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Inspection on 07/11/07 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 7th November 2007.

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

The inspector 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.

What the care home does well

In the main, good assessment processes identify people`s needs. This is then transferred into care planning, which had improved to reflect people`s preferred lifestyles. Good social histories provided staff with knowledge of people`s previous lifestyles. At interview, staff knew people`s histories and physical needs. People in the home looked well presented and cared for. Meals were appetising and served in a congenial atmosphere with choices available. One person said, "I have really enjoyed my dinner, compliments to the chef." Another said, "Staff treat me very well, I have a newspaper delivered and the food is very good."Comments from relatives included "Staff are very good with him I can go home and know he is safe" also " My wife is always kept clean and tidy, nails are done and the hairdresser does her hair". One comment received from a relative visiting the dementia unit said "I am very happy with the staff on the dementia unit, my father is well looked after." Staff said that they felt training had improved their practices and that they felt supported by the management team.

What has improved since the last inspection?

Care plans and care delivery had improved since the last inspection and, in most cases, people`s preferences were recorded. Improvements had been made in staff training and the lack of activities for people in the home had been addressed in some areas. Cross-infection issues had been addressed, with staff receiving training and staff meetings stating the need for appropriate use of equipment, for example, wheelchairs to be used with footplates at all times.

What the care home could do better:

Acorn Lodge is an 85 bedded home with the registered manager only having nine hours` supernumerary. We feel this is insufficient time to develop the service and maintain overall standards throughout the home. These hours need to be reviewed in line with the responsibilities of the registered manager. The residential unit is the largest unit in the home providing care for up to 40 people. At the time of this inspection 35 people were being accommodated. In some instances, the unit manager had failed to provide a care plan for each assessed need. The manager needs to make sure that, as part of his responsibilities, he checks that each unit manager is managing their unit properly and has all the required documentation for each person in place. We saw some medication was left unattended, with no risk assessment being in place for those who self medicate. The recording of medication also needs to be better.The unit manager on the residential unit was also providing hands on care, which left little time for completion of necessary record keeping. The supernumerary hours of the unit manager need to be reviewed in order to maintain standards Although activities had improved slightly, this was only for one hour a week on the dementia and nursing units and none on the residential unit. Other activities were reliant on staff availability. One person said, "I am bored, there is nothing to do". Observations on the day found some staff to be very task orientated which also infringed on people`s privacy and dignity, with a number of people being ready for bed just after teatime. This was felt to be a practice the staff had in place as part of their routine, rather than the residents` routines. Odours were also present; a review of care and ancillary staffing levels needs to take place on the residential unit in order to maintain standards. It was recommended on the previous inspection that the dementia unit provide adequate signage to aid people`s orientation. The manager said this was in the process of being done. Recruitment procedures need to be more robust to ensure people`s protection in the home. We could not evidence that the owner of the home had completed Regulation 26 visits in line with the Care Homes Regulations 2000, in which a written report should be completed each month on an unannounced visit he has made to the service. He should demonstrate in this report that he interviews (with their consent and in private) people who use the service, their representatives and staff working in the home. The report should also include a tour of the home, looking at records, events and records of any complaints. This would show us that the owner, when he makes such a visit, listens to people and actions anything they tell him which needs sorting out.

