Inspection on 18/11/05 for Acres Nook

This inspection was carried out on 18th November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Acres Nook 23/06/08

Acres Nook 30/08/06

Acres Nook 08/06/05

Acres Nook 14/12/04

Acres Nook 19/07/04

Acres Nook 09/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Acres Nook Boathorse Road Kidsgrove Stoke-on-trent Staffordshire ST7 4JA Lead Inspector Mr Peter Dawson Unannounced Inspection 18th November 2005 01:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 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. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Acres Nook Address Boathorse Road Kidsgrove Stoke-on-trent Staffordshire ST7 4JA 01782 773774 01782 777560 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) Modelfuture Limited, Ashbourne Limited, Ashbourne Consolidated Group Jeanette Blandford Care Home 72 Category(ies) of Old age, not falling within any other category registration, with number (72), Physical disability (36), Physical disability of places over 65 years of age (48) Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 36 Physical Disability (PD) - minimum age 30 years on admission Date of last inspection Brief Description of the Service: Acres Nook is a purpose built care home providing both personal and nursing care and accommodating up to 72 people. The home can admit residents from the age of 30 years. Acres Nook Centre is a two storey property set in its own grounds. Accommodation is provided on both floors and the home endeavours to ensure that the ground floor is for dedicated use by older people and the first floor by young adults. A passenger lift and stairs provide access between the floor. Each group has its own allocated staff team. The majority of bedrooms are single and a small number have en-suite facilities. Both floors have lounges, a dining room, assisted bathing and toilet facilities. The laundry an kitchen are sited on the ground floor. Externally the home has enclosed gardens to the rear. There is a paved forecourt that is divided to provide a sitting area for residents and a parking area. The home is within walking distance of the main shopping area in Kidsgrove town and is on a main ‘bus route into the City of Stoke on Trent and Newcastle. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the time of this unannounced inspection there were 58 people in residence – 29 on each of the two units. That figure includes 11 people not assessed as requiring nursing care. The Acting Manager has been in the home since April and made very significant changes in all aspects of care and management that were necessary following a number of serious complaints about standards of care. Residents confirmed that changes made were necessary and the right ones for them. Most residents were seen and ten residents spoken to in the home. One visitor was seen and spoken to, concluding that she was now happy with the care provided and the changes made to improve the standards in the home. All communal areas were inspected and a sample of bedrooms (12). Staff were spoken to, were positive about the changes made and stated that staff morale was good. A sample of care plans were seen and tracked and a range of other records relating to the areas inspected. This was a positive inspection with a good, open, positive and frank discussion with managers about the changes made and the need to continue to improve and monitor care in the home. The inspection focused particularly upon areas of care practice, including health, social and personal care which had given cause for concern in the recent past -and also a focus upon the many environmental requirements made in the last report. What the service does well: Residents now feel supported and are satisfied with the changes made in the home which affect their quality of life. Good engagement between residents and staff was observed in both client groups of the home. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 6 The communal areas on the ground floor are particularly pleasing, comfortable and attractive (older people). The areas on the first floor require improvements which are in process. The therapeutic activities provided are diverse for the two groups but provided to a high and satisfactory standard – this ranges from holidays for young adults to 1:1 activity with frail elderly residents. Residents state their satisfaction with this service. Links with the community are paramount for young adults, with social, recreational and educational opportunities accessed with support from staff where required. There is a very relaxed and homely atmosphere in the home. Residents talk freely to visitors and clearly feel some “ownership” of the home. What has improved since the last inspection? Many improvements were required at the time of the last inspection when 18 requirements and two recommendations made. – That number included some issues not actioned on the previous inspection and some requirements following complaints to the home earlier in the year. Eight of the requirements related to the environment and all have been or are being addressed satisfactorily (see body of report). All Care plans have been re-written on new format and are reviewed on a monthly basis by the named nurse with involvement of residents wherever possible. Residents also now sign care plans where possible, or relatives if appropriate. Relatives are now kept informed of all changes affecting residents. Letters have been sent to all relatives informing them of the changes being made to improve communication. The call system is being monitored by managers to ensure waiting times are kept to a minimum. A specialist chair for wheelchair user has been provided for whilst sitting in the lounge area. Staff training has improved the skills in relation to feeding residents. A mobile payphone is now available to residents ensuring privacy. Staff have received training in Vulnerable Adults issues. A planned programme of redecoration/refurbishment has been provided to the Commission and the programme is well under way. