Inspection on 30/04/09 for Acorn Nursing Home

This inspection was carried out on 30th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Acorn Nursing Home 29/12/09

Acorn Nursing Home 25/09/09

Acorn Nursing Home 06/07/09

Acorn Nursing Home 10/02/09

Acorn Nursing Home 27/03/08

Acorn Nursing Home 02/10/07

Acorn Nursing Home 11/01/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Random inspection report Care homes for older people Name: Address: Acorn Nursing Home 125 Newton Drive Blackpool Lancashire FY3 8LZ zero star poor service 10/02/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Stephanie West Date: 3 0 0 4 2 0 0 9 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 Conditions of registration: 0 3 The registered person may provide the following category of service only: Care home with nursing - Code N. To people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Physical disability - Code PD. The maximum number of service users who can be accommodated is: 40. 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. Care Homes for Older People Page 2 of 10 1 0 0 2 2 0 0 9 Brief description of the care home 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 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 3 of 10 What we found: This visit was carried out to look at the arrangements for the safe handling of medication and to discuss any changes made, following the previous inspection. The visit lasted approximately six hours and involved discussing the handling of medication with nursing staff, examination of medicine records and storage arrangements. This visit focused on medicines handling, other areas and requirements were not examined on this occasion. At the end of the inspection feedback was given to the manager. Overall, we found that action had been taken to improve medicines record keeping but that the homes audit was quite narrow and had failed to identify other concerns about the safe handling of medicines at the home. These need to be addressed to help ensure the health and wellbeing of people at the service is best protected. We looked at medicines administration. People are able to take their own medication should they wish to and are able; this promotes their independence. But, we found that written assessments were not always completed to help identify any support people may need to manage their medicines safely. One person spoken with was happy with the arrangements made for them to self-administer medicines and with the support provided. But, although there was reference in the daily records, their medicines records had not been updated following changes to their medication on discharge from hospital, nor when another medicine was stopped. In fact self-administration records had continued to show nurses prompted the use of the stopped medication. It is important that accurate and up-to-date records are maintained to support safe self-administration. Qualified nurses administered all other medicines. Care was taken to ensure enough time was left between doses of the same medicines, but it was of concern that almost everyone had their breakfast medicines before night staff went off duty at eight o, clock in the morning. Staff said that breakfast was served until around 11 o clock, but arrangements had not been made to ensure special label instructions such as before food or after food were followed when administering medicines. Consideration should be given to the times that medicines are administered to help ensure they are offered at both the best and right times. We looked at medicines record keeping. Since the previous visit staff had carried out audits (checks) of the medicines paperwork. We found the records of medicines receipt; administration and disposal were mostly clearly made. Most medicines were provided in a monitored dosage system - this was used correctly. But, it was not possible to track (account for) the safe handling of medicines in bottles and boxes because these did not align with the medicines paperwork, nor was any quantity carried forward from previous months recorded. This meant it was not possible to tell whether these medicines had been given properly. It was of concern that one person had missed doses of their prescribed pain-killer because there were none left to give, and had been given paracetamol instead. This increases the risk that pain will not be well managed. Additionally, it was not possible to tell where the paracetamol had come from. A second person had run out of lactulose. Stock control needs to be such that sufficient supplies of medication are kept in the home to allow continuity of treatment, without overstocking. It was of concern that although medication was discussed and recorded at pre-admission, we saw that current medication was not confirmed with the prescriber for someone who Care Homes for Older People Page 4 of 10 had recently come to the home. The home did not have a complete and up-to-date list of currently prescribed medicines for this person. One medicine had not been administered until twelve days after the person had come to the home. Two other medicines mentioned at pre-admission were not being administered, it was not possible to tell if they were currently prescribed or had been stopped. Additionally, a prescribed spray was kept and self-administered by the service user but the spray was not included on their list of current medicines, there was no record of self-administration and not all nurses knew about it. To support the safe administration of medication; complete, clear and up-todate lists of currently prescribed medication must be maintained for people living at the home. Records of doctors visits were mostly clearly recorded so changes to peoples medicine could be tracked. One person had recently completed a course of antibiotics. Clear records were made and these were started promptly once prescribed. But it was of concern that the persons care file recorded an allergy to the prescribed antibiotic - this had not been brought to the attention of the prescriber. It is recommended that staff look at where this type of information is recorded to see if arrangements can be made to reduce the risk of this type of information being missed. We found that medicines including controlled drugs were stored securely. This helps to ensure that they are not misused or mishandled. But, there were several unwanted medicines (mostly sprays and inhalers) awaiting safe disposal. The nurse-in-charge explained that they were unaware of how to dispose of these items. This needs to be checked with the homes waste contractor, as unwanted medicines should not be allowed to accumulate. The manager had started to carry out audits of medicines handling at the home, but these were quite narrow and looked mainly at the completeness of the medicines administration records. It is recommended that a wider written audit of medicines handling is carried out to help ensure should any weaknesses arise they will be identified and promptly addressed. What the care home does well: What they could do better: 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 2. Care Homes for Older People Page 5 of 10 Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. 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 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. 3 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. 31/03/2009 Care Homes for Older People Page 7 of 10 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, 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 9 13 Complete, clear and accurate 01/06/2009 lists of currently prescribed medication must be maintained for people living at the service. And, Sufficient stocks of medicine must be maintained without overstocking to help ensure medicines are safely administered as prescribed. 2 9 13 Where people choose to self- 01/06/2009 administer medication assessments need to be completed and any support needed recorded to help ensure people always receive any help they may need to safely selfadminister. Care Homes for Older People Page 8 of 10 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. No Refer to Standard Good Practice Recommendations 1 9 The times that medicines are administered needs to be monitored to help ensure medicines are given at the best and right times. Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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