CARE HOMES FOR OLDER PEOPLE Acorn Lodge Nursing Home Guido Street Failsworth Oldham Lancashire M35 0AL Lead Inspector Steve Chick Unannounced Inspection 7th November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Acorn Lodge Nursing Home DS0000025427.V355117.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.V355117.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.V355117.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 3rd July 2007 Brief Description of the Service: Acorn Lodge is a purpose built home situated on a main road close to the Failsworth/Manchester border. The home provides personal care for up to 40 service users accommodated on the ground floor. In addition, the home provides general nursing care for up to 20 service users and specialist care for up to 25 service users with dementia. Fees for accommodation and care at the home range from £333 to £594 per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. Service users requiring nursing care are all accommodated on the first floor. The home is owned and operated by Mr Goorwappa and a manager, who is also a registered nurse, assists him in the management on a day-to-day basis. The majority of bedrooms are single en-suite. One double room is provided for couples or service users who wish to share. Seven lounge/dining rooms, two “quiet” lounges and two conservatories offer a variety of settings in which service users are able to receive visitors, socialise and participate in activities. The home is on a main bus route with a bus stop outside. There is ample parking for visitors’ cars. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was made to the home on 7th November 2007. This inspection looked at all the key standards and included a review of all available information received by the Commission for Social Care (CSCI) about the service provided at the home since the last inspection. During the site visit information was taken from various sources which including observing care practices and talking to people in the home. The manager, relatives and some members of the staff team were also interviewed. A tour of the home was undertaken and a sample of care, employment and health and safety records were seen. Comments from people and their relatives are also included in this report. This is the second inspection of the home in 2007. The registered manager was asked to produce an improvement plan from the last inspection demonstrating how he would make the necessary improvements. We used this document on this inspection to see if what the provider said he was going to do has been done, and whether this has improved the care provided to the people living at the home. We found that a lot of improvements had been made, with others being in the process of being addressed which has provided a more positive outcome for people in the home. What the service does well: In the main, good assessment processes identify people’s needs. This is then transferred into care planning, which had improved to reflect people’s preferred lifestyles. Good social histories provided staff with knowledge of people’s previous lifestyles. At interview, staff knew people’s histories and physical needs. People in the home looked well presented and cared for. Meals were appetising and served in a congenial atmosphere with choices available. One person said, “I have really enjoyed my dinner, compliments to the chef.” Another said, “Staff treat me very well, I have a newspaper delivered and the food is very good.” Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 6 Comments from relatives included “Staff are very good with him I can go home and know he is safe” also “ My wife is always kept clean and tidy, nails are done and the hairdresser does her hair”. One comment received from a relative visiting the dementia unit said “I am very happy with the staff on the dementia unit, my father is well looked after.” Staff said that they felt training had improved their practices and that they felt supported by the management team. What has improved since the last inspection? What they could do better: Acorn Lodge is an 85 bedded home with the registered manager only having nine hours’ supernumerary. We feel this is insufficient time to develop the service and maintain overall standards throughout the home. These hours need to be reviewed in line with the responsibilities of the registered manager. The residential unit is the largest unit in the home providing care for up to 40 people. At the time of this inspection 35 people were being accommodated. In some instances, the unit manager had failed to provide a care plan for each assessed need. The manager needs to make sure that, as part of his responsibilities, he checks that each unit manager is managing their unit properly and has all the required documentation for each person in place. We saw some medication was left unattended, with no risk assessment being in place for those who self medicate. The recording of medication also needs to be better. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 7 The unit manager on the residential unit was also providing hands on care, which left little time for completion of necessary record keeping. The supernumerary hours of the unit manager need to be reviewed in order to maintain standards Although activities had improved slightly, this was only for one hour a week on the dementia and nursing units and none on the residential unit. Other activities were reliant on staff availability. One person said, “I am bored, there is nothing to do”. Observations on the day found some staff to be very task orientated which also infringed on people’s privacy and dignity, with a number of people being ready for bed just after teatime. This was felt to be a practice the staff had in place as part of their routine, rather than the residents’ routines. Odours were also present; a review of care and ancillary staffing levels needs to take place on the residential unit in order to maintain standards. It was recommended on the previous inspection that the dementia unit provide adequate signage to aid people’s orientation. The manager said this was in the process of being done. Recruitment procedures need to be more robust to ensure people’s protection in the home. We could not evidence that the owner of the home had completed Regulation 26 visits in line with the Care Homes Regulations 2000, in which a written report should be completed each month on an unannounced visit he has made to the service. He should demonstrate in this report that he interviews (with their consent and in private) people who use the service, their representatives and staff working in the home. The report should also include a tour of the home, looking at records, events and records of any complaints. This would show us that the owner, when he makes such a visit, listens to people and actions anything they tell him which needs sorting out. 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.V355117.