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 7 All surplus items in bathrooms and sluices have been removed and now kept clear. All bedpans have been replaced as required. Bath hoist chairs are now part of cleaning schedules. An additional member of staff required on the ground floor at breakfast time (elderly) has been provided. Staff have received training to improve clinical waste disposal. Supervision for all staff has been introduced. The garden areas have been improved. A better level of communication between management, residents and their families has been put into place. This clearly has improved. What they could do better: 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. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 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 Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3–5 Standards 3 – 5 were inspected and found to be met. Pre-admission assessments are carried out and care management assessments obtained prior to admission. EVIDENCE: Information relating to the Statement of Purpose was not inspected on this visit. Pre-admission assessments are carried out by the homes staff prior to admission and were evidenced in care planning information seen. Care Management assessments are sought and generally obtained – again evidenced in care planning information which was based upon both assessments. Written confirmation is given to residents prior to admission indicating that the home can meet their needs. The preferred option is for prospective residents to visit the home prior to admission and this is arranged wherever possible. This was confirmed in discussions with recently admitted residents. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10 The majority of care plans have been updated providing a good required standard of information available. There has been considerable staff time invested in this process. Health care needs were seen to be adequately recorded and early identification of needs evident. There has been a vast improvement in the management of tissue viability resulting in a dramatic reduction in the incidence of pressure area sores. Some aspect of medication require attention including the times that medication is given and accurate completion of MAR sheets. EVIDENCE: The standard of care planning at the time of the last inspection (June 2005) was inadequate and requirement made to provided more comprehensive information and to reviewed plans on a regular basis with residents/relatives as required. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 11 This has been done. In fact the home have re-written/revised virtually all the plans in place and applied the new format/procedure to all new residents. The home have worked hard to achieve this and the results provide a higher standard of care planning information. There has been resident involvement where possible e.g. younger residents on the first floor have spent time with staff revising/reviewing the information already established in the previous plans and updated/revised them as necessary. Sampled care plans seen included clear and concise information required to provide care. There were good examples seen of social history/life story completed in detail by/with resident/relative/staff. Plans are reviewed on a monthly basis by the Named Nurse – there is a schedule of reviews (seen) for allocation and completion of reviews. There is input from residents/relatives where possible. The Manager countersigns the reviews as a monitoring process. It was positive to see care staff had an input into daily recording of notes, specifically relating to personal care. The were countersigned by the nursing staff. All care plans are now signed by resident/relative. Relatives have all received letters about the proposed changes and have been involved in those changes. Risk assessments are part of the care planning information, were seen to be established where risk was present and reviewed on a regular monthly basis with other care planning information. A younger resident admitted 11 days prior to the inspection had had three falls, all had been documented and risk assessments reviewed after each fall and appropriate action taken for referral to hospital. Documentation indicated relatives were informed/involved at each stage and care plan discussed and revised. A requirement in the last report to ensure the call bell was answered swiftly, following comments from residents has been addressed. The unit managers now monitor this checking print-outs from the call system for any delays. There were no obvious lengthy responses to the system observed during the inspection. Another requirement of the last report to provide a resident identified with a specialist chair to avoid long periods in her wheelchair has been addressed – the chair was on order and arrived one week following the inspection. The Acting Manager reported that a considerable number of residents had pressure area sores at the point she was brought into the home, earlier in the year. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 12 This situation has been vastly improved and at this time there is one resident with grade four sore and related to the persons resistance to care. Four people have superficial grade two sores - two imported recently from hospitals and there is one person with a grade one sore. Some documentation was seen and required professional standards in place to record, grade, treat and monitor pressure area sores. The improvements in tissue viability achieved over the past months are very significant and due to screening systems, early action and appropriate positive treatment. There is a range of pressure relieving equipment available in the home, most in use but some available immediately from storage if required. There are some 15 alternating mattresses available in the home. Two specialist beds have been purchased and a new medical futon in use. Several purchased in the recent past. There is a range of pro-pad mattresses/cushions in use and some in storage for use. Nutritional/waterlow assessments appeared the norm in care planning information with regular reviews also. Residents weight is recorded on a monthly basis (seen in care plans) or weekly if there are concerns about weight loss which is then investigated/monitored. Health care records seen provided chronological information in relation to health care interventions by external staff. There was good and adequate recording of nursing interventions in the home. A recent situation where a resident was transferred to hospital during the night, but not escorted has been addressed by the Acting Manager. Instructions have been given to all staff stating that all transfers to hospital must be accompanied by relatives if possible but if this is not possible then residents must be escorted by staff. Residents must not go alone. The medication system was inspected. MDS (blister packs) used. The medication round was being completed on the first floor at 11 am – reported to have taken two hours. The last medication given at 11 a.m. was in fact prescribed at 8 a.m.- The resident concerned does not wake until 9 am anyway. The medication “round” on the ground floor had taken 1.75 hours and completed before 11 a.m. Usually there are two nurses on duty on the first floor and 1 on the ground floor. This situation is not satisfactory. The home must review the availability of Nursing staff to administer medication and ensure it is given close to the prescribed times. There is a clear cumulative effect for some medication which is subsequently prescribed for 1pm. - This is sometimes delayed purposely but the whole situation is unsatisfactory and must be reviewed and addressed. – This was also a requirement of the previous report. There were some gaps on MAR sheets although medication had been given from the blister packs. All medication must be signed for at the point of administration. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 13 A medication prescribed had been out of stock for three weeks. This is a trial drug prescribed via Consultant but reportedly the pharmacist was unable to supply the drug. This should be discussed with the Consultant concerned and the implications for the trial/suitability/effectiveness made determined. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Standards relating to Daily Life & Social Activities were found to be met. A suitable range of activities are provided for the diverse needs of the total resident group, this includes 1:1 engagements where group activity is not appropriate. External activities for the younger residents are ongoing and staff support with transport provided where required. EVIDENCE: The programme of activities provided at Acres Nook is reported to be very good. Activities Co-ordinators were not seen at the time of this inspection but residents spoke highly of the activities workers and several on the first floor were asking what time the co-ordinator would arrive They were delighted when reminded that a disco was being arranged for them later in the day. Residents said that activities provided both in the home and externally took account of their interests and wishes. Transport is seemingly readily available as needed. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 15 Five younger residents regularly attend Day Care Centres at Blurton, Fenton and Kidsgrove on one or two days each week providing a range of suitable activities and social opportunities. This year a group of four residents went on holiday with staff for the first time, enjoyed the experience and the home intend to extend this in the future for a larger number of residents. A recently admitted resident goes home each Saturday morning, stays two nights and goes directly to a day centre on Monday returning to Acres Nook on Monday night. This maintains the important contact with family and a good example of the shared care concept. Residents were seen rising late into the morning indicating a flexibility of routines. Residents spoken to said that their preferred lifestyles were known by staff and that they were accommodated. Several younger residents who socialise during the day in the main upstairs dining area were spoken to separately and in a small group. They were very complimentary about staff care and described the home as “excellent”. The food was reported to be good in quality, quantity and type and there was a very strong feel of satisfaction expressed by this group. Food choices were known and special diets or preferred dishes served as required. Residents confirmed that visiting times were flexible, that they went out with their relatives and assistance was provided to access community facilities e.g. shops, pubs etc. and transport was always available to them. A requirement of the last report was made to cease the practice of staff standing up in the dining areas whilst feeding residents. The mid-day meal was served and it was noted that those residents on both floors requiring staff assistance with eating were supported in a sensitive and unhurried way. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 - 18 There is a clear and concise complaints procedure in place. There has been staff training in adult protection since the last report. EVIDENCE: The complaints procedure was displayed in the home and provided clear and concise instructions for reporting abuse. The procedure is available to both residents and visitors. The complaints procedure contained all information required in Regulation 22. More training for staff in adult protection was required in the last report. This has been done. There has been training by the provider and training packs for staff use received and worked through. This now needs to be expanded into supervision and staff meetings. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 - 26 Much work has been done to improve the environment as required in the last report. Seven of the eight environmental requirements have been addressed – the other, to provide locks on bedroom doors is being pursued. This is repeated as a requirement. One further requirement is made which is to improve the appearance of the first floor dining area which is the main social meeting point for residents on that floor. The providers are complimented upon their actions to address the previous requirements. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 18 EVIDENCE: This is a purpose-built care home. There are only a small number of en-suite bedrooms but adequate number of toilet and bathing areas located throughout the building and easily accessed from bedrooms and the communal area. Corridor and door widths comply with requirements for wheelchair access. There are many wheelchair users in the home, particularly the younger adults on the first floor, but access is good with shaft lift and appropriate adaptations to access the external parts of the building. The garden/patio area is used throughout the summer, is pleasant, has good seating and easily accessed – it is much used. The redecoration/refurbishment of the home has not been an ongoing process in the recent past. – At the time of the last inspection there had been some minor improvements but the provider was required to supply the Commission with a copy of an improvement programme and specific requirements were additionally made in relation to the environment. With the exception of one, all 8 environmental requirements have been satisfactorily addressed – they are: 1. A portable payphone has been provided for residents use on the first floor, this was seen and available to be plugged into several points available in the building. (Some residents also have fixed telephones installed and some mobile telephones). 2. A planned programme of redecoration/improvement has been supplied to the Commission and is realistic, adequate and in process. 3. Locks have not been provided on bedroom doors as required – the home are presently sourcing appropriate locks that will be cleared with the Fire Officer prior to fitting where they are required/appropriate. 4. Items stored in bathrooms and sluices have now been removed to a suitable storage area. 5. All bedpans identified have been replaced. 6. The kitchen fridge has been replaced. 7. Cleaning schedules now include cleaning bath hoist chairs. –Inspected and satisfactory. 8. Procedures for disposal of clinical waste have been clarified for staff with some training in Health & Safety/Infection control. – more training is to follow. A recommendation to employ a gardener has been considered, but residents have been involved with staff including the maintenance person, in some gardening tasks as part of social skill enhancement. Some improvements have been made and the matter further considered after the winter. It was reported (as seen as sampled) that many bedrooms had been redecorated from the homes budget a total of 42 rooms. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 19 The two first floor lounges had been redecorated carpets and curtains in many bedrooms have been or are in the process of being replaced to match the redecoration which has taken place. The downstairs corridors have been redecorated. Upstairs corridors planned and also bathroom and dining room on the first floor too. Presently the social areas used by the younger adults group on the first floor are not entirely satisfactory, although some changes are being made. The small lounge has been redecorated and not presently in use, the activities rooms transferred to large area and awaiting delivery of new carpet/soft furnishings. The dining area on the first floor is the preferred meeting place for residents throughout the day, it is to be redecorated but presents as stark with tables/chairs only and virtually no softening/personalisation to present a comfortable and homely setting. Most residents were gathered and spoken to in this area and it is important that the room is decorated and improved with furniture/fittings/equipment to present a more homely and relaxing atmosphere. A resident did comment that she did not like the dining room and often uses the dining room on the ground floor to socialise. In contrast the ground floor lounge and dining areas are bright, comfortable and furnished/fitted along domestic lines. There is a conservatory off the main lounge area which is pleasant, comfortable and welcoming and used for some activities/to receive visitors etc. Older people are cared for in this area and the environment is good in terms of furniture, equipment and décor. The home is well equipped with bathing facilities – there are three bathrooms and a shower room on each of the two floors all with appropriate assisted facilities. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 There has been a vast improvement in staff recruitment, training and deployment over the period of this report and the last report. Staffing levels are consistent and stable. Training has improved staff skills and morale with the resultant improvements sought by residents and relatives. Agency staff are now used minimally providing greater continuity. EVIDENCE: There was a period of instability in the home earlier in the year, resulting in the Manager and several staff leaving. The events leading to and following this had an inevitable effect upon residents and visitors and the lines of communication dramatically suffered. There were complaints from relatives about inadequate staffing levels. The present Acting Manager was brought into the home in April to address the many required outstanding issues. Many were immediately addressed and evident at the time of the last inspection, these included urgent statutory training for staff and improvements in communication processes with residents/relatives/visitors. New staff have been appointed with appropriate induction programmes and since the last report there has been staff training in Health & Safety, Vulnerable Adults, NVQ training, food hygiene, and Fire Safety. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 21 Staff training has improved. A requirement to introduce supervision has been addressed, Managers attend course on supervision and appraisal. A system of staff supervision has commenced with all staff having been involved in an initial assessment of their needs. Training is higher profile in the home – there is now a training day each Thursday, staff are paid to attend, the Unit Managers are the trainers and work through the various staff training packs and information to improve awareness and practice across the spectrum of care e.g. questionnaires are completed in relation to adult abuse. This is a very positive move raising staff training on the homes agenda. The present staffing levels comply with the staffing notice issued prior to 2002 as required. The staffing level is: Two nurses on duty throughout the 24 hour period – this increases to three nurses on days ( 8 – 8). – this applies to the home generally. Additionally there are care staff on duty via: Ground floor (older people) 5 : 4 on days but often this is 6 :5. First floor: (Young Adults) – 6 : 5 on days. At weekends then number on the first floor is 5:4 - 3 people out overnight and others with relatives. One resident on first floor has 1:1 staffing for three hours per day. Activities workers work total of 36 hours per week (6 days). The kitchen is staffed 8 am – 7 pm daily. There is full time housekeeper and maintenance worker and also full time administrator. There are also laundry staff. A requirement of the last report to provide an additional member of staff on the ground floor at breakfast time due to high dependency levels has been addressed – a 6th person is provided for that period and often longer. A requirement was made relating to improvements in the staff recruitment procedures but staff files were not inspected on this visit. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33 and 36 - 38 As there is not a Registered Manager approved by the Commission at this time it is not possible to assess standards 31 and 32. The Acting Manager gives a very positive lead in the home and the management structure has been strengthened to review and improve standards of care and management. A system of staff supervision has been introduced. Health & Safety aspects inspected were in place and adequate. Regular fire drills for staff being the only omission. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 23 EVIDENCE: The previous Manager resigned earlier in the year. An Acting Manager from another of the Groups homes was brought in to jointly manage the home with a senior manager from the Group. The Acting Manager now manages the home and has made application to become the Registered Manager at Acres Nook. Her application is in process and will now be determined swiftly by the Commission The Acting Manager provides a very positive lead in the home and has been instrumental in the vast and very necessary changes required in many areas of care and management in the home. The details are outlined earlier in this report. There was a very open and relaxed atmosphere in the home at the time of the inspection. Residents confirmed the changes made were for the better and in their interests. The previous lack of communication with residents and relatives appears to be have been resolved. The Company carried out audits in the home regularly and their Representatives been necessarily involved in the swift changes that were required to be made to improve both care and management processes. The home now has two Unit Managers – one for older people on ground floor and one for Young Adults on the first floor. Additionally there is a Manager for night operations. This has strengthened the management structure and allowed quality improvements in service delivery. Letters have been sent to all relatives informing and reassuring them about the changes put in place. A meeting is planned in the near future for residents/relatives to further personalise the communication systems. Staff supervision has been introduced and will be ongoing. Safe Working Practices were inspected/sampled. Fire equipment was checked regularly with weekly testing of the fire alarm system and emergency lighting. – It was noted that the last fire drill was 28.1.05. – It is a requirement of this report that all staff must receive fire drills in accordance with the Fire Officers recommendations: Six monthly for day staff and three monthly for night staff. There has bee considerable staff training in Moving & Handling, First Aid, Food Hygiene and Infection control over the past months. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 24 Risk assessments in relation to resident activity were seen to be part of the care planning information system and regularly reviewed with care plans. All staff receive induction training to NTO standards. Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 3 x x 3 3 2 Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 26 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 OP9 Regulation 13(2) Requirement Medication must be administered at or around the time prescribed. Previous timescale not met. Bedroom door locks must be provided, approved by the Fire Officer and residents given keys if they wish. Previous timescale not met. First floor dining area to be redecorated and fitted to provide a homely atmosphere in contrast to the present stark appearance. Timescale for action 18/11/05 2 OP24 12(4) 31/12/05 3 OP19 23(2)(a)& (h) 31/12/05 4 5 OP9 OP38 13(2) 23(4) All medication must be signed 18/11/05 for at the point of administration. Fire drills must be provided as 30/11/05 required for all staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 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 Acres Nook DS0000026933.V267061.R01.S.doc Version 5.0 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!