Inspection on 23/06/08 for Acres Nook

This inspection was carried out on 23rd June 2008.

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

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

Other inspections for this house

Acres Nook 30/08/06

Acres Nook 18/11/05

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

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Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Acres Nook Boathorse Road Kidsgrove Stoke-on-trent Staffordshire ST7 4JA Lead Inspector Yvonne Allen and Wendy Jones Key Unannounced Inspection 23rd June 2008 09:30 X10029.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.V368307.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 and Care Homes for Adults 18 – 65*. 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.V368307.R01.S.doc Version 5.2 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, Currently Vacant Care Home 72 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (72), of places Physical disability (36), Physical disability over 65 years of age (48) Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (with nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories. Old age not falling in any other category OP 72. Physical Disability PD 36. Physical Disability over 65 years of age PD (E) 48. Dementia over 55 years of age DE 14. The maximum number of service users to be accommodated is: 72 2. Date of last inspection 30th August 2006 Brief Description of the Service: Acres Nook is a purpose built care home providing both personal and nursing care and accommodation for up to seventy-two people from the age of eighteen years. Acres Nook Care Centre is a two-storey property set within its own grounds. Accommodation is provided to both floors and the home endeavours to ensure that the ground floor is dedicated to older people and the first floor to younger adults. A passenger lift and stairs provides access between the floors. Both groups have their own staff team. The majority of bedrooms are single and a small number have an en-suite facility comprising of a toilet and wash hand basin. Both floors have lounges, a dining room, assisted bathing and toilet facilities. The laundry and 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 the people using the service and a small parking area. There is also parking to the rear of the property. 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-onTrent. The fees for this home at the time of the Inspection ranged from £314.00 to £1070. Items not covered by the fees include hairdressing services, newspapers, toiletries, trips and holidays. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the commission, carried out this Key inspection visit over one day. All of the Key minimum standards were assessed and for each outcome a judgement has been made, based on the evidence gathered. These judgements tell us what it is like for the people who live in this home. Prior to the inspection visit the Providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to under-take a self-assessment, which focuses on how well outcomes are met for people using the service. Information from this AQAA was used to plan the inspection visit and references to it have been included in this report. The ways in which we gathered evidence to make our judgements were as follows – We looked at any information we had received about the home since the last Key Inspection. This included any compliments, complaints and Safeguarding referrals we had received. We spoke with the people who live in the home We spoke with the staff who work at the home Discussions were held with the manager of the home We spoke with professionals who are involved with the home. This included a nurse specialist. We examined relevant paperwork and documentation at the home. We walked around the home and we visited all the communal areas and a selection of bedrooms. We looked at how staff interact with and care for the people who live at the home. We are trying to improve the way we engage with people who use services so we can gain a real understanding of their views and experiences of social care services. We are using a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 6 During this inspection an expert by experience joined us from 10am to 1pm. She spoke to some of the people who live at the home and made observations about the care they received. She also looked around the home and spoke to some visiting relatives and some staff members. The expert by experience then wrote a short report for us and her comments have been included in the main body of this inspection report. At the end of the inspection visit we discussed our findings with the manager. There were no immediate requirements made. What the service does well: What has improved since the last inspection? There has been some redecoration and refurbishment carried out at the home since the last inspection. This has helped to improve the appearance of the home internally for the people who live there. There has also been the development of a dementia care unit since the last inspection. This unit has been specifically decorated and adapted to meet the needs of people with dementia. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 8 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. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2 and 3 were assessed. Standard 6 was not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are assessed before they move into the home to ensure that their basic personal and nursing care needs of individuals can be met, however the process could be improved further by better assessments of individual social needs and requirements based on life histories. People who live in the home are not supplied with up to date information about it. This information is needed so people know what to expect from the service. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 11 EVIDENCE: In their AQAA the Providers tell us – “We provide detailed information to any prospective service user. Enquirers details are taken and followed up . Enquirers are welcomed to view the home at any time. We offer trial visits and stays. Information about the home is available via numerous outlets. A comprehensive pre-admission assessment is carried out. We have prefered status with the Multiple Sclerosis Society and attend the ms group weekly as well as having regular input from our local specialist nurses.” We saw a copy of the Service User Guide and Statement Of Purpose in the entrance to the home. This contained the last inspection report. When we spoke to some of the people who live in the home on the second floor unit, they told us that they had not seen copies of these documents and did not know where they were. The Service User Guide does not contain the range of fees charged and this information will need to be included, so that people are aware of how much the home charges. We looked at a number of care plans on both units in the home where evidence was seen of pre admission assessment of needs being done. There was evidence of good assessment with care management information also on file. There was also evidence of family involvement in the admission process. Discussions with a relative identified that he was involved in the admission and that he felt that his relative’s needs were met at the home. He told us “I came to have a look around because mother was not able to.” On the whole, pre admission assessments tend to focus on physical and health needs whereas social needs and personal histories are not always recorded well. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 13 We looked at standards 6, 7, 8, 9, 10, 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person using the service has a plan of care in place but the quality of the care plans are variable and do not always reflect and uphold the preferences and choices of individuals. Nurses have the necessary skills and expertise required for this client group and involvement of health care professionals ensures that the health care needs of the people using the service are met. EVIDENCE: In their AQAA the Providers tell us – “Comprehensive pre-admission assessments provide the base line for individual care planning. We then devise a care plan based on information gained from the multidisciplinary team involved with the service users care. All necessary specialist equipment is provided on admission. Care plans are regularly reviewed and ammended as needed. Changes to residents care needs are discussed with the individual and their significant others and all are supported throughout any health deterioration, with staff in the home trained in palliative care. The Home Manager is a registered nurse and is available on an on-call rota. Comprehensive medication policies ensure the safe administration and management of medicines in the home”. The staff at the home understand the right of individuals to take control of their lives and to make their own decisions and choices. There is some evidence that individuals are involved in some decision making about the home, such as day to day living and social activities, but this tends to be the people whose communication styles are more easily understood by staff. Individuals with more diverse needs find it harder to have their opinions listened to. Areas where individuals can affect change are limited. The expert by experience told us - “I observed staff preparing and lifting residents in the main lounge for lunch and this was done with care and with a friendly attitude. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 14 I spoke with a lady who is registered blind and who was sitting in the main lounge area. She was sitting opposite the television, which was on at high volume (as it also was in the dementia lounge). No one appeared to be paying any attention to it. I asked her what she did each day and she replied ‘I’m blind – what can I do? I asked her how she called a carer when she needed help to get up and she said she just called out. The nurse said that relatives have requested a buzzer to be installed on the wall near to where she sits so she can call for assistance more easily and that this will be done.” At the end of the inspection visit, we discussed the needs of this individual resident and asked whether she could go out for a day to a specialised daycare unit for visually impaired people. We were told that such day care facilities are virtually impossible to access. It is recommended that the Provider explore the possibility of finding a suitable day care placement for this lady in order to meet her specific needs and improve her quality of life. The expert by experience then spoke with gentlemen in his room. She reported: “There was a single plastic mattress lying on the floor of the room, which, in such a small room, was really in the way. He told me that it was there all the time. The nurse said it was placed at night at the side of his bed so if he fell out, he would not hurt himself. I thought at the least it should be stored during the day, and not left lying in his room. He said he was reasonably happy with his life in the home and that staff treated him well. I was concerned that there was a large plastic jug of water on his tray – which he said had been there