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.V355117.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): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. An assessment of need is obtained prior to people being admitted to ensure their needs can be met. EVIDENCE: The managers from each unit obtained an assessment of need from professionals or undertook their own assessment, if qualified to do so. Assessments also demonstrated how the home would be able to meet people’s needs, providing a clear picture of the care practices required. One person said, “Staff are very good with him, I can go home and know he is safe.” Another person said, “It is very good here. It has been a pleasant surprise to know how good it is and recommends it to other people.” Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 10 One person who had been in the home four months said they had not received any information prior to entering the home. Other people said they had received some information. Acorn Lodge Nursing Home DS0000025427.V355117.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): Standards 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. In the main, care practices had improved. The lack of detailed care planning linked to assessments of people’s needs and irregularities in medication procedures on the residential unit may pose a risk to some people in the home. EVIDENCE: Case files on the nursing unit were completed in full with good social histories. A care plan was in place for each assessed need. Waterlow scores were maintained as an aid to the prevention of pressure sores. Nutritional screening was also undertaken. The preferences of people on this unit were recorded, however this was not a standardised procedure throughout the home. People appeared well cared for and were smartly presented. Staff were observed using safe working practices and, at interview, gave details of training courses attended showing a good understanding of people’s needs. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 12 This training was available to all units and included dementia care, moving and handling and infection control and the protection of vulnerable adults. There was also evidence that all staff were encouraged to take part in future training in palliative care through the NHS Macmillan Nurses. Care plans on the dementia care unit were detailed and comprehensive, with a care plan for each assessed need, social histories and people’s preferences. People on this unit appeared well cared for and interviews with two relatives confirmed this. Their comments included “I am kept informed of things, he looks better and receives appropriate medical care. I am happy with the staff on the dementia unit and my father is looked after.” Also, ‘my wife is always kept clean and tidy and her nails are done, the hairdresser also does her hair”. Observations made throughout the day on this unit identified that people received good interactions on a regular basis from staff who dealt with their needs in a sensitive manner. Examination of three case files on the residential unit found that not all the assessed needs of people had appropriate care plans, for example, asthma and epilepsy. The manager said that people had shown no signs of these since admission. However, people were receiving medication for these conditions with one person self-administering inhalers without a risk assessment being in place. Another example is of one person who required regular turns to help prevent pressure sores. No care plan or risk assessment was in place; however, position changes had been recorded in daily notes. People are at risk if staff do not have appropriate information of how to deal with any emergency that may arise. The preferences of people on the residential unit had not been recorded. At interview, staff knew their needs of people in the home and had access to care plans. The manager said time limits had lead to things not being recorded in full because the care of 35 people required them to be hands on alongside dealing with professional queries and reviews. There was evidence to support this through observations made throughout the day. Some of these issues were linked to requirements on the previous inspection from which the unit manager had to produce an improvement plan. The improvement plan stated more time would be allowed to devise appropriate care plans, which at the time of this inspection had not been allocated to the residential manager. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 13 Matters relating to medication also caused concerns. One person in the main lounge was left with medication beside her to take when they wanted to. We raised this issue with staff and manager who failed to see the potential danger to other people in this situation. The manager and staff both said that the person in question would not let another person take the medication. We advised the manager that this practice must stop immediately and that staff must approach people on a regular basis to ask if they are ready to take their medication with medication being held securely in the interim. Some people on the residential unit were receiving eye-drops which, when administered, had not been recorded on medication sheets; however, these had been recorded in daily notes so that staff were aware of this and outcomes remained positive for people in the home. In order for outcomes to remain positive, all treatments involving medication procedures must be recorded. Recording of medication on other units was completed accurately. Other units also had photographs of people on medication files. This should be a uniform approach, including the residential unit. This would ensure that staff, especially new staff, could easily recognise the person they are administrating to. Through the day people’s appearance was well cared for; however, before 6pm six people were in their nightclothes, some without dressing gowns leading to their privacy and dignity being compromised. These practices must be justified through care planning and consultations should anyone wish to retire to bed early either through choice or medical reasons. Staffing levels being reduced at 8pm may have an impact on people’s choices in the home. The manager should monitor this practice in line with the dependency levels of people in the home and review the deployment of staff. This practice was not witnessed on the dementia or nursing units. However, at the time of this inspection the number of people requiring care was much higher on the residential unit than the nursing and dementia unit. Comments from people on the residential unit and their relatives were positive; these included, “Staff are always very good to my husband”, “Staff are always respectful to me and the person in charge makes sure the job is done properly”. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. Continuing to review social activities both on group and individual levels will ensure people in the home have a sense of fulfilment. EVIDENCE: Issues relating to people’s daily life were identified on the previous inspection. The manager had stated in their improvement plan that a record of activities was to be entered separately in people’s notes, which, in most cases, had been addressed and was ongoing. The manager on the dementia unit acknowledged that more work was needed in this area, which was still under review. The level of activities varied throughout the home. The nursing and dementia units had an activities person, however this was only one hour a week. Staffing levels and lower numbers of people in these units at the time of inspection meant that staff could pay more attention to people’s needs and preferences. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 15 The recording of people’s needs and preferences varied from unit to unit, however the manager of the dementia unit said that their documentation was on trial to assess its effectiveness, which may be then used on other units. The residential unit did not have the same provision. A record was maintained of activities, for example, watching television or listening to music; very little else was recorded with the latter not being a sufficient activity due to the fact that is what most of the people did all day. The manager said staff do activities when time permits and they intended to help people to make Christmas cards which they enjoy doing. As mentioned previously in this report, the demands on staff on the residential unit is high and does impose limits to staff availability. One person said, “I am bored here, there is nothing to do”. Meals were served in congenial settings. We sampled the meal and found it to be tasty and nutritional. Comments overheard from people in the dining room included: “I have really enjoyed my dinner, compliments to the chef” and “The food is really good here”. We spoke to the cook who discussed people’s choices, in that, a cooked breakfast was an option that several people enjoyed. There was also a choice of a hot meal both at dinner and tea. Special birthday teas were made for people who could invite their relatives. The cook also stated there was no restrictions on his budget and if there was a need for something special, then it could be purchased. Menus were displayed on a white board. People’s wishes on when they wish to retire to bed need to be recorded in care planning. For those people who may have difficulty in communicating, consultations must take place with relatives or advocates. Comments from people in the home included “Staff treat me very well, I have a newspaper delivered and the food is very good” also “On the whole it is a very good home”. Another said “I am younger than most, others are to old to sit and talk to, I spend a lot of time in my room.” One relative said, “My wife is always kept clean and tidy, her nails are done and the hairdresser does her hair.” Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People were confident that complaints would be listened to, taken seriously and acted upon. Staff training in the protection of vulnerable adults ensured people’s protection. EVIDENCE: The complaints procedure was displayed in the entrance of the home. People who live in the home said they felt comfortable in raising any concerns they had with staff or management. One person said, “ I would know who to complain to either the manager or social worker”. No complaints had been received by the home or the CSCI since the last inspection. Oldham’s inter-agency procedure for the protection of vulnerable adults is used by the home (POVA). Staff interviewed demonstrated an understanding of how abuse may present and their part in reporting any such event. Staff in the home receive adult protection training, either accessed through Oldham Social Services training consortium or through NVQ level 2. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 17 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): Standards 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Overall, the environment is suitable to people’s needs. EVIDENCE: On each of the units is a lounge and dining area, which were well presented. The residential unit also provides two conservatory areas. The home is suitable to meet the needs of people in the home. Specialist equipment is provided, for example, grab rails, nurse call systems and assisted bathing and toilet facilities. Ramped access is provided to the front door and there is level access throughout the home. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 18 Many people had personalised their rooms with possessions from home. On the whole, the home was clean and tidy. However, on the downstairs residential units there were odours, especially in the entrance and one of the lounges. Some of the corridor carpets throughout the home were stained and worn and should be included in the home’s refurbishment plan. To aid people on the dementia care unit in recognising specific areas of the home, improvements are required to provide people with a supportive environment. An example being additional signage in a picture format showing toilets and bathrooms. This was noted on the previous inspection. The action plan completed by the home to address issues from the last inspection stated that this would be put into place. However, this had not been completed at the time of this inspection. The manager on the dementia unit said they were confident that senior management was addressing this issue. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 19 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): Standards 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. A review of staffing levels on the residential unit and the implementation of robust recruitment procedures would ensure people’s safety in the home. EVIDENCE: Staffing levels on the nursing and dementia care units met the needs of people receiving care at the time of this inspection. There was evidence that staff received appropriate induction in line with skills for care and training according to people’s needs. For example, dementia care, moving and handling, infection control and access to a 12-week palliative care course run by the NHS Macmillan Nurses. Staff at interview confirmed that induction procedures had been completed and said they had access to lots of training and felt that this did improve their competency. The residential area of the home is provided on the ground floor and covers a large area accommodating up to 35 people. Throughout the day there is one unit manager and five care staff. This number drops at 8pm to four care staff. