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Inspection on 10/02/09 for Acorn Nursing Home

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

This inspection was carried out on 10th February 2009.

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

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

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Acorn Nursing Home 125 Newton Drive Blackpool Lancashire FY3 8LZ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christopher Bond     Date: 1 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Acorn Nursing Home 125 Newton Drive Blackpool Lancashire FY3 8LZ 01253392440 01253305705 matron@acornnursinghome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Axelbond Ltd care home 40 Number of places (if applicable): Under 65 Over 65 37 0 old age, not falling within any other category physical disability Additional conditions: 0 3 The home is registered for a maximum of 40 service users to include:- *Up to 37 service users in the category of OP (Old age not falling within any other category). *Up to 3 service users in the category of PD (Physical disability). Date of last inspection Brief description of the care home Acorn Nursing Home is a large home situated in a residential part of Blackpool. The home is close to Stanley Park and Victoria Hospital. The town centre is approximately two miles away and can be reached by a bus service, which stops near by. There are some small shops in the local vicinity. There are several parking spaces to the side of the house. The building has three floors and a lift is available for the residents to use. Most of the rooms are on the ground floor and the first floor. There are two dining areas and a separate lounge for the use of residents who smoke. The main lounge is at the rear of the house overlooking an extensive garden. There is plenty of space for the residents to sit out when the weather is warm. Care Homes for Older People Page 4 of 34 Brief description of the care home Information relating to the homes Service User Guide and Statement of Purpose is included in the welcome pack, which is given to all prospective residents. This information explains the care service that is offered, who the owner and staff are, and what the resident can expect if he or she decides to live at the home. At the time of this visit the information given to the Commission showed that the fees for care at the home are from GBP 361.06 to GBP 495.97 per week, with added expenses for hairdressing and chiropody. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: As part of the inspection process an unannounced visit took place over a total of 7 hours. The residents personal files and care plans were examined. Care staff records and recruitment records were also looked at. Safety certificates and medication records were examined in detail. We spoke at length to the manager of the service during our visit. We also spoke to three care staff, the administration officer, and the chef. People who used the service were also spoken to as part of the inspection process. We also spoke to two visitors to the home to find out their views of the service. Care Homes for Older People Page 6 of 34 The Commission for Social Care Inspection also sent out surveys to the care staff of this home to tell us about their experiences of working at The Acorn Nursing Home. We received information about the home from the local authority social services, who have placed people at this home. Lancashire Fire Service were also contacted about an inspection that they had done at the home. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 34 This was a home that was in a period of transition. There had been a change of manager since our last inspection. The new manager needs to develop a level of managerial experience and skill. Although the service provided a good level of care, there were areas that needed to be improved on. These can be addressed through the manager actually managing the home, and directing what is happening, and not being involved in the hands on delivery of care on a day-to-day basis, which may be distracting. Information about this home needs to be brought up to date. The documents that should be given to people who are thinking about using the service were out of date and were in need of review. Although everyone had a care plan, some of the information within these was incomplete. More care needs to be taken by the manager and care staff when completing these and current information must be readily available. Care plans are there to tell the carers what current health and social care the people who use the service are receiving, they need to be regularly reviewed and updated with important information which is clear, precise and consistent. It was found that nursing procedures were being carried out on one resident who had not been assessed as needing nursing care. Items were used that had not been prescribed for that person. The staff had also informed the nurse that this person was a nursing patient, when in fact she was not. We were told this information by the local authority. Also, when someone takes their prescribed medication this should be recorded on a chart. Some people had gaps on their records and this didnt tell us whether the medication had been taken or not. Medication is important and if it is not taken then it could mean that someone is at risk if it is not taken when directed by a doctor. The manager was unaware of current good practice in ensuring that the people who use the service are properly safeguarded from harm. Reporting procedures were wrong. The complaints procedure had not been updated and still had the old managers name on. This may seem insignificant, but if the information that people are given is confusing it may deter them from voicing their opinion