the ‘best part of a week’ but no cup or glass to drink from it”. When we spoke to the Providers they told us that jugs of water and juice are provided and changed daily for individuals. The expert by experience also reported, “I asked another resident about showering and bathing, and she said that she had not had a bath since she had been there (two months) and was given showers once or twice a week”. When we looked at care plans this was confirmed. Individuals did receive daily personal care but choices are not always documented in respect of bathing preferences, times and frequency. There was evidence, particularly on the Young Persons Unit, of how the staff know and record the preferred communication styles of the individual, and use proven methods that enable the person to lead a full life that promotes independence and choice. These included communication aides such as photographs and symbols. On this unit staff understand the importance of people being supported to take control of their own lives. The people using the service are encouraged to make their own decisions and choices. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 15 Throughout the units each person has a care plan in place but the practice of involving them in the development and review of the plan is variable. One of the people using the service told us “I don’t know about care plans.” Another said - “ I know about the records that the staff keep and my key worker talks to me and my relatives about things that concern me.” Some people using the service and/or representatives have signed their agreement with the care plan whilst others are left blank. Care plans are not always consistently reviewed and updated as required. We found two plans that were not completed whilst others had had regular reviews. Risk assessments are completed but these are basic and mainly focus on keeping residents safe. There is some evidence that decisions are agreed with the person but not consistently. There is basic information available to inform the people using the service of their rights. Documentation is provided but often not in formats understandable to people. There was evidence of the involvement of healthcare professionals such as the Epilepsy Nurse, Palliative Care Nurse, Dietician, Chiropodist, Dentist and GP. Nurses have received training in the care of tracheotomies. Special equipment is in place for prevention and/or treatment of pressure damage and the nurses at the home liaise with the Tissue Viability Team based at the hospital. We spoke with a continence nurse specialist who was visiting the home. She told us that she was happy with the continence care provided at the home and that staff listen and act on her advice. She said that she has given staff training on several occasions and that this has been effective. We looked at the medication process and this was found to be satisfactory although the British National Formulary (BNF) should be updated as the current version is for March 2007. Individuals are able to self-administer medication if they wish to following a suitable risk assessment. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 16 Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed all the standards for this outcome. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a planned programme of activities and entertainment designed to meet the social and therapeutic needs of the people using the service. Little consideration is given to supporting the individuality or social preferences of people with dementia care needs. Staff do not always talk to or interact with individual residents or respect their rights. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 18 EVIDENCE: In their AQAA the Providers tell us – “We create an atmosphere that is warm, welcoming and friendly. Residents are encouraged to spend their time as they wish. Daily activities are provided and feedback from residents and relatives is positive. A number of residents attend day centres to maintain contact with their friends and a group of residents attend the multiple sclerosis group every Monday which enables them to talk to other people with the condition as well as forming friendhips outside the home. We have a new activities coordinator on the ypd unit who is very motivated and is working alongside our coordinator on the elderly care unit to ensure that residents and their families are actively involved in activities of their choice. This ensures that their hobbies and interests are continued wherever possible in order to maintain their individuality.” We talked to several residents about the opportunities they have to occupy them selves, or engage in activities. One person said that he tends to occupy himself with his hobbies and interests, does not routinely get involved with some of the activities that are arranged in the home. He said that he has been involved in the residents’ meetings. One person said that she would like to go swimming, shopping and out for meals, and would also like to receive regular physiotherapy sessions She told us that she goes to a day centre for a couple of days per week. Another person has no social history in her care records, except that she attends a day centre, and there is no evidence in her records of her being involved in recreational activities in the home. The last relative/resident meeting was dated 10/04/08. Comments include, “residents would like to go out more for pub lunches.” A resident said that she would like to go to bed later now that the light nights were here. The home has an activities co-ordinator for each of the floors, and from discussions it was evident that efforts are made to engage people using the service in activities either group or individual. During this visit a music and movement session was taking place, the activities co-ordinator stated that, “ I try to organise some form of exercise activity on a daily basis, it’s so important particularly for the younger adults with physical disabilities. I also support residents with their individual and exercise or physio routines.” Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 19 There is evidence that the home is trying to arrange day trips and short breaks away for the people using the service, examples include trips to Centre Parks and Blackpool. And the co-ordinator is committed to increasing the opportunities for people using the service. New initiatives include, a home bar which is open 3 days per week, which is welcomed by some people but ideally they should have the opportunities to go out of the home if they want to have this type of experience, to integrate into the local community. The people who live in the home can attend church on request and church service s are also held within the home. The people we spoke to did not know what the menu choice was for the day, there was no evidence of menus being available in the dining rooms and staff didn’t know what the choices were either, they contacted the kitchen to find out. One person said, “The meals are okay, the staff tell us what the choices are usually.” Another said, “ I never know what the meal choices are, and have to be careful for health reasons what I eat. The cook does know what I can and can’t have.” Another said, “ I like the food but never know what is on the menu.” We discussed menus and food choices with the cook. The organisation responsible for catering issues standard menus to the homes, which have been designed around health eating and are nutritionally sound. There is some flexibility for local dishes and preferences. The menus are organised over a four weeks period. From discussion it was evident that the menus are used as a template but that decisions about what is served to individuals is made by the catering team. There did not appear to be much evidence of discussion with individuals about the foods they would like to eat. The cook confirmed that care staff usually inform her if any one has a special diet and she gave an account of the procedure she follows for those individuals who require a pureed or soft diet. A separate record is maintained of the foods offered that are not on the standard menu. A hot breakfast is provided every other day, for example - bacon and tomatoes or sausage and beans etc. The care assistant helping in the ground floor dining room at lunchtime was observed to be ignoring the people around her. She told us that she had completed NVQ level 2. She went about her duties in the dining room without speaking to any of the people using the service the whole time we were there (10 minutes). We spoke to the son of a resident and he thought that the meals are good in the home. He told us that his mother likes the meals. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 20 We spoke with 4 residents sat at dining room tables waiting for lunch – all said that the meals are good at the home. One gentleman said that the meals were good, he said, but had ‘dropped off lately’ due he thought to staff having been away a lot. He said that sometimes they were kept waiting a long time for meals to be served. This was observed to some degree in the elderly care dining room with residents kept waiting at the dining tables for a long period of time before receiving their lunch. One of the people using the service told us that she would like to go swimming and we discussed this possibility with the manager. The home employs 3 activity co-ordinators. Two were off duty at the time of the visit. We met one of them who has recently been employed by the home. She was working on the young person’s unit. We observed her with one person carrying out therapeutic limb movements and exercises. This activity co-ordinator told us told us that she is arranging trips out for the people using the service. Trips out are arranged to places of interest and there were photos up on the wall to evidence this. The home still has its own minibus in which to take people out. Although there is an activity and entertainment programme in place for some people, there was not much activity underway with the other people in the elderly care unit downstairs and many were sleeping. The expert by experience said - “One gentleman told us that he mostly watched TV and read (though there was no evidence of reading material) and asked where he got books from, he said you had to ask for them. My overall impression, having spent time in both day lounges, is that there seems practically no interaction between residents, and limited interaction between staff and residents. I noticed that during the lunch in the dementia unit, staff were not on hand to help residents to eat, or talking to them. This could have been an ideal opportunity to stimulate residents, to talk about the food, with the aid, perhaps of photographs of specific food items. I thought the contrast between the pleasant dining area in the main unit, and the smaller, more, basic dining area in ‘dementia’ unit, was marked. There was more activity in the main one, unlike the smaller, dementia lunchroom where there was almost silence. There were no menus on display in either dining room and it was unclear what choice residents had over what they ate for lunch, although I was told they are offered a choice the day before. (For people with dementia – this may be difficult). The fourth resident, in the dementia unit, said that she was happy with the home and the staff. She said the food was good, but would prefer a cooked breakfast to cereal. With regard to activities, I was informed that there were two part-time activity coordinators on the elderly residents’ units, but there was no one there on the morning of my visit and no activities going on. I heard mention of quizzes, and bingo and some outings, but would have liked to have seen evidence of Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 21 activities specifically relating to dementia, e.g. group conversation sessions, reminiscences etc. I think it is important to provide some kind of activity in the morning as well as in the afternoon. Often people are more alert in the morning.” Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems adopted by the home help to keep the people using the service safe but do not always encourage them to raise any concerns they might have. EVIDENCE: In their AQAA the Providers tell us – “Relatives and residents are made fully aware of how to raise concerns. The home responds thoroughly and effectively to complaints and concerns. Maintain and review complaints logs to as an indicator to improvement in service provision. Open door policy encourages comments and questions before complaint is raised.” Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 23 We have received one complaint since the last inspection, which was effectively investigated by the Provider at the time. The new manager confirmed that she is starting to log concerns and complaints and will deal with them as per their procedure. The Complaints procedure is displayed on the wall. Some people say they know how to make a complaint but others do not. Staff are aware of the complaints procedure but may not realise the importance of listening to, and then acting on residents’ concerns. The son of one resident and the daughter of another both stated that they would know who to go to and that concerns they had had in the past had been sorted out quickly. One resident told us - “ I don’t know how to make a complaint, I wouldn’t know who to go to,” and she didn’t know who her key worker was.” The cook said that she didn’t record any of the complaints or compliments received about the quality or choice of food provided, this is a real opportunity missed to evidence if people satisfied with the food they receive. Some staff have had training around safeguarding adults but others have a limited understanding in this area. We spoke to several staff members, one told us that she was not familiar with safe guarding procedures when asked, but understood what constituted abuse and what to do about it if it was suspected. The others confirmed that they had received training in Safe Guarding procedures and were aware of the relevant procedures. We looked at their respective training records and this confirmed that they had received the training. We also looked at their recruitment folders and these confirmed that they had all received the required checks prior to being offered employment at the home. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,24,26 and 30 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a safe, clean and homely environment, which has been adapted to meet their specific needs. However, people are not always able to remain private in their own bedrooms. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 25 EVIDENCE: In their AQAA the Providers tell us – “The home provides a homely and comfortable environment which is clean and is odour free. Home Manager and Operations Manager monthly audits identify areas for improvement and maintain standards. Residents are encouraged to personalise their own bedrooms. All areas of the home are wheelchair accessible and All necessary equipment and training is provided. All areas of the home have available nurse call alarms. To enable the independence of all our residents on our Younger Persons Unit we have arranged to have environment control systems installed for use of nurse call buzzers and to perform tasks such as putting on their tv and lights etc to allow them to maintain as much independence as possible. The environment on our dementia care unit has been specifically designed to offer stimulation to the residents”. We looked around all the communal areas and a random sample of bedrooms. Bedrooms had been personalised and adapted to suit the needs of the person. The young persons unit had been redecorated since the last inspection. Bedrooms on this unit were very much personalised and adapted. The store cupboard on this unit was very untidy and full of extraneous items. The fire door to this room was left open even though it had a sign on saying “fire door keep locked”. The acting manager said that she had asked staff many times to keep this locked. Also she said that the room was in the process of being sorted out. We observed the use of specialist equipment for people with specific physical limitations and pressure relieving equipment. The environment was clean, warm and well lit. The ground floor dining room had been redecorated since the last inspection and tables were laid attractively for lunch. The programme of redecoration and refurbishment now needs to continue through the remainder of the home, as some areas are still looking worn and shabby. We spoke with several people using the service and visited their bedrooms. One of the people stated that he was moving to a new room because his current room is too small for him to turn around in his wheelchairs, he has been in this room for about five years. His current room needs some minor redecoration, for example there is some flaked paint and some scuffed woodwork, but the room is well personalised and evidence that he has made it his own with the support of his family and the staff team. His new bedroom is much bigger and has a laminated floor covering, which he says will also make manoeuvring his wheelchair easier. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 26 Another person’s room was visited. It is a single room and has a basic appearance although some personalisation is evident. Another room was seen to be larger, with an abundance of personal belongings and despite the need for specialist equipment appeared comfortable and homely. The person stated that he is satisfied with the environment. We looked at two bathrooms, the hot water temperature was low in one of the bathrooms and there was shampoo, deodorant and talcum powder in the cupboard, all items were unnamed suggesting communal use. This is not acceptable, and does not meet with person centred principles. The expert by experience told us “The care home is split into two areas of provision. On the ground floor are two units – one a 12-bedded unit called the ‘dementia unit’ and the other for elderly residents with various nursing needs. (The first floor is dedicated to younger adults). The corridor in the ‘dementia’ unit was colourfully decorated on a floral theme and very welcoming. I was able to engage four residents (two from each unit) and two relatives in conversation. There are two outside areas, one enclosed for the ‘dementia’ residents and one larger area, which looked a bit neglected, with overgrown grass etc. The ‘dementia’ outdoor area, too, might benefit from some comfortable chairs, and whilst the sand ‘beach’ area was a nice idea, I thought the two deck chairs, could be a safety hazard for residents with dementia, as they might trap their fingers in them. I am sure that the new manager, who has only been in post for a matter of weeks, will address these issues. I met a resident and her daughter and friend in her room in the dementia unit. The room was not en-suite and I was shown the very small corner sink, which she washed. The resident was very lucid. She said that she was unhappy with the way in which a man ‘came into her room’ once when she was washing and another time when she was in bed. The policy of the home is to keep residents’ rooms unlocked and preferably with the doors ajar. Residents cannot lock them from the inside. The relative and friend felt that this was an invasion of privacy and a loss of dignity. Perhaps the home should review this policy and consider allowing residents to lock their doors, staff retaining a master key. This individual is a private person and this privacy should be respected.” Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All the standards for this outcome were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A trained staff team cares for the people who live in the home. Staff do not interact well with people with dementia and cannot be sure that their needs are met. EVIDENCE: In their AQAA the Providers tell us – “All staff are well trained for the purpose and thoroughly checked prior to employment. All statutory recruitment checks, mandatory training sessions and personnel Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 28 files are maintained and monitored. All staff have detailed induction under supervision of a mentor, during which time they are supernumery. A high percentage of our staff are qualified to NVQ level 2 and 3. All staff undertake regular supervision and appraisal sessions. Rotas are evaluated with regard to skill mix.” We interviewed four staff members; care staff did not know what the General Social Care Council code of conduct was. Staff confirmed that they had undergone pre employment checks and had received mandatory training. We interviewed a Registered Nurse who has worked at the home since 2005. She told us that staff turnover is rapid at the home. She said that she is just completing the Student Mentorship Course run at keele University and that the home has paid for this. She confirmed that she has done Moving and Handling and fire safety and fire drills, the most recent being last Tuesday. She confirmed also that she has received Whistle Blowing and PoVA training and she explained what she would do as the nurse in charge if a safeguarding incident arose. She confirmed that she attends staff meetings held at the home and that she enjoys working at the home. Staff files were examined and evidence of training certificates were seen to confirm the above. Some of the required information of newly appointed staff was missing and were informed that these were with Head Office. It is recommended that all information be kept together in the staff file for inspection and auditing purposes. At the time of the visit there were 57 people living in the home. On the Dementia care unit there were 10 people. There were 16 people with elderly frail nursing needs and 3 with residential care needs. There were 20 Young People with nursing needs and 5 with residential care needs. There was 1 in person in hospital at the time of the visit. Staff on duty at the time comprised of the newly appointed manager (who, we were informed, would be registering with us). The Deputy Manager – who was working on the Young Persons unit and the Registered Nurse who was working on the elderly frail unit. We were informed that the following staff numbers was normal for the home and examination of staff rotas confirmed this. From 8am-8pm there are 2 nurses then 1 at night. 