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 20 There was evidence on the day of inspection that the unit manager did not have sufficient supernumerary hours to complete all the documentation required. Also, as mentioned previously in this report, several people were bathed and in their nightclothes before 6pm. This is an unacceptable practice, especially when people’s privacy and dignity are not maintained. Recruitment procedures and two staff files were examined. In both cases checks were insufficient in order to afford protection for people in the home. For example, a reference was in place, which was not stated on the application form and there was no explanation as to why this had been obtained. The second reference was from a family member. There was no record of a Criminal Record Bureau check (CRB) or protection of vulnerable adults (POVA). The other file contained one undated reference from one person and an undated reference from a family member. No CRB or POVA first check was available for examination. The unit managers from both the nursing and dementia care said they were confident that people had not been employed without CRB or POVA first checks and that these records may have been with the administrator. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 21 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): Standards 31, 32, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. A review of management supernumerary hours would promote the health, safety and well being of people in the home. EVIDENCE: The management structure in the home comprises of a home manager registered with the CSCI and a unit manager for each area of residential, nursing and dementia care. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 22 The registered manager is a qualified nurse with many years’ experience. They have also completed a management course. The unit managers are RMN and RGN qualified, with the residential manger qualified to NVQ level 4. As mentioned previously in this report, the unit manager on the residential unit had little time to complete managerial duties because of the need to help with care duties. This resulted in different quality standards on each unit. A uniform approach to general practices, assessments and care planning would enhance procedures in the home. The role of the registered manager would be to ensure that there are effective procedures on each unit. However, inspectors were informed that the supernumerary management hours were nine, with the registered manager being practice based on the dementia care unit, together with the unit manager. Acorn Lodge is an 85-bedded home which requires substantial management hours in order to maintain good standards and review care practices and development. A review and increase in supernumerary management hours for each of the unit managers and the registered manager would enhance the managerial quality in the home. At interview, staff said they experience management as being positive in offering support. Staff are kept aware of people’s needs through regular handovers and staff meetings. Minutes of staff meetings were seen where health and safety matters were addressed, for example, ensure that footplates are used on wheelchairs at all times. Records of staff supervision were also seen, with staff confirming that this took place. Managers reported that no money was held within Acorn Lodge for people in the home. Several issues were raised on the previous inspection that required action. The manager was asked to complete an improvement plan of how these would be met. It was found that on this inspection many issues had been addressed and others were in the process of being completed, for example, additional signage in the environment on the dementia care unit. Senior staff said that people in the home inspection, however it is undertaken by the inspection. quality assurance and the views of relatives, staff and were sought. There was some evidence of this on was reported that most of the quality assurance process administrator who was unavailable at the time of this Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 23 Staff had undertaken health and safety training. Records were maintained of professionals’ health and safety checks on equipment in the home. Fire equipment had been serviced and regular alarm test had been completed. The owner of the home had failed to make visits under Regulation 26 of the Care Homes Regulations 2000, in which a written report each month on an unannounced visit he has made to the service should be completed. They should 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. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 3 3 X X 3 Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Timescale for action 31/12/07 2 OP29 19 3 OP9 13 People on the residential care unit 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. Ensure new staff have two 15/12/07 references, Criminal Record Bureau check or POVA first in place before commencing employment in order to afford protection for people living in the home. 15/12/07 Ensure medication is not left with people unattended and only signed for at the point of administration to ensure the protection of people in the home. A risk assessment must be completed for people in the home who self medicate. All treatments using prescribed medication must be recorded on MAR sheets. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 26 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 2 3 Refer to Standard OP7 OP9 OP10 Good Practice Recommendations Ensure the preference of people on the residential unit is recorded in care planning. Provide photos on medication files on the residential unit to ensure people can be easily recognised and bring in line with other units in the home. Review the practice of getting people into their nightclothes early, in order to maintain their privacy and dignity. Should this practice be needed, it must be justified in care planning with consultations with family and other professionals being recorded, especially for those people in the home who cannot speak for themselves. 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. In order that residents living with dementia have a supportive environment, the registered manager should ensure that there is improved and adequate signage, for example, toilets could show a picture of a toilet. Review domestic routines to ensure the elimination of odours in order to provide a congenial environment for people in the home. 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. Review the registered manager’s supernumerary hours to ensure regular reviews of the service development. 4 5 OP12 OP19 6 7 OP26 OP27 8 OP31 Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 9 Refer to Standard OP33 Good Practice Recommendations The owner of the home had failed to make visits under Regulation 26 of the Care Homes regulations 2000 in which a written report each month on an unannounced visit he has made to the service should be completed. They should 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. Acorn Lodge Nursing Home DS0000025427.V355117.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Old Trafford 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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