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Inspection on 06/08/08 for Acorn Lodge Nursing Home

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

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

What the care home does well

The service makes sure that all prospective residents have a care needs assessment before moving into the home. Residents and relatives who were spoken to during this visit were positive about the care and support services. They expressed confidence in the staff team and felt that it was a well-established team. Comments from residents included: "I feel you can do what you want and the staff are very friendly. The meals are good here". "I wouldn`t change anything here, I find this place comfortable". One relative said, "It`s absolutely fabulous here. The home was really supportive during her admission. The staff are so kind and professional and so kind to my mum and me. They arranged introductory visits before moving in and were very kind and sensitive in their approach".

What has improved since the last inspection?

Since the last inspection visit there has been an increase of supernumerary hours for the registered manager to complete managerial duties in connection to the day to day running of the home. These have been increased from nine hours to 16. However, this increase remains insufficient to manage a home of this size. Since the pharmacist visited the service, on 17th July 2008, the home has improved the storage and recording of medicines on the dementia care unit.

CARE HOMES FOR OLDER PEOPLE Acorn Lodge Nursing Home Guido Street Failsworth Oldham Lancashire M35 0AL Lead Inspector Ann Connolly Unannounced Inspection 6th August 2008 09:30 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.V369929.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.V369929.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.V369929.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. 17th July 2008 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 £360 to £516 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.V369929.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 0 stars. This means the people who use this service experience poor quality outcomes. This was an unannounced inspection that took place on 6th August 2008, commencing at 09:30am. During the site visit a selection of records, care plans, policies and procedures were examined. Discussions took place with the registered manager, the registered owner, staff working in the home and the residents living there. Questionnaires were given to the people who live in the home asking them to comment on how the home is run and managed, and for their views about how the staff supported them. Some of these comments have been included in this report. Several residents living in the home were spoken to during the visit, and discussions took place with them to find out what they thought about the home and what they felt about how the staff supported them. The service has also been asked to fill in a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This is one of the ways that we get information from the manager of the service about how they are meeting outcomes for people using their service. Since the last inspection visit, which took place on 7th November 2007, the Commission for Social Care Inspection has not received any complaints about this service. The registered manager said they had received one complaint about the service, which was fully investigated. The service has had one safeguarding referral made to Social Services, and this is currently under investigation. A pharmacist inspector visited the home on 17th July 2008 to look at how medicines were managed. The findings of the inspection were sent to the home in a random inspection report. Copies of this report can be obtained from the Commission for Social Care Inspection. The pharmacist revisited the service on 18th August 2008 and this report contains the findings of that visit. The pharmacist’s inspection took five hours and involved looking at medicines and records, and discussion with staff and residents. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The registered manager needs to develop systems for monitoring the assessment process. This will make sure that he has an overview of residents’ care needs and be able to evaluate staffing levels and skills to ensure that the service can confidently and safely meet needs of residents in the home. Some of the information and risk assessments on the care plans were not up to date. Care plans must be reviewed on a regular basis to ensure that the current health care needs of residents are met. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 7 Administration and recording of medicines needs to be improved to ensure that residents are not placed at unnecessary risk. There must be an effective system in place to check medicines and staff competence to help make sure that people who live in the home are kept safe. Many comments from relatives and residents stated that they would like activities to be offered on a consistent and regular basis. Staff should continue to seek the views and preferences of people in the home, so that there is a good understanding of what people would like to do in their leisure and social time. Care planning should include details of how to meet individual needs and preferred lifestyle options. Monitoring systems need to be improved so that the registered manager has an overall view of how complaints are managed on each unit and so that he can be confident that residents are able to express their views and that complaints are responded to in an appropriate and timely manner. A number of requirements and recommendations have been made in the report for work to be carried out to ensure the safety and comfort of people living and working in the home. The main area that requires improvement is for the registered manager to be provided with sufficient supernumerary hours in order to carry out the effective management of the home. This will ensure that systems are in place to monitor the day-to-day business of the home. This will help to ensure the safety and well being of residents living there and provide opportunities to develop the service in a way that promotes positive outcomes for residents. The registered provider is aware of the shortfalls in management structure, and hours provided to carry out this task, and is currently reviewing this. 