or concern. The carpet in the main lounge had several stains on it, particularly in one small area. We also noticed that one of the double glazed units in a bedroom was cloudy and the view out of the window was obscured because of this. Some of the care staff told us that their induction to the service wasnt very good and that they were thrown in at the deep end. The owner of the home has changed the induction process and we saw new forms that were to be filled in when someone starts work. A good induction is important because it shows that people understand what the home does, and what level of care they are expected to provide. The staff also need to be supported properly and have individual meetings with their line manager about their competencies, training and general progress. Care Homes for Older People Page 9 of 34 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information that was available for people to read about the home was not current and had not been reviewed. People had their needs written down properly before they came to live at the home, meaning that their care could be planned properly. Evidence: As part of this inspection we looked at the information that the home gives out to prospective residents before they make a decision as to whether or not the home can meet their needs. Every home should have a current Service User Guide that gives people important information about the home and the services it provides. Although we were given a guide to look at, the information in it wasnt current. There had been a number of changes at the home, including a change of manager. The guide had not been reviewed since 2007. This meant that people were not getting current information about the service. The people we spoke to also seemed unsure of the importance of this document. Care Homes for Older People Page 12 of 34 Evidence: There was, however, a small brochure available that had recently been produced that gave brief information about the purpose of the home and some of the services it provides. We looked at some of the care records of the people who lived at the home. We found that all had had an assessment completed before they came into the home. There were quite thorough and the information gathered informed the service as to whether the needs of the prospective service user could be met properly. This home did not provide intermediate care and we have not assessed this standard. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning at this home was inconsistent. The information available about the care needs of some of the people who use the service was incomplete, which could cause confusion about their care. Evidence: All of the people who lived at this home had a plan of care that told the nurses and care staff how to care for them and what their particular health and social care needs were. This was a nursing home and such records are very important when it comes to caring for people with complex needs. All of the information in these care plans should have been current and properly reviewed. We looked at six care plans and although most of the information that we found was current, there were exceptions to this. For example, we looked at the wound chart for one resident. The information told the carers what treatment this person was receiving for the wound and how the wound was progressing, the information then suddenly stopped. The manager told us that this wound had healed but there was no information in the plan to tell us this. Another resident had to be fed via a peg feed. There wasnt much information to tell people Care Homes for Older People Page 14 of 34 Evidence: how this was done and how the peg should be cleaned. All the information about nursing practice should be clear, precise, current and consistent. In some of the care plans this was not the case. We also looked at weight records for the residents. The charts did not specify a date and it wasnt clear what year the recordings had been made. There were records of what weight people were in the main office but this information had not been transferred to the main care plan. Sometimes peoples weight can indicate problems or health issues. This information should be available on the main care plan together with any information to direct staff as to any care intervention needed. Frequent reviews of the care plans are important because it helps the care staff of the home to take stock and be aware of changing need, and also provide a consistent level of care. Reviews also help the staff to ensure that the information is current and record progress, or even help address a decline in health. We found that some reviews were infrequent. The information that was recorded in the reviews was very brief. The manager agreed with us that reviews need to be frequent and contain detailed outcome statements, and said that she was planning to make changes. Most of the residents at this nursing home had been prescribed medication by their doctor and their were records kept that showed what medication was being taken, when this should be taken, and who helped the person to take it. The medical record sheets that we looked at were, in most cases, completed correctly. There were, however, frequent occurrences of medication not being signed for: places where signatures should have been were left blank with no explanation as to why. We couldnt therefore be sure that medication had been taken because there was nothing to tell us that it had been, or been refused. This is dangerous, and could put the residents at risk if they do not receive medication that is prescribed for them. All prescribed medication must be signed for, or an explanation recorded as to why it hasnt been taken. We were also told by the local authority that a nurse from the Primary Care Trust had recently visited the home in