6 carers upstairs (YPD) from 8-2 then 4/5 until 8pm Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 29 Dementia Unit – 2 carers on all day Nursing downstairs –3 to 4 carers from 8am until 2pm then 2 until 8pm Nights – 2 carers upstairs, 3 downstairs and 1 on dementia unit plus 2 nurses. Ancillary staff – kitchen and domestic – appeared adequate 1 full time maintenance person and 3 activities co-ordinators There is also 1 administrator working at the home. Staff training also includes Palliative and Dementia Care and staff confirmed that these had taken place. NVQ training is underway at the home and the manager confirmed that she will be taking this forward. Nurses also receive regular clinical update training, one example is tracheotomy care. It was noted by the expert by experience that the staff atmosphere on the dementia care unit was not good. The 2 staff members were not interacting well with the people using the service or each other. It was later identified that the manager had held a meeting with them about this. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 31 Standards 31,33,35,37,38,39 and 42 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a satisfactory management structure in the home and, although the manager is new to post, she is supported by senior staff and Regional Management. The open culture at the home will be further developed by improving outcomes for the people using the service and ensuring that the home is run in their best interests. EVIDENCE: In their AQAA the Providers told us – “We have a thorough system of quality auditing. Policies and procedures provide guidance and ensure the home operates within best practice and legal guidelines. There is effective communication throughout the home with regular staff meetings and updates.” We met the new acting manager Miranda who told us that she would be applying to become Registered Manager at the home. She has only been in post for a very short time. The Care Manager Natalie, who has worked at the home for many years was on duty at the time of the inspection and will support the manager. Each unit has a manager in place. The Quality Assurance system adopted by Southern Cross is in place with audits of all the services. Also, the Regional Manager visits monthly and completes a monitoring form, which is kept at the home. Meetings are held in respect of the people using the service and staff and minutes of these were seen. There is a need to obtain the views of the people using the service more often as evidence for this is limited. The same system is in place for maintenance of personal allowances and the people using the service have access to their monies whenever they require it. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 32 Health and safety is maintained at the home. Records were seen of maintenance and servicing of equipment. These are up to date, as are tests of fire alarms, hot water temps and other relevant checks. Individual risk assessments are in place in care plans. Environmental risk assessments are also in place. The manager will need to address the improvements needed and highlighted in this report. These were discussed with her during the feedback. At the time of the visit, the manager was very new to post, only having been there for a couple of weeks. She has plans in place to improve outcomes for the people who live at the home. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 33 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 2 x 3 3 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 ENVIRONMENT Standard No Score 19 3 20 x 21 x 22 x 23 x 24 x 25 x 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 x 33 2 34 x 35 3 36 x 37 x 38 3 Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP12 Regulation 16(2)(m, n) Requirement The quality of life must be improved for the residents on the dementia care unit. This is in reference to the meeting of social care needs. Individuals must be given the option of being able to lock their door following a suitable risk assessment. This is to ensure that privacy and dignity are promoted. Care plans must be reviewed regularly with the resident/representative so that they have an input into their care and documentation must be completed as required. Timescale for action 20/08/08 2 OP10 12(4)(a) 20/08/08 3 OP7 15(2) 20/08/08 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. Refer to Standard OP12 Good Practice Recommendations It is recommended that the Provider explore the possibility of finding a suitable day care placement for the lady who is DS0000026933.V368307.R01.S.doc Version 5.2 Page 35 Acres Nook 2 3 OP33 OP15 4 OP1 registered blind in order to meet her specific needs and improve her quality of life. Individuals should have the opportunity to express their views as to the running of the home. Therefore residents’ views should be obtained regularly and recorded. The Provider should be able to demonstrate that individuals are given choices in respect of the meals provided. Each individual should have sight of a menu and be provided with the meal of their choice. The alternative dish on offer for each meal should be made know to the residents. The Service User Guide does not contain the range of fees charged and these should be included, so that people are aware of how much the home charges. The Provider should also ensure that the Statement Of Purpose, Service User Guide and last inspection report are made available and accessible to all the people who live in the home so that they have up to date information about the home they live in. Acres Nook DS0000026933.V368307.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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