CARE HOMES FOR OLDER PEOPLE
Acorn Nursing Home 125 Newton Drive Blackpool Lancashire FY3 8LZ Lead Inspector
Christopher Bond Unannounced Inspection 2nd October 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Acorn Nursing Home DS0000068202.V346985.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 Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Acorn Nursing Home Address 125 Newton Drive Blackpool Lancashire FY3 8LZ 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) 01253 392440 01253 305705 awlison.matron@btconnect.com Axelbond Limited Mrs Ann Wilson Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (37), Physical disability (3) of places Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 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). 11th January 2007 Date of last inspection Brief Description of the Service: 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. Information relating to the home’s 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 (02/10/07) the information given to the Commission showed that the fees for care at the home are from £348.23 to £474.00 per week, with added expenses for hairdressing and chiropody. Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. As part of the inspection process an unannounced site visit took place over a total of 5 hours on the 2nd October 2007. A tour of the home was carried out, which included bedrooms, lounge, dining areas, and bathrooms. The residents’ personal files and care plans were examined. Care staff records and recruitment records were also looked at. Safety certificates and medication records for the home were also examined. The managers, residents, care staff and visitors to the home were spoken to during the inspection. Every year the registered person is asked to provide us with written information about the quality of the service they provide and to make an assessment of the quality of their service. This information, in part, has been used to focus our inspection activity and is included in this report. What the service does well:
The catering arrangements are good and all of the residents that were spoken to said that they liked the food and looked forward to mealtimes. The bedrooms that were seen were quite large and some had en-suite facilities. The rooms are regularly decorated; a carpet was being fitted to one room whilst we were there. The home is a good entertainment programme with a variety of activities taking place on a weekly basis. The home has its own mini-bus, which is used to take the residents on planned outings. Almost all of the care staff either have a nationally recognised qualification in care or are working towards this. Over 50 of the staff are now qualified. This means that the care staff are better prepared to provide care for the residents of the home. The home provides a thorough training programme for its staff using an external training provider. All training is certificated. A good training programme helps the home to provide a good service. Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
The care plans were complicated and hard to follow; important information could be lost because of this. Some of the care staff agreed with this when we asked them about the plans. Not enough information was being written in the plans regarding pressure area care and wound care. This led to confusion amongst the care staff as to what care was being given. The frequency of Blood sugar level checks were not addressed in the care plans for those residents who had diabetes. There were clear inconsistencies noted between information regarding checks made on blood sugar levels contained on the chart on the office wall, the information contained in the care plan and the knowledge of care staff. Some of the care plans had not been reviewed. When reviews had taken place there were no outcome statements or indication as to whether or not the action that was being taken by the home was effective. Appropriate pressure redistribution aids were not in place to initially prevent tissue breakdown and, if pressure sores were in evidence, to prevent further tissue deterioration and to aid wound healing. The provision of pressure redistribution aids should be subject to risk assessment for individual residents. Appropriate pressure redistribution aids should be provided which are commensurate with the degree of risk identified. The care plan should identify the make/ type of aid to be used and in what circumstances, i.e. whilst in a bed or whilst in a chair. There was very little information on the care plans about the social needs of the residents, their interests, their previous lives or their current hobbies. It is important that the residents’ are seen as people who have had full and interesting lives and not just as nursing patients. This gives the care staff information that they can use when talking to people and helping them to remember important things in their lives to stimulate memories. The care plans need to be much more ‘person centred’.
Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 7 Some people had not been risk assessed in areas where there might be hazardous. For example, one person had no risk assessment for bed rails, which stop the person falling out of bed. There is a risk of people trying to climb over them or getting stuck between the rails and this must be assessed to help minimise the danger. Other risk assessments that had been completed had not been signed or dated. People were still being moved around the home without footplates on their wheelchairs. One resident was seen having to ‘run’ his legs to prevent his feet getting caught. The manager also witnessed this. Although training in good wheelchair practice had been recommended at an earlier inspection it was clear that instructions put in place were not being followed by staff. All the information about staff members was put together in large files. These should be separate, individual personnel folders for data protection considerations and ease of reference. The complaints procedure was displayed in the home and was part of the Service User Guide. This procedure was, however, out of date as it had the name of the previous owner on it. There was also no time scale specified as to how long the home would take to deal with complaints and concerns. In view of the number of issues highlighted by this report which are required to be addressed, the owner of the home is required to submit a report to the Commission for Social Care Inspection demonstrating the findings of his unannounced visits to the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Acorn Nursing Home DS0000068202.V346985.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 Nursing Home DS0000068202.V346985.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): Standards 1, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information given to prospective residents and their families about this home is good meaning that an informed decision can be made about the suitability of the service and what it can offer potential customers. EVIDENCE: There was plenty of information available for prospective residents to make an informed and balanced decision as to whether the Acorn would be able to address their individual needs. The home had a Statement of Purpose and an illustrated Service User Guide. These were given to each individual resident and their families to explain the services that were on offer and the arrangement that were made within the home to care for people successfully. The service also had a website and other links on the Internet to help people to make a decision. Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 10 Several care plans were looked at and assessments were available to help ensure that the care staff had a good idea of the needs of the prospective resident. These also helped the manager to make a decision as to whether or not the home had the resources to care for the resident before he or she came to live at the Acorn. The last admission to the home was a person who came from another care home on an emergency basis. The District Nurse had done an assessment and the manager was in the process of preparing a care plan for this person. The home had a procedure for admitting people in the event of an emergency to ensure that good information is gathered. Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Poor care planning and practice is putting the residents of the home at risk. EVIDENCE: Everybody who lived at Acorn Nursing Home had a plan of care in place. However the care plans we saw did not clearly document care needs or describe in any detail the care to be given. The care staff rely on this information to provide a competent standard of care and to keep abreast of the changes in the persons needs and condition. There are a number of aspects that need addressing by the manager of the home in order that it can be seen that people are being cared for properly. The care plans were complicated and hard to follow; important information could be lost because of this. Some of the care staff agreed with this when we asked them about the plans. Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 12 Some of the care plans had not been formally reviewed on a regular basis. When reviews had taken place there were no outcome statements or indication as to whether or not the action that was being taken by the home was effective. Some of the care plans had not been updated to reflect the residents’ current needs. We asked some of the care staff about some of the residents’ care and the care plan did not match up with the information that we were given. There was very little information on the care plans about the social needs of the residents, their interests, their previous lives or their current hobbies. It is important that the residents’ are seen as people who have had full and interesting lives and not just as nursing patients. This gives the care staff information that they can use when talking to people and helping them to remember important things in their lives to stimulate memories. The care plans need to be much more ‘person centred’. Some people had not been risk assessed in areas where there might be hazards. For example two people had bed rail checklists, which indicated hazards but no risk assessments, or management plans were in place. There is a risk of people trying to climb over bed rails or getting stuck between the rails. This must be assessed to help minimise the danger. Other risk assessments that had been completed had not been signed or dated. People were still being moved around the home without footplates on their wheelchairs. One resident was seen having to ‘run’ his legs to prevent his feet getting caught. The manager also witnessed this. Although training in good wheelchair practice had been recommended at an earlier inspection it was clear that instructions put in place were not being followed by staff. There had been recent training in how to move people properly and comfortably. Important equipment wasn’t being used in some cases because the staff spoken to felt it was ‘less hassle’ and easier not to use it. Two staff were seen doing a ‘drag lift’ on a resident to transfer them. This is poor practice and dangerous and shouldn’t be used. Some of the wound charts on the care plans were not specific enough and hadn’t been updated. This is poor practice and can affect the way wounds are cared for. No one in the main lounge was using pressure -relieving cushions to help prevent pressure sores. Care plans did not contain enough information regarding blood sugar monitoring for those people with diabetes. Records were available to demonstrate that blood sugar monitoring was taking place however, although one persons blood sugar was noted to be high, there were no directions in the care plan to indicate what action staff should take in this situation. Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 13 One resident had been diagnosed as terminally ill and an ‘end of life pathway’ had been completed the day before to help ensure that the persons needs were dealt with properly and appropriately before their death. One of the registered nurses was unclear of what this pathway was. Other carers hadn’t been told about the person being terminally ill. This indicates a lack of training in this type of end of life care. Random inspections of the home had taken place in June 2007 and August 2007 where similar issues had been identified and raised with the owner of the home and the manager. Medication issues were being dealt with appropriately. The residents’ prescribed medication was being administered properly and the storage was good. Record charts were seen and were found to be filled in appropriately. Some of the residents had been prescribed ‘controlled’ medication (because of its content or strength). This was being administered and recorded correctly. There were instances seen of good care practice and the residents were spoken to respectfully and pleasantly. One resident commented, “The girls are nice, if you need anything they’re there. They always say ‘good morning’ to me and call me by my proper name.” Another resident said, “They’re doing a marvellous job.” Acorn Nursing Home DS0000068202.V346985.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: A hairdresser was working at the home during the inspection and some of the residents had had their hair done. There were several activities that took place regularly at the home. These included trips out to the shops and to shows, weekly entertainers visiting the home, bingo, and other social activities. There were plans to employ an activities coordinator to improve the activities that were on offer. Unfortunately there was very little information on the care plans about the residents’ likes and dislikes with regards to activities. Their hobbies, skills, interests and pastimes were not documented in detail and it would be difficult for a resident to continue an interest that they had enjoyed at home because the care staff would know little of this. As much information of this nature should be obtained from families and from the person themselves in order that personal interests are not lost. Some of the rooms had personal telephone points fitted, which were financed by the occupier of the room. This was similar with Sky TV.
Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 15 There was a particular room set aside for residents who smoked. One gentleman said that this was important to him because he liked to smoke a pipe. There were visitors to the home during the inspection and several of the residents were able to confirm that they had regular visits from friends and family. One visitor confirmed that he was always welcomed at the home and was given privacy when talking to his friend. The manager confirmed that there were residents meetings on a regular basis where people could voice their opinions on the home and the services offered. At the last meeting a decision was made to alter the menu of the home. Several of the residents said that they enjoyed the food at the home and looked forward to meal times. One gentleman commented, “I have a good appetite and I enjoy nearly everything that I eat. The food is cooked very well.” We looked at the menu for the home. This rotated on a four weekly basis and there was a choice available. The cook was spoken to and it was confirmed that fresh meat and vegetables were ordered on a regular basis. The dining room was pleasant and the tables were properly set, with tablecloths. Acorn Nursing Home DS0000068202.V346985.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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures for dealing with and reporting abuse were satisfactory ensuring any safeguarding matters are appropriately managed. EVIDENCE: There were policy documents for the staff to read about how to ensure that people were safeguarded from harm. All of the staff that were spoken to said that they had a good awareness of this important issue and knew what to do if they were not happy about something they had seen. The manager was aware of her responsibilities and knew whom to contact should abuse be suspected. Recent training had taken place regarding elder abuse and this was repeated to ensure that most of the care staff had this important training. It is important that all of the care staff that work at the home have access to this information as it helps to ensure that people are safeguarded from harm. All of the staff that were spoken to said that they knew what to do if someone was unhappy about the service. The complaints procedure was displayed in the home and was part of the Service User Guide. This procedure was, however, out of date as it had the name of the previous owner on it. There was also no time scale specified as to how long the home would take to deal with complaints and concerns. This is usually 28 days and the procedure should be altered to reflect this. Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 17 The manager was aware of her role regarding the complaints procedure and how complaints can be used as a quality tool to ensure that the home is run in the best interests of the residents. Three of the residents that we spoke to said that they were aware of the procedure to follow if they were unhappy about anything at the home. All felt confident that their concerns would be dealt with appropriately. Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 23, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a planned maintenance and renewal programme for the redecoration and refurbishment of the home to ensure residents live in a comfortable, homely, clean and safe environment. EVIDENCE: We looked at several bedrooms at the Acorn. We also looked at the lounge and dining areas, kitchens and laundry areas. All of the areas that were seen were clean and fresh smelling and there were domestics working in the home whilst we were there. The bedrooms that were seen were quite large and some had en-suite facilities. A handyman worked at the home and several of the bedrooms had been recently decorated and had new carpets and curtains fitted. The residents were encouraged to bring furniture with them when they came to live at the home in order that the rooms could be made personal. There were also
Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 19 personal items such as photographs, pictures, ornaments, bedspreads and books in evidence, which helped to make the residents feel more at home. Three of the residents that we spoke to said that they liked their bedrooms and found them comfortable. There were several lounge areas. The large lounge at the rear of the home overlooked the garden and there was a ramp leading from the large patio doors into the garden. This lounge was pleasant but there were several stains on the carpet. Some of the residents liked to sit in the hallway of the home close to the front door. The nurse call system was also located in this area. It was difficult hearing what people had to say in this area because of the highpitched alarm system. The laundry area was clean and well organised, and the problems that the home had been having with the laundry equipment had been ironed out. There had been no recent incidents of the residents’ clothes being damaged since the laundry equipment had been reconfigured. Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were protected by good staffing numbers and well trained care staff. Good recruitment practices helped to make sure that the residents of the home were safer. EVIDENCE: There were enough care staff on duty during the inspection to ensure that the assessed needs of the residents were adequately dealt with. The staff rotas showed that staffing was good and that there were plenty of staff on each shift to ensure that people were being properly looked after. The rota also showed that the residents were being properly supported at night. Most of the care staff had achieved a nationally recognised qualification in care (National Vocational Qualification level 2 or 3). There was a good induction process to help ensure that new care staff were competent before commencing their role. There was also a good training programme to ensure that the care staff were able to improve their skill and learn new ways to care for people. There had been recent training in dementia awareness, elder abuse, health and safety, infection control, food safety and fire safety. We spoke to a trainer during the inspection from an external training organisation that was providing training in Dementia awareness that day. He spoke of the variety of training that the organisation had provided for the home.
Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 21 It is also very important to ensure that the staff are taught how to help move people who may not be able to move properly themselves. There had been regular moving and handling training within the home but we saw some of the staff in the home not following set procedures and lifting manually because it was ‘easier’. This affected the comfort and wellbeing of the residents. Staff records showed that new carers had been properly checked before starting their jobs, including obtaining Criminal Records Bureau disclosures. This helped to make sure that the residents were safer by ensuring that suitable staff are employed. A previous random inspection had found that character references from previous employers had not been asked for before a carer was employed. There was evidence within the care staff files to show that the correct information had been gathered prior to employment. The service was now keeping a photograph of all of the staff that worked at the home, and proof of address. Care staff information, however, was difficult to find. It is recommended that each staff member has a separate personnel file where all important information can be kept. All of the staff information is presently being kept in three large ring –binders. Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36, and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Quality monitoring and recording of care practice was in need of improvement. Inconsistent care planning compromised the residents’ health, safety and welfare. EVIDENCE: The manager of the home was now spending more of her time actually managing the service. Less time was spent in her role as a trained nurse. This was a large home with a lot of care staff and time is important when checking that policies and procedures are being correctly followed and that the residents are being looked after properly. There were, however, several issues identified during the inspection regarding recording information properly within the care plans. It needs to be seen that
Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 23 the staff are all working together, with the same information, to ensure that areas such as pressure sore care and wound care are properly dealt with. Risk assessment was poor, and where proper risk assessments were available, some of these were not signed or dated. A more thorough care planning system is needed and the manager needs to ensure that all aspects of a persons life are addressed and not just the problems and symptoms that they present. Some aspects of care that we observed during the inspection were unacceptable, particularly with regard to care planning, moving the residents properly and ensuring that the care staff use wheelchairs safely and considerately. The manager needs to ensure that these issues are managed and adressed. The owner must also provide the Commission for Social Care Inspection with regular quality monitoring reports regarding how the home is performing. This is required by law. The home employs an office manager who oversees the administration and financial aspect of the home. Good records were being kept of safety checks. These showed that professionals were checking the lift, electric and gas equipment and the fire alarm system regularly. This helped to ensure that the residents lived in a safe home. Trained maintenance people were also checking the lifting equipment in the home on a regular basis. No evidence could be found of one-to-one supervision meetings with the trained staff or carers. These records should be contained on individual staff files and contain references to the support and advice received from a manager. A management training programme was due to take place for the senior staff at the home to give them more skills regarding the running of the service and the support of care staff. This included training in the management of change, and in conflict resolution. Acorn Nursing Home DS0000068202.V346985.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 3 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 X X 3 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 2 X 2 Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Care plans must provide adequate directions for staff to follow in respect of pressure sore prevention and wound care. Timescale of 31/07/07 not achieved. Care plans must reflect the resident’s current state of health and be updated to allow for changes in people’s condition. Risk assessments must be undertaken for people at the home when considering the appropriateness of the application of bed rails. Timescale of 31/07/07 not achieved. All care plans must be reviewed regularly. Appropriate outcomes must be recorded in the review process. Adequate care plan directions regarding monitoring of blood sugar levels must be in place for those residents’ who are diabetic. The owner of the home must undertake monthly unannounced visits to the home and provide a
DS0000068202.V346985.R01.S.doc Timescale for action 30/11/07 2. OP7 15 (1) 30/11/07 3. OP38 13 (3) (c) 30/11/07 4. OP7 15 (1) 30/11/07 5. OP8 23 (2) (n) 31/10/07 6 OP32 26 31/10/07 Acorn Nursing Home Version 5.2 Page 26 7 OP8 23 (2) (n) report to the Commission for Social Care Inspection of the findings. People living at the home must be provided with appropriate pressure redistribution aids in order to prevent pressure sores and, where these have developed, to prevent further deterioration and promote wound healing. Timescale of 31/07/07 not achieved. 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3. 4. 5. 6 7 Refer to Standard OP36 OP7 OP29 OP16 OP16 OP8 OP8 Good Practice Recommendations All care staff must receive regular recorded supervision. Care plans should be ‘person centred’ and contain, in detail, information about residents’ personal interests and life history. Staff files should be individual and separate and contain full personnel records, including supervision and training records. The complaints procedure should contain the name of the current proprietor. The complaints procedure should contain a target timescale in which a complaint should be dealt with. Footplates should be used on wheelchairs at all times to prevent injury to residents unless risk assessments show this to be inappropriate. Training should be organised for the care staff in good wheelchair practice. Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Acorn Nursing Home DS0000068202.V346985.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