order to complete a nursing assessment on a particular resident. It was found that nursing procedures were being carried out on residents who had not been assessed as needing nursing care and that medication was being administered without having been prescribed by a general practicioner. This type of medication must only be given as directed by a doctor and, if nursing staff at the home are admimistering this then the nursing task must be delegated to a named nurse by the District Nurse. The staff had also informed the nurse that this person was a nursing patient, when in fact she was not. Care Homes for Older People Page 15 of 34 Evidence: The last key inspection of this home showed that foot plates were not being used on some of the wheelchairs. This has now been addressed by the service and all of the wheelchairs that we saw had foot plates attached. The manager also told us that a review had recently taken place to ensure that all those who used wheelchairs had the correct type and size of chair. People were also being helped to move around the home more safely and the staff had received training to help them to do this properly, using the correct equipment. Two of the staff told us that they had received recent training in this area. There were pressure redistribution aids available for those residents who had the potential to develop pressure sores. Several people were using special cushions in the lounge area of the home whilst we were there. There were other pressure redistribution aids available should any one develop pressure sores. There had been documents completed regarding the preferred place of care for each person. A decision had been taken by some residents about where they would like to be cared for when they were at the end stages of their life. Some of the information in these documents was incomplete. It would be useful for these to be looked at again and proper, current information entered to prevent any confusion. The manger told us of special care that people receive when they are close to the end of their life. This care pathway is important, and reflects good practice for terminally ill residents. We observed some of the care staff whilst they were working. Everyone was polite and respectful to the residents, and spent time talking with them. The residents we spoke to were happy with the care they were receiving, although one person told us that care was sometimes rushed, and the staff always seemed very busy. Another person told us that she thought the staff were a bit young and the home could do with a few more mature staff. One other resident told us, Im pleased, they do a good job, we have a good laugh. There were also quite a few visitors to the home whilst we were there, and we spoke to two visitors who were friends or relatives of residents. Again there were concerns about the young staff. One visitor commented, They (the care staff) dont seem to have much in common with the people who live here. Another visitor told us, I think they do well here, Im an ex-nurse and Im pleased with the level of care thats on offer. There were people who lived at this home who were showing signs of developing dementia. It had been some time since training for the staff had taken place in this area. The manager confirmed that training in Dementia Awareness was being looked at, and would be available shortly for the care staff. Care Homes for Older People Page 16 of 34 Evidence: Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy regular and appropriate activities at this home. Catering arrangements are good and the people who use the service enjoy a balanced and nutritious diet. Evidence: We spoke to a number of people who used this service about the meals that were served. Most of the People we spoke to said that they thoroughly enjoyed these and the standard of catering was very good. There were two dining areas, which were well furnished and pleasant. The chef told us that fresh produce was used as often as possible and there were regular deliveries of fresh meat, fish and vegetable. We looked at the menus that were available and there was a good choice of meals. The manager told us that alternatives were available for those who did not like what was on the menu. One of the residents told us, The food here is excellent. Theres nearly always something I enjoy on the menu.There were nutritional assessments on the care plans, along with details of special diets for those who required them. The care plans held some information about the social needs of the people who used the service. There was a sheet that contained information about previous lives, family history, interests and hobbies. Information such as this is essential because the care Care Homes for Older People Page 18 of 34 Evidence: staff will have a greater knowledge of the person and what they have done in their lives. This will help to build relationships and help ensure that peoples social care needs are addressed as well as their immediate health issues. There was an activities coordinator at this service. A list of daily activities was attached to the notice board. Some people were playing carpet skittles in the main lounge whilst we were there and two people who used the service had gone out to the pub with care staff on the mini-bus. The manager told us that people enjoyed bingo sessions, arts and crafts and other daily activities. Entertainers were also booked on a weekly basis. Two people who used the service told us that they enjoyed the weekly entertainment. One person commented, Its nice to have something to do, and the singers are usually good. We like a bit of a sing-song. We spoke to two of the carers who were on duty during the day: they told us that activities were regular and that the residents enjoyed social events and leisure persuits. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could be placed at risk through poor safeguarding procedures. Information regarding how to complain was old and in need of review, which could cause confusion for the people who use the service. Evidence: We looked at the complaints procedure for this home. This procedure is important because it tells the residents, and their friends and families, how to complain and who to complain to. The procedure also tells people who use the service that their complaint will be taken seriously and investigated within a given timescale. Unfortunately the procedure that we saw had not been reviewed and was still in the name of the previous manager. This would cause confusion for those wishing to pass on their concerns. A copy of this procedure should also be in the Statement of Purpose and Service User Guide for the home. Although this was the case, the information was again old, and could cause uncertainty and confusion. There had been two complaints about the service since our last key inspection. The owner of the home had taken these seriously and had addressed these areas of concern. Changes had been made to help ensure that people were happy with their care. Care Homes for Older People Page 20 of 34 Evidence: Eight of the care staff who replied to our survey told us that they would pass information on to the manager should someone who uses the service have concerns about the home, or the care that they receive. It is important that care staff know what to do if concerns are raised. We also looked at safeguarding procedures for the service. These are important because the procedure informs the manager of what action to take to ensure that the people who use the service are protected from harm, and what action to take should any wrongdoing be suspected. The procedure had not been reviewed for some time and we found that it contained the wrong advice. The manager told us that she would investigate any incidents herself and make a decision as to what action to take. Current good practice with regard to keeping people safe includes ensuring that the local authority are the first people to be informed and they lead any investigation that may necessary. They are also involved in the decision to suspend any care staff suspected of wrongdoing. This procedure is in place to ensure that all safeguarding issues are dealt with properly and thoroughly. The manager, and owner of the home must familiarise themselves with this procedure and ensure that all safeguarding issues, should they occur, follow the correct route. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are provided with a comfortable, clean, hygienic and homely environment. Bedrooms were personalised, meaning that residents should feel at home with their belongings around them. Evidence: During our visit we were given tour of the service by the manager. The home was clean and smelled fresh in most areas. There was a slight odour in two of the rooms and the manager told us that carpets were going to be replaced in these rooms. All of the rooms were fairly large and the rooms had their own toilet and washing facilities. The beds that we saw were in good condition and the furniture was fairly new. Some of the residents had brought photographs, ornaments, pictures and other belongings with them to make the rooms more homely and individual. All of the rooms that we saw were nicely decorated and had plenty of natural light. We spoke to several people who used the service. One person commented, My room is fine, theres not much of a view but it suits my needs. There were nice views from some of the rooms, which overlooked the garden and across Blackpool. Some of the rooms had new flooring fitted and the curtains had been replaced. There were three lounges at this home. The rear lounge overlooked the garden area. Care Homes for Older People Page 22 of 34 Evidence: The people who were using this room looked relaxed and happy, and there were two carers in this room. The furniture was in good condition, there were, however, some stains on the carpet. This was particularly evident in one section of the room. One lady that we spoke to said that she liked it in this room because it was quiet and light. There was a smaller lounge at the front of the building and also a smokers lounge. The home looked well maintained throughout, apart from the windows in one of the bedrooms: the seals had gone and the glass was cloudy which restricted the view. This needs to be rectified. There was a large garden area to the rear of the house, and plenty of places for the residents to sit out when the weather was good. We also looked at the laundry area where some of the equipment had recently been replaced. There were large bathrooms on each floor of this home, within easy reach of the bedrooms and main facilities. The service also had a lift that could take the residents up to all three floors. Care Homes for Older People Page 23 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Parts of the recruitment process were inconsistent, some staff were not checked properly and didnt have their skills assessed prior to starting work. Training for the staff was improving, meaning that they had more skills and knowledge to provide a better service. Evidence: We spoke to the administration officer who told us that all of the care staff files had been sorted out and each staff member now had an individual file. We looked at these during our visit. We noticed tat these records were far more transparent and information was clear and easy to find. This was an improvement from the findings on our last inspection visit. We noticed that a number of the care staff had not had their Criminal Records disclosures renewed when they began work at the Acorn Nursing Home. These disclosures are not transferable and a new one should be obtained for all new