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.V369929.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.V369929.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 (Standard 6 was not assessed as Acorn Lodge does not provide intermediate care) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Assessment procedures were in place so that staff have information about a person’s support needs prior to them coming to stay at the home. EVIDENCE: Three care plans files were looked at during this visit. The manager said that admissions are not made to the home until a full care needs assessment has been undertaken. The manager also said that information from the care manager’s assessment from the placing authority was used, in addition to the information obtained in the home’s own assessment. The information was used to generate a working care plan so that staff had the essential information to help them in providing care and support in an appropriate manner. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 10 Although the assessment information was in place, further development is necessary to show that the prospective resident has been involved in the process, and to demonstrate that they have been consulted about their lifestyle preferences, social interests, how they perceive their care needs and consulted on how they want to be supported. On one care plan there was no evidence of the pre-admission assessment information provided by the placing authority and the information in the home’s initial assessment was very brief. The registered manager said that it was usually the unit manager who was involved in the assessment of prospective residents, and he said that he did not get involved in this process. It was recommended that the registered manager should oversee this process and have some involvement to monitor and ensure that admission procedures were followed correctly and to ensure that the assessment documentation used by the home contained all the relevant information to ensure care and support are provided in a safe and appropriate way. The registered manager also needs to satisfy himself that the staff in the home have the necessary skills and experience to meet the assessed needs of any individual moving into the home. Acorn Lodge Nursing Home DS0000025427.V369929.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 plans did not always contain up to date information or relevant risk assessments, and this could potentially place individual residents at risk if they do not receive appropriate care and support due to lack of information. Poor practice in the administration and recording of medicines means that the health and wellbeing of residents is placed at unnecessary risk. EVIDENCE: Three care plans were looked at on the Dementia unit. All files are numbered in reference to the room they occupy. Each file starts with an index system to make easy reference for staff using the file. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 12 The initial information on the care plans which were looked at was very brief and could be more narrative to provide important information about the care needs and requirements of individual residents admitted into the home. On one file there was a document entitled ‘my life story’. This appeared to be an effort to develop person centred planning and was set up on 22nd March 2006. From case tracking of residents, we found several examples of information and risk assessments which were not up to date. On one assessment there was a risk assessment in place for the use of bed rails. This was completed on 15th October 2006. It referred to a turning chart, which was not included on the plan. Following discussion with staff it emerged that this individual no longer required support to be turned at intervals as there had been a change in care needs. The care plan had not been updated to reflect this and there had been no review of the risk assessment since 15th October 2006. On one care plan, the moving and handling assessment was not informative in terms of advising staff of procedures for a particular resident. This means that staff are not always provided with the necessary information to help them to assist in moving and handling tasks in a safe way. Some residents were using chairs which meant they were tilted backwards and not able to move independently. The care plan of one resident supported in one of these chairs was looked at. This care plan failed to provide any rationale for the use of this chair. There was no consent agreement for its use and no risk assessment in place for use of this equipment. Two other residents were identified as using this type of chair. One of the care plans included an assessment completed by the community physiotherapist. The assessment stated the use of this chair was appropriate to meet care needs. However, the other care plan did not contain any information about why the chair was used, there was no reference to any other professional assessment and there was no risk assessment for the use of this equipment. The registered manager must make sure that all care plans are reviewed regularly and that the information is up to date to reflect current care and support needs of each individual. The manager must be confident that care plans are accurate for the person they support and that all equipment used is appropriate and used in a safe way. Care plans included records of weight charts and there was evidence that these were reviewed on a monthly basis. Daily report records were maintained with sometimes two entries per day. Some of the recordings on the daily notes did not relate directly to the care plan and did not clearly show if the interventions were meeting the assessed care needs of individual residents. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 13 One care plan included instruction from a relative about medical intervention. This was very specific about when to request medical services. This could be confusing and misleading for the care staff providing care. In the light of the Mental Capacity Act it is advised that this statement is reviewed with input from appropriate professional services and the local authority if care management services are involved. This will ensure that the individual concerned receives all care and future planned care needs in a safe and appropriate way. Feedback from some residents and relatives was very positive. One resident said, “You can do what you want and staff are very friendly. I wouldn’t change anything. I looked at two or three homes before I moved in. I find this place very comfortable”. One relative said, “It is absolutely fabulous here. I was dreading my mother coming into a home, however, the home were very supportive about the admission. They arranged introductory admissions and have kept me informed about care arrangements”. During this visit there was evidence to show that residents were supported to access a range of healthcare services. Residents who were spoken to said they only had to ask and they could see a General Practitioner (GP) at any time. Records provided evidence that health visits are maintained and indicated that five visits had been made to one resident since March 2008, one visit by an optician, two by a chiropodist and one by a physiotherapist. We looked at how medicines are stored in the home and found that improvements have been made in the security of medicines on the dementia unit. This helps to ensure that medicines are not misused or mishandled. We compared a sample of medicines records and stock. We found that some medicines had not been recorded when they were received by the home and that there was no system of carrying stock over from the previous month. This made it impossible to check whether medicines in bottles and packets were being given correctly. We checked the records of medicine administration. We found that there were some improvements in the records on the dementia unit and this meant that we could now see when creams and food supplements had been given. However some records were still incorrect and sometimes there was not enough information in residents’ care files to make sure that medicines were given correctly. We found that some administration records contained a photograph of the resident to help with identification. However, a number of photographs were missing or were not named. This could lead to confusion and medicine may be given to the wrong resident in error. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 14 We spoke to one resident who looked after her own medicines, she was very happy with the support provided by the home. We looked at how controlled drugs (medicines that can be misused) were managed. We were concerned to find that a patch applied to the skin to treat severe pain had not been given to a resident correctly. This patch must be changed every three days for it to work properly. The records showed that on one occasion the patch was applied a day late and on the day of inspection the patch had not been changed for six days. This means that the resident would not have been getting the pain relief that they needed. The resident was spoken with and said that they were not in pain, however their care plan showed that they did not always tell staff when they were in pain. We were also concerned that the administration records wrongly showed that on two occasions this patch had been changed when it had not been. We also found that the records for another controlled drug were incorrect. Records of the receipt, administration and disposal of medication must be clear and accurate so that medicines can be fully accounted for to show that they are being given correctly. We looked at how controlled drugs were stored. We found that on the residential unit the medicines were secure but the cupboard used did not meet the current law. Controlled drugs must be secured securely to prevent misuse and mishandling. We looked at how medicines were audited (checked). The manager does not carry out audits on medicines or assess staff competence. Checks on medicines handling are important because they help ensure medicines are administered as prescribed and help to make sure that staff are competent. Acorn Lodge Nursing Home DS0000025427.V369929.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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. A warm reception is given to visitors. Residents are encouraged and supported to maintain contact with family and friends. Systems need to be developed to support residents to be involved in identifying their preferred lifestyle. EVIDENCE: Overall residents and their relatives expressed satisfaction about the home. Comments from residents and relatives included the following: “I feel you can do what you want and the staff are friendly”; “The care and attention to residents is excellent”; “I looked at two or three homes before I visited here and I find this place most comfortable. There are activities, I like bingo. I know who the manager is, and I would go to him if there was a problem”. One relative said that she had been trying to help the staff to arrange more activities on the residential unit. She said they had been receptive to her ideas and, as a result, some positive activities had taken place. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 16 There is no designated activities organiser, but staff on the residential unit said they provided activities as part of the day-to-day routine. We were told that activities consisted of bingo and quizzes. A weekly film event had also been introduced to the activity programme. There was limited information on the initial assessment about the individual’s lifestyle preferences. This means that staff do not always have the information to integrate historical and lifestyle preferences into the care plan system. Some relatives said they would like more activities or opportunities for their relatives to go out to local community places. These comments appeared to be said on behalf of residents who were unable to express themselves. Residents on the residential unit who were able to contribute to the feedback said they had been offered opportunities to go out to garden centres, etc, however, the frequency of these activities was sometimes restricted, as staff had often organised these trips using their own free time, as these were not regularly offered by the home. A music activity was taking place on the dementia unit. The scene was very chaotic and noisy and the activity did not seem to be well planned or have any meaningful purpose for individual residents. The way the activity was presented was not age appropriate. The meal served during the visit appeared wholesome and was well presented. Residents were offered a choice of menu. There were mixed comments from residents about the quality of the food served, but most indicated they either ‘usually’ or ‘sometimes’ liked the meals. The catering staff confirmed that when residents did not like any choices on the menu, every effort would be made to offer a suitable alternative. Acorn Lodge Nursing Home DS0000025427.V369929.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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Systems are in place to support residents to express their complaints and staff had an understanding of adult protection procedures. Documentation must be maintained so that complaints can be monitored effectively to ensure that residents are protected. EVIDENCE: There is a complaints procedure displayed in the entrance of the home. Residents who were spoken to expressed confidence in raising any issue of concern. According to the home’s register, only one complaint had been received since the last inspection. The response to the complaint was appropriate. In conversations with some family members, it seemed that the management did not always take small requests seriously. This disappointed them as they felt it was important to the quality of life for their relative. This approach did not reflect a poster displayed in staff areas, which stated, ‘What may seem a small matter to management can be of great importance to some people living in the home’. One relative said that they were not convinced that staff really knew the small important care needs. They said that when they approached staff some of them seemed ‘a bit defensive’. They said that instead of listening and finding a solution, they seemed to ‘find an excuse’. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 18 The registered manager had not implemented any system to monitor and oversee any complaints made on each unit. It was recommended that the registered manager should develop a system for monitoring complaints so that he can be confident that all complaints are responded to appropriately and in a timely manner. This will ensure that the home learns from complaints, and any patterns which identify poor practice can be picked up at an early stage and fully addressed. The registered manager stated that all staff had received training in safeguarding adults. Most of the training is provided ‘in-house’, and delivered by a member of staff who is designated as the training officer. It was noted that the home had not accessed any of the safeguarding training offered by the local authority which is free of charge. A copy of the local authority guidelines was not located on site and the registered manager is advised to ensure that each unit has a copy of the Oldham policies and procedures. Staff should be given time to read the local authority guidelines. Staff who were spoken to demonstrated a good understanding of what to do in the event of an allegation of abuse. They were aware that the local authority Social Services department take the lead in all investigations and that the commission must be notified of any incident affecting the well being of residents in the home. At the time of this visit, there was one safeguarding referral which was currently under investigation using local adult safeguarding procedures. Acorn Lodge Nursing Home DS0000025427.V369929.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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents are generally provided with a pleasant environment. Improvements were needed to the cleaning of some areas to maintain an odour free environment. EVIDENCE: As part of the visit a tour of the building took place. Most communal areas and bedrooms were found to be personalised and were cleaned to a reasonable standard. The registered manager said that all staff have received training in infection control and that protective clothing was provided and used by staff. Staff were seen using protective clothing and gloves during this visit. However, the training matrix showed that not all staff had been updated in infection control. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 20 Most of the feedback from residents and their families was very positive about the environment at Acorn Lodge. People spoken to said that the home was always tidy and provided a pleasant environment. There was evidence of an ongoing rolling programme of decoration and refurbishment. The newly decorated areas and new carpets were of a good standard and showed that improvements were being made to provide a pleasant environment for residents and visitors. The external garden areas were large and provided opportunities for development in order to make them safe and pleasant for residents to use in the warmer weather. At the time of this visit the condition of the outside space limited any safe and effective use of the space. Some garden furniture was unsteady and therefore unsafe to use. The flagged patio area was uneven and presented tripping hazards. Furniture was cluttered and the area did not present as an inviting area for residents to use. It was recommended that the outside space should be developed in order to provide a pleasant and safe external area for residents to enjoy all year round. A requirement has been made to assess furnishings and flags and undertake a risk assessment of the existing external space. On a tour of the ground floor residential unit,(large lounge to the right of the main entrance), there was a strong and lingering odour. A domestic was spraying the area with an air freshener spray to disguise the odour. This amount of spray could become unpleasant for some people, and it was recommended that the problem is dealt with at the source by deep cleaning or re-placement of carpets. The carpet in the lounge, and especially on the corridor leading into the lounge, was tacky and sticky underfoot. This may be as a result of spillage as the meals are served from the hotplate just outside the lounge area. This requires attention and cleaning so that residents are provided with a clean and hygienic environment. One relative commented in a survey form by saying, “I feel that more attention could be made to hygiene standards”. Discussions were held with other family visitors and residents. One relative said, “I suppose we have made a good choice”. One resident said, “I like my own space, they respect this. I suppose you have got to put up with the smells”. On inspection of the bathroom areas there were a number of creams and ointments in a cupboard. These had been prescribed for named people, however, the labels had been removed and appeared to be used as communal creams and ointments. Creams and ointments must only be used by the people for whom they were prescribed. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 21 Window restrictors were not fitted on the stairwell areas. A risk assessment must be carried out to see if they are needed. 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. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence, including a visit to this service. Residents are supported by an established staff team. EVIDENCE: During this visit, there were sufficient staff on duty to meet the needs of the residents. Staff were seen spending one to one time with residents and providing support for those residents with high dependency needs. The registered manager said that staffing levels were constantly reviewed, and the dependency levels of the residents were taken into consideration when setting the rota. Staffing on the residential care only unit consisted of five carers throughout the day, on the dementia unit there was a qualified RMN and four carers, and on the nursing unit there was a qualified RGN and three carers. Most staff work a 08:00 to 20:00 hour shift. At the time of this visit the registered manager said that were a number of staff vacancies, but that existing staff were covering and some of the night staff had been deployed on to day shifts. He said this was helping to maintain continuity for residents and avoided using large numbers of bank staff. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 23 Each unit has a designated senior or manager assigned to the unit. During discussions with the registered manager it became evident that he provides the qualified cover on one of the units for most of the week, and only has 16 hours per week to specifically manage the service as registered manager. At the time of this visit a qualified person was covering the dementia unit, leaving the registered manager to assist with this inspection visit. All new staff undertake induction training. Staff who were spoken to confirmed that they had received induction training, and that there were ongoing opportunities for training and development. Records of induction were evidenced on the three files that were looked at. Staff spoken to said that they received most of their training ‘in-house’. A copy of staff training matrix was received detailing staff attendance at planned training sessions. The clerical assistant maintains the information on computer and all training is monitored and managed by an ‘in-house’ teacher/trainer. Three staff files were looked at during this visit, and all of them contained the appropriate paperwork and Criminal Record Bureau (CRB) disclosures. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 24 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 36 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 management systems to ensure the home is running in the best interests of residents. EVIDENCE: The registered manager is a qualified nurse with many years’ experience. The manager has also completed a manager’s course. During initial discussions with the registered manager, and based on findings made throughout the day, it was evident that there were insufficient hours allocated for managerial tasks. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 25 On the last inspection in November 2007 only nine hours per week were allocated supernumerary for the registered manager to carry out managerial tasks. On this visit, the hours had been increased to 16 hours per week. The registered manager was not given the hours required or the directive to take complete control of the day-to-day management of the home. The registered manager was unable to demonstrate that he has the time, autonomy and full responsibility for managing the home. The manager said he did not think he had a job description to reflect this role. The registered provider should ensure that the manager has a job description which outlines the roles and responsibilities of this position, and enables the manager to take responsibility for fulfilling his duties. Internal communication systems failed to evidence that the registered manager was informed of issues relating to the health, safety and well being of residents on each unit. The registered manager was advised to develop internal recording systems for the purpose of handover or passing on relevant information from each unit on a daily basis. The appointment of staff on each unit was the responsibility of the unit manager. The registered manager was not involved in the selection of staff and the registered manager said he might only be involved if he had the time. This again identified a failure in the registered manager being actively involved in this process. Discussion with the registered manager relating to the pre-admission assessment of a prospective residents indicated that it was the unit manager that takes the lead, with the registered manager having no input at all in the process. This again identified a failure in the registered manager being actively involved in the process. The registered manager needs to be satisfied that assessments are able to confirm if the needs of the individual resident will be met by the staffing levels and the skills and experience of staff employed in the home at any given time. The registered manager said that he met with the registered provider on an informal arrangement, and could contact him by telephone. There was no written evidence to record these meetings, no record of the topics discussed, outcomes or action plans. All staff who were spoken to said that they found the registered manager approachable and could consult with him about any issues of concern. However, there was evidence during this inspection that some staff had not felt confident in going to the registered manager with a serious concern, and they had gone directly to external agencies (Social Services). This issue is currently being investigated under safeguarding procedures. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 26 Basic management systems were not in place to hold unit managers accountable to the registered manager. The overall role of the registered manager should be to ensure that there effective procedures on each unit and that each unit manager is accountable to the registered manager. Discussion with the registered manager highlighted further shortfalls in the overall management of the home as he said that there was insufficient time to monitor staff training and development. Staff who were spoken to said they were given supervision from the unit managers. The three staff files that were looked at provided written confirmation that recent supervision sessions had taken place. A supervision file was located on the office desk of one of the units which contained a number of documents relating to named staff members and covered a range of topics. This file was accessible to anyone entering the office and did not respect privacy and confidentiality of information. This was discussed with the registered manager at the time of this visit. The manager addressed this immediately and provided secure storage of this confidential information. Systems are in place for the management of small amounts of money to be used on behalf of residents. The system appeared secure, however there is a concern that the registered manager of the service does not appear to be directly involved in management and accounting of finances. In most cases residents’ money is managed by the local authority or paid directly to relatives. There is a need for the registered manager to be directly involved in finance management for all service users so that he can satisfy himself that this system is working properly and so that residents’ finances are accounted for. All fire exit doors have locks on which are overridden once the fire alarm is activated. The maintenance person confirmed they activate on test. The release mechanisms were seen on a number of doors. The manager stated the home has been advised on the fitting of magnetic release systems. Plans are being put in place to convert to this type of system. The home records accidents on headed record sheets devised by the home. This does not comply with date protection guidelines as all completed accident records are held in order of occurrence in a ring binder. Records of accidents relating to named individuals must be transferred to their personal file, to assist in monitoring number and frequency. It is recommended that an accident register, which meets Date Protection guidelines is used. It is also recommended that an analysis of the frequency and number of accidents to named individuals is undertaken to assess patterns, possible cause and action to be taken to minimise occurrence. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 27 One example looked at related to an accident that happened to a resident on 19th July 2008 and stated that she tripped and fell. The report needs to be more specific as to cause of the trip, to identify the hazard and action to reduce its occurrence. During this visit, there was no evidence available to confirm that the registered owner had made visits to comply with Regulation 26 of the Care Homes Regulation 2000. The registered owner should make visits to the home each month and should interview, with their consent, and in private, people who use the service and their representative, and staff working in the home. This report should also include an inspection of the home, its records and events and records of any complaints. Discussion took place with the registered owner of the service. He said that he recognised the recent shortfalls in the management structure, and was currently in the process of reviewing the management structure and managerial hours. The registered owner and registered manager will be required to submit an improvement plan to the Commission to provide details on how they intend to meet these shortfalls. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 28 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 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 2 3 X X Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? 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 Timescale for action 17/10/08 2 OP9 13 (2) 3 OP9 13 (2) 4 OP9 13 (2) All residents must have a care plan and risk assessment in place for all their assessed needs. These plans must be reviewed on a regular basis to enable an audit trail of any discontinued treatments or needs in order to ensure people’s health care needs are met. Creams and ointments must only 12/10/08 be applied to the person they are prescribed for. Giving a resident medicines that are not prescribed for them may affect their health and well-being. There must be an effective 26/10/08 system in place to check medicines and staff competence to help make sure that people who live in the home are kept safe. Medicines must be given to 12/10/08 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 not met). DS0000025427.V369929.R01.S.doc Version 5.2 Acorn Lodge Nursing Home Page 30 5 OP9 17 (1) 6 OP9 13 (2) 7 OP19 23 8 9 OP19 23 26 OP33 10 OP33 10 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 not met). A legally compliant controlled drug cupboard must be available to store controlled drugs to prevent mishandling and misuse. The external patio areas and outdoor furniture must be risk assessed to ensure that a safe environment is provided for residents wishing to use this facility. A risk assessment must be carried out on stairwell windows to see if restrictors are required. The owner of the home must arrange for regular visits to be made to the care home in 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. Systems must be developed to ensure that the registered manager has an overview of the day-to-day operations of the home so that the health safety and well being of residents is protected. 12/10/08 07/11/08 02/10/08 05/10/08 05/10/08 10/10/08 Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 31 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 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. Medicines that are prescribed to be given ‘when required’ should have clear written instructions for staff to follow to ensure they are given correctly. Residents care files should contain adequate information about medicines to ensure that they are given and handled correctly. Photographs used to identify residents prior to administration of medicines should be added or updated as necessary. 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. The registered manager should have a system in place to monitor all complaints made on the individual units. This will ensure that the manager can be confident that complaints are responded to in an appropriate and timely manner. The registered manager should ensure that all staff have received updated training in safeguarding adults so they can be confident on what action to take in the event of an allegation of abuse. Training for staff should include domestic staff and any other staff who have regular contact with service users. Safeguarding procedures relating to the local authority should be available on each unit and staff should be given time to read and sign up to the guidelines. The registered manager should assess all communal areas and arrange for suitable cleaning or replacement of carpets as appropriate. This will ensure that residents and their families benefit from a clean environment free from DS0000025427.V369929.R01.S.doc Version 5.2 Page 32 2 OP9 3 4 OP12 OP16 5 OP18 6 7 OP18 OP19 Acorn Lodge Nursing Home 8 OP27 9 OP31 10 11 OP31 OP38 12 OP38 odours. Review staffing levels and unit manager’s supernumerary management hours on the residential unit. Ensure the unit manager has sufficient time to fulfil their role and care staff hours are sufficient to ensure people’s needs are met. The registered manager must be given enough supernumerary hours to manage the care home with sufficient care, competence and skill, and make sure that working practices are monitored regularly to ensure the health safety and well being of residents living there. Review the registered manager’s supernumerary hours to ensure regular reviews of the service development. The manager is advised to transfer all accidents relating to named individuals to their personal file, to assist in monitoring number and frequency. The home is advised to access an accident register, which meets Date Protection guidelines. The manager should be provided with a job description which outlines the roles and responsibilities of this position, and enables him to take responsibility for fulfilling his duties. Acorn Lodge Nursing Home DS0000025427.V369929.R01.S.doc Version 5.2 Page 33 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.V369929.R01.S.doc Version 5.2 Page 34 - 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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