visited daily and that more often than not a member of staff spent time sitting with his relative. Visitors were complimentary about the staff, and felt that the staff were always around and available to answer their queries. Staff who were spoken to said they had received induction prior to starting work and that they had plenty of access to training and development opportunities. The clerical assistant kept a record of all staff training. There was evidence that staff had attended a range of courses. However it was noted that no staff had yet attended training in the implementation of the mental Capacity Act. A sample of two staff files were looked at to see whether the required documentation was in place and if the necessary safety checks had been made. There was evidence of Criminal Record Bureau checks (CRB) having Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 22 been undertaken, however some shortfalls were seen in the recruitment process. For example, one file did not have a photograph or proof of identity. In the same file only one referee had been identified on the application form and a reference had not been obtained from them. There was a character reference and a reference from a family member. This does not fully protect people living at the home. The files looked at contained some photocopied documents and there was no evidence that the original documents had been seen. It is recommended that all photocopied documents are signed and dated to indicate that the original has been seen. In addition, in the files looked at, there was no evidence that a set interview format had been used or that notes were taken. It is recommended that a set interview format is used and notes are taken during the interview process. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to the management systems to ensure that the home is run in the best interest of the people living there. EVIDENCE: Since the last inspection visit the registered manager has been given appropriate hours to effectively manage the home and the unit manager of the residential unit had been given a half day a week to meet her managerial responsibilities. There were still some shortfalls in the management of the home, which have been clearly identified in the report, with particular reference to the care Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 24 planning process, the administration of medicines and the recruitment process. All of these shortfalls have the potential to put people at risk. There were no systems in the home for reviewing the quality of the service provided. The manager should develop monitoring systems, within the home, to review and improve the quality of care provided to people living at the home. The previous report required that the owner of the home must arrange regular visits to be made to the home, in accordance with Regulation 26 of the Care Homes Regulations and provide the Commission with monthly reports until further notice. This requirement had not been met and has been reiterated in this report. Since the last inspection visit the manager had obtained an accident recording book in line with the Data Protection Act. Once the use of this book has been implemented, it is recommended that the manager analysis the frequency and number of accidents to assess patterns, possible cause and action to be taken to minimise occurrence. Two policy folders were seen. One set of policies and procedures were dated 2005 and were not personalised to Acorn Lodge and the policies and procedures in the other folder were not dated. It is recommended that the policies and procedures are reviewed and updated to ensure they are personal to the home and contain up to date information in line with current good practice guidelines and current legislation. The individual financial records for service users were looked at. A system remains in place for small amounts of money to be held and used on behalf of people. The system was secure and records provided evidence of running totals for individual accounts and included receipts for any purchases made on peoples behalf. At the last inspection the manager was not sure how the overall accounting system for peoples finances was managed. He was advised to develop systems to monitor the handling of peoples finances in order to satisfy himself that the system was working properly and that the financial interests of people were protected. Since the last inspection visit the local authority has been involved in working with the manager to improve the systems for financial management of peoples finances. Arrangements had been made to transfer peoples individual accounts so that they are held in client affairs within the social services department. This will ensure that the financial interests of people will be protected. In future the manager will need to make a formal request to client affairs if a person needs to withdraw money to make individual purchases. It is recommended that the policies and procedures relating to finances are reviewed and updated to clearly set out the systems to be followed at Acron Lodge. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 25 The manager confirmed that on occasions, staff do purchase items on behalf of a person . However, there was no record of agreement that people had given their permission for staff to make purchases on their behalf. It is recommended that written agreements be developed between people and the home setting out permission for the staff to purchase personal items for that person and the receipt be signed by the person purchasing items. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 26 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 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 2 x x 2 Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement To ensure that the health and welfare of people living at the home are fully met, a detailed plan of care, which includes peoples personal choice and preferences , must be implemented for each identified care need. To ensure that people are not placed at unnecessary risk the risk assessment for the use of bed rails must be further developed to include the risk of entrapment. To ensure people are not put at risk an accurate record of fluids must be maintained, with particular reference to thickened fluids. There must be effective auditing systems in place system in place to check medicines are given correctly. Also systems to ensure staff that handle medicines are competent to do so safely to help make sure that people who live in the home are kept safe. Previous timescale of 26/10/08 had not been met. DS0000025427.V373987.R01.S.doc Timescale for action 09/03/09 2. OP7 13 09/03/09 3. OP8 17 09/03/09 4. OP9 13 09/03/09 Acorn Lodge Nursing Home Version 5.2 Page 28 5. OP9 13 (2) Medicines must be given to residents as prescribed because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. Previous timescale of 14/08/08 and 12/10/08 had not been met. 09/02/09 6. OP9 17 (1) Clear and accurate records of medicines received into, administered and disposed of by the home must be maintained so that medicines can be fully accounted for to show that they are being given correctly and to prevent mishandling. Previous timescale of 14/08/08 and 12/10/08 had not been met. 09/02/09 7. OP9 13 All medicines must be stored safely and securely. Medicines must be stored at the correct temperatures so they work properly. Controlled drugs must be stored in a cabinet, which is fixed to the wall accordance with the Misuse of Drugs (Safe Custody) regulations, to prevent misuse. The external patio area must be risk assessed to ensure that a safe environment is provided for people wishing to use this facility. Previous time scale of 2/1/08 had not been met. All staff files must include all the details listed in Schedule 2 to ensure the recruitment procedure protects residents. The owner of the home must arrange for regular visits to be made to the care home in DS0000025427.V373987.R01.S.doc 09/02/09 8. OP19 23 09/03/09 9. OP29 19 and schedule 2 26 09/03/09 10. OP33 09/03/09 Acorn Lodge Nursing Home Version 5.2 Page 29 accordance with this regulation, and provide the Commission with monthly reports until further notice. The owner must arrange to interview, with their consent and in private, people who use the service their representatives and staff working in the home. The report should also include an inspection of the home, its records, events and records of any complaints. Previous timescale of 5/10/08 had not been met. 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 OP3 Good Practice Recommendations 1. Assessment documentation should be developed to show that prospective residents have been consulted about their lifestyle preferences, social interests, how they perceive their care needs and to show that they have been consulted on how they want to be supported. 2. To ensure that the home can continue to meet a persons needs following hospital admission it is recommended that prior to being discharged a further assessments of needs is undertaken. 1. To ensure any shortfalls are identified and addressed it is recommended that a formal care plan audit is implemented. 2. It is recommended that the daily evaluation reports are written in sufficient detail to accurately reflect the care given. 3. It is recommended that residents individual plans of care include details of their personal choice, preferences and social care needs. Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 30 2. OP7 3. OP9 1. Medicines that are prescribed to be given ‘when required’ should have clear written instructions for staff to follow to ensure they are given correctly. 2. Adequate information about how to administer medicines should be available to ensure that they are given and handled correctly. 4. OP10 1. To promote personal choice and peoples dignity it is recommended that baths or showers, depending on personal preferences, are offered on a more regular basis. 2. It is recommended that to promote the dignity of people and prevent the risk of cross infection people should have their own toiletries. 1. To avoid confusion there should only be one complaint procedure in place. 2. The complaint procedure should be reviewed and amended to accurately reflect the procedure within Acorn Lodge. 3. The registered manager should have a system in place to monitor all concerns and complaints made to ensure that they are responded to in an appropriate and timely manner and any patterns of poor practice can be identified at an early stage and fully addressed. To ensure that people are not put at unnecessary risk it is recommended that safeguarding adults refresher training be provided for those staff who are not fully aware of the correct procedure to follow in the event of an allegation of abuse being made. . 1. It is recommended that a set interview format is used and notes are taken during the interview process. 2. It is recommended that written evidence be maintained that the original documentation has been seen, the date and by whom. 3. It is recommended that if a reference is not obtained by the applicant’s last/current employer, as detailed on the application form, the reason is clearly recorded. It is recommended that staff receive training on the Mental Capacity Act. It is recommended that the policies and procedures are reviewed and updated to ensure they are personal to the home, contain up to date informant in line with current good practice guidelines and current legalisation. DS0000025427.V373987.R01.S.doc Version 5.2 Page 31 5. OP16 6. OP18 7. OP29 8. 9. OP30 OP33 Acorn Lodge Nursing Home 10. OP35 1. It is recommended that the policies and procedures relating to finances are reviewed and updated to clearly set out the systems to be followed at the home. 2. It is recommended that written agreements be developed between people and the home setting out permission for the staff to purchase personal items for that person and the receipt be signed by the person purchasing items. It is recommended that the manager analysis the frequency and number of accidents to assess patterns, possible cause and action to be taken to minimise occurrence. 11. OP38 Acorn Lodge Nursing Home DS0000025427.V373987.R01.S.doc Version 5.2 Page 32 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. 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