care staff. We also noticed that the some of the domestic staff did not have full enhanced disclosures. It is good practice to ensure that this happens because they are in direct contact with the people who use the service and have access to bedrooms. It was good to see that steps had been taken to ensure that the important information Care Homes for Older People Page 24 of 34 Evidence: that was required about each staff member was in place in the care staff files. This is important because good checks and information helps to ensure the people who use the service are safer. However, the files that we saw did not contain records of any individual support given by the management team. The manager of the home agreed that this type of support had not been taking place for the care staff. Individual support is important because it enables performance and training issues to be discussed and recorded. Information regarding induction of new care staff was limited. This should be recorded for every new employee to explain what instruction they have had regarding care practice at the home. This helps to make sure that new staff are prepared for their role and have an idea of what they may expect as care workers. We sent out surveys to the care staff to ask them about their views of the home. A number of care staff told us that their induction was poor and only covered important areas partly or not at all. One carer told us, I didnt get my induction until a month into the job. Another commented, I wasnt shown how to use the equipment; youre kind of thrown in at the deep end when you start and expected to know what to do. The owner of the home has now introduced an induction checklist to help ensure that important areas are covered. There are important areas of work that must be explained to all new care staff. A full induction programme must be available prior to the person beginning their work as a carer where things can be explained and equipment demonstrated. This, ideally, should be over a few days and the carer should begin work only after they have been assessed as having the skills to work competently as a carer. The manager showed us what training had taken place since the last key inspection and what had been planned for the carers. There had been some training events, and several relevant courses had been planned. Over 50 of the non- nursing staff had a nationally recognised qualification in care (National Vocational Qualification level 2 or 3). Good, regular training helps to ensure that the care staff have the knowledge, skills and ability to undertake their duties correctly. There were also some concerns from the care staff, within the surveys that were returned to us, regarding staffing at the home. Many said that there werent enough staff because of high sickness rates and there was only sometimes enough staff to meet assessed needs of the residents. We looked at the staffing rotas for the home and these showed that there were enough staff employed in the home to ensure that needs were met. The manager agreed that staffing levels had been a problem but the morale of the staff had improved and sickness levels had reduced. Care Homes for Older People Page 25 of 34 Evidence: The residents we spoke to were happy with the care they were receiving, although one person told us that care was sometimes rushed, and the staff always seemed very busy. Good staffing levels are very important as this gives the carers time to do things properly and spend time with the people who use the service. Care Homes for Older People Page 26 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality and standards were not what they should be because the home did not have a registered manager who could devote their full time to managing the service properly. The care staff did not have regular individual support, which is essential in times of change. Evidence: There had been changes to the management of this home since we last inspected the service. The service was in transition. The new manager was in the process of applying to become registered with the Commission for Social Care Inspection. She was a registered nurse and was part of the care team at the home prior to the previous manager leaving. There were concerns regarding the amount of time she was actually managing the home. Because of staffing shortages she had spent a lot of time performing care tasks in her role as a nurse. She was unfamiliar with some of the processes of management Care Homes for Older People Page 27 of 34 Evidence: and had not gained knowledge yet in areas such as safeguarding the residents of the home, and what the procedure should be if someone is suspected of wrongdoing. There seemed to be a lack of awareness in ensuring the Statement of Purpose and Service User Guide were available to all and contained clear information as to the services that were offered by the home. The care staff were not being individually supervised properly and no records were being kept of individual support meetings. Such support is very important, particularly during times of organisational change. The support meetings need to take place at least six times a year for all of the staff, and a yearly assessment should also be completed. Eight of the care staff who completed the survey that we sent to them told us that direct, individual management support was only availabe sometimes. There also needs to be a full review of the policies and procedures for the service. These are what the manager should consult if theres an issue that needs addressing and guidance is needed. These should be reviewed on a regular basis to ensure that the information they contain is correct and current. Quality control also seemed to be an issue at this home. The manager needs to have systems in place to ensure that regular checks take pace throughout the home by the management team. This is where things such as the medication not being signed for are picked up. This is easy to do if the manager is given time to manage the service. If she spends a lot of her time providing care for the people who use the service then things will be missed. There had been some positive changes since our last visit to the service. The nursing station had been moved to an office close to the front door. This enables the staff to be more aware of who is calling at the home, and the main door can be answered promptly. There have also been developments in the amount and type of entertainment and activities that the people who use the service are offered. There were records to show that major appliances within the home had been serviced properly and that safety equipment had been examined by suitably qualified persons to ensure that the health, safety and welfare of the residents was being properly addressed. The gas system, electrical installation and lift had been serviced on a regular basis and there were certificates to show that this had taken place. The owner of the home must ensure that the proper mandatory safety training is provided for all of the staff, and refreshed on a regular basis. This includes first aid, food hygiene awareness, health and safety awareness, and infection control. There had been training in moving and handling since out last key inspection. There also needs to Care Homes for Older People Page 28 of 34 Evidence: be a better understanding of risk assessment for the residents of the service. Although risk assessment was apparent in some on the care plans we looked at, this was brief and un-focussed. The home had recently undergone an inspection by Lancashire Fire Service in October 2008 and several areas of concern were identified which the owner was required to address. An enforcement notice was issued . The manager of the home assured us that each area of concern had been dealt with adequately and properly. We also spoke to the fire service who told us that they were satisfied with the work that the home had done to help ensure that people lived in a safe home. It is, however, important that fire awareness training and procedures continue to be implemented on a regular basis and that all of the care staff are fully aware of the actions to take in case of an emergency. Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The care plan must contain current and accurate information. Information must be accurate in order that health needs are dealt with properly and consistently. 31/03/2009 2 9 13 Medication record sheets (Mar records). Must be completed properly on all occasions. The staff must sign these sheets when medication is given or enter the relevant code to explain why it was not administered. Missing medication can be dangerous and it is important to know why it was not given. 31/03/2009 3 9 13 Administration of medication. The manager must ensure that medical procedures carried out on non-nursing 31/03/2009 Care Homes for Older People Page 31 of 34 residents are done through consultation with the persons GP. Any medication must be prescribed for that person. 4 18 12 The people who use the 31/03/2009 service must be safeguarded from harm. The manager must have good and accurate knowledge about safeguarding procedures to help ensure that people live in a safe home. Information regarding safeguarding in the home must be robust and accurate. 5 31 9 The owner of the service must appoint a suitably qualified, experienced and skilled person to be registered as manager. This is to help ensure that the home is run properly and in the best interests of the people who live there. 6 37 17 The records, policies and 31/03/2009 procedures of the home must be accurate and up-todate. Care records and procedures regarding safeguarding issues must be accessible and accurate. 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Older People Page 32 of 34 No. Refer to Standard Good Practice Recommendations 1 1 All of the information available about the services the home provides should be current and reviewed regularly. This means that people who are to use the service only have current information about the home. Training should be provided for the care staff regarding awareness of the needs of residents who have dementia. All information that is available about making a complaint should be current and accurate, and reviewed on a regular basis. The carpet in the main lounge was heavily soiled in places and this should be addressed. People enjoy living in pleasant surroundings. The double glazed units in one of the bedrooms was in need of attention as the view had become obscured by condensation which would directly affect the person who used this room. Staffing at the home should be sufficient to ensure that the people who use the service have their assessed needs met properly. All of the care staff who come to work at the home should have a Criminal Records Bureau disclosure carried out before they begin work. This helps to ensure that the residents live in a safer home. All of the care staff that begin work at the home should have a full induction to the service before they begin their duties. This is to ensure that they have a knowledge of the care process, and are competent to do their job. All of the staff who work at the home should have regular, individual, recorded support from the management team. This is important for their development, and ensuring that their performance is acceptable. Mandatory safety training must be provided for all of the care staff to help ensure that the home is run in the best interests of the residents. 2 3 8 16 4 19 5 19 6 27 7 29 8 30 9 37 10 38 Care Homes for Older People Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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