Inspection on 08/06/05 for Acres Nook

This inspection was carried out on 8th June 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 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 23/06/08

Acres Nook 30/08/06

Acres Nook 18/11/05

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 HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Acres Nook Boathorse Road Kidsgrove Stoke-on-Trent Staffordshire ST7 4JA Lead Inspector Yvonne Allen Unannounced 8 June 2005 10:00 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 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 E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Acres Nook Address Acres Nook Boathorse Road Kidsgrove Stoke-on-trent Staffordshire ST7 4JA 01782 773774 01782 777560 Telephone number Fax number Email 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 Jeanette Blandford CRH 72 Category(ies) of PD (36), PD(E) 48, OP (72) registration, with number of places Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 36 Physical Disability (PD) - minumum age 30yrs on admission. Date of last inspection 19TH July 2005 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 service users. The home can admit service users 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 service users and the first floor to younger adults. A passenger lift and stairs provides access between the floors. Both service users 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 service users 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-on-Trent. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 6 hours by 2 inspectors. During the course of the day a tour of the home was conducted where many bedrooms, all communal areas, the kitchen, laundry and garden were inspected. Inspectors spoke with many residents, staff members and the management team. Lengthy discussions were also held with visiting relatives. Relevant records and documentation were examined and inspectors directly observed the delivery of care and activities within the home. Some weeks prior to the inspection the providers had provided the CSCI with an action plan outlining how they planned to address recent concerns and problems at the home. Not all standards were assessed on this visit. The majority of those standards assessed were fully met and others were almost met. The standards scoring 1 were because there is a requirement for a registered manager, albeit the home is well managed on a temporary basis. The other score of 1 was due to a lack of documentation of formal staff supervision. However staff at the home felt well supported and directed by the managers. At the end of the inspection verbal feedback was given to the acting managers. What the service does well: Since the last inspection there had been an intensive staff-training programme developed and successfully implemented at the home. All staff spoken to had received mandatory training and felt sure of their job roles. Staff felt very well supported by the temporary managers. The management style was identified as being open and transparent. The temporary managers had worked very hard to address the problems, which had previously developed within the home. The therapeutic activities provided by the home for the residents were very good. The activities team were dedicated and enthusiastic. There was a vibrant atmosphere between the co-ordinators and the residents involved in the activities. The co-ordinators worked hard to encourage the residents to become involved. They had also organised trips out and had recently taken residents on holiday. Links with the local community were maintained and enriched the social and educational opportunities for the residents. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The standard of care plans will need reviewing and discussions with the managers identified that this was next on the agenda for improvement. The plans will also need to reflect involvement and consultation with residents and/or their representatives. The recruitment procedure will need tightening up and all the information required will need to be obtained. The Registered Manager had left the home and at the time of the inspection there was no Registered Manager in the post, thus a scoring of 1 has been attributed to this standard. The managers will need to ensure that requirements made as a result of complaint investigations are addressed. This was in relation to the provision of an extra member of staff to help residents with delivery of their breakfasts. This was identified as being a problem earlier this year and was still a problem at this inspection. This had a knock on effect of residents having to wait for their medication, some of which was up to 2 hours late. Although there had been some improvements to the environment, there is still a long way to go to ensure that the home is meeting standards both internally and externally. A planned programme of redecoration and refurbishment is required by the CSCI. The home also needs a gardener, as the maintenance of the exterior of the home is a job in itself. Residents and their families must be kept informed of any changes in the home and the reasons for the changes. Those spoken had felt very worried and Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 7 unsure of what was happening. They stated that they had received a letter but that verbal communication as well would have helped. 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 E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 8 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 Standards 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 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 9 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. 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. Prospective service users have an opportunity to “test drive” the home. 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 All Residents undergo an assessment of their needs before being offered a placement at the home. After a period of uncertainty at the home it is now evident that individual assessed needs are being met on a continuous basis. EVIDENCE: Residents undergo an assessment of needs before being offered a place at the home. This pre-admission assessment was seen contained in individual care plans. Assessments had been carried out by the previous manager, acting manager and registered nurses from the home. In some instances other professionals had been involved in assessments, these included social workers and doctors. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 10 Residents and their families receive confirmation that the home they are entering can meet their assessed needs. Those spoken to on the day of the inspection stated that, although they had had concerns about the home they now felt that services at the home had improved and was now meeting their needs. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, and 10 Further attention to personal care needs and individual care plans is required. The registered person promotes and maintains residents’ health and ensures access to health care services. The medication process in the home is in need of reviewing. The home needs to address some areas of concern in order to ensure that privacy and dignity are maintained for residents. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 12 EVIDENCE: A selection of care plans was examined on both units. The overall standard of care planning was in need of some improvement. Plans were inconsistent with some having been reviewed more regularly than others. Plans had not always been evaluated with the resident and/or their representative and there was limited evidence of consultation or participation with the resident. Personal risk assessments had been developed within the plans and residents were given opportunities to make choices in relation to all aspects of their care. Residents spoken to at the time of the inspection confirmed this. Not all personal care needs were being met effectively. One resident stated that she sometimes had to wait up to half an hour to be taken to the toilet after ringing the call bell. Inspectors noted that, on the day of inspection, call bells were left ringing for a considerable length of time and it is essential that the acting manager monitors this and takes action where necessary. Another resident was observed slipping down in her wheelchair, which she had been left sitting in the lounge, as there was no suitable easy chair for her. A requirement for this lady to have a special chair had been made following a complaint visit to the home earlier this year and this had not been addressed. The inspector was informed that a chair had been ordered for this lady and was due to be delivered that week. Individual health care needs had been assessed and there was evidence of monitoring of health including visits by healthcare professionals. Residents spoken to stated that they could see the doctor when they needed to. One resident was staying in her room for the day as she felt unwell and she had seen the doctor who had prescribed medication for her. There was evidence of visits by the optician and chiropodist. There was evidence of the monitoring of tissue viability, nutrition, mobility and nursing care. Care plans were in place for the monitoring and treatment of diabetes and other medical conditions. One of the residents had been reassessed and involvement with the dietician in relation to his PEG feed and change to his feeding routine had meant that this resident could now get out of bed and into a chair. The inspector observed a medication round being administered by the nurse on duty. There was concern regarding the fact that medication was being administered at 11am when it was prescribed for 9am. The nurse stated that she had started the round at 9am but had waited for some of the residents to come to the dining room for breakfast. Also, due to staff sickness that morning, she had been helping the care staff. Medication should be administered at or around the time for when it is prescribed as this can have a cumulative effect – with some residents having more medication at 1pm – there should be a four-hour gap in-between. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 13 Residents spoken to confirmed that their privacy and dignity were respected and that most of the staff were very helpful and attentive. It was noted that dignity was not always upheld during mealtimes with some of the staff standing up whilst feeding residents. This practice must stop. It was also noted that a resident was making a personal telephone call from the nurses, desk on the second floor. Another resident commented that there used to be a plug in mobile public telephone, which was used from bedrooms. There is a need for this type of telephone on this unit so that residents can make calls in private. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 The routines of daily living and activities are made flexible and varied to suit residents’ expectations, preferences and capacities. Links with the local community are good and support and enrich residents’ social and educational opportunities. Residents receive a varied, appealing, wholesome and nutritious diet. EVIDENCE: The programme of activities and entertainment provided at the home was very good. The activity co-ordinators were observed on the day of the inspection interacting very well with the residents. It was a sunny day and gazebos had been erected outside the front of the home. Residents were enjoying ice creams and playing games, there was a good atmosphere with plenty of chattering and laughing. Earlier on residents on the second floor had been involved in activities. Residents and their families spoke highly of the activities co-ordinators. Trips out had taken place and the co-ordinators were careful to include all the residents in turn on the trips out. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 15 It was noted that, in order to meet the social needs of residents at the home, a permanent minibus is required for this home with a tailgate lift. Without this some residents would be excluded from trips out. This has been a complaint issue raised by an advocate of one of the residents earlier this year. The home had recently organised a holiday to Centre Parcs with three residents. These residents confirmed that they had really enjoyed this. All activities and entertainment in which the residents participate were documented. The co-ordinators also carried out one-to-one care where residents are unable to participate in the activities arranged. Links with the community were maintained with some residents visiting the local shops and amenities on a regular basis. Residents went out for pub lunches and out with their families. Church services are held on a regular basis and some residents go out to church. One of the residents went to see Elton John at the Britannia Stadium recently. The lunchtime meal appeared appetising and nutritious. Residents spoken to confirmed that the meals at the home were good. Menus were based on a four weekly rota and offered variety. There was an alternative available at every mealtime. Special diets and preferences were catered for and the cook had a list of what residents had chosen for their next meal. There was a separate menu for the YPD unit based on their preferences. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 16 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’ legal rights are protected. Service users are protected from abuse. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 There is a simple, clear and accessible complaints procedure in the home. After a period of uncertainty, residents and their families can now be assured that their concerns will be listened to and taken seriously. Staff will need further direction in local vulnerable adult policies and procedures to ensure that these are followed. EVIDENCE: There was a clear complaints procedure in place, which was displayed in the home. The acting manager logged complaints and action taken was documented. Since the last inspection there had been three complaints received by the CSCI of which some of the issues of concern were upheld. Issues raised included personal care, lack of staff and attitude of staff, not meeting personal needs, health and safety issues and a lack of communication. It was identified that some of the requirements from the last complaint investigation had not been addressed. This was brought to the attention of the acting manager who stated that she would address these. These have also been included in the requirements of this report for urgent action. A member of staff spoken to stated that she was aware of the policy and procedure in relation to adult protection. However her explanation of what she would do in relation to this pointed to the fact that she needed more training in this area. It is important that all staff are aware of the local policy and procedures in relation to the protection of vulnerable adults. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 17 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 have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22 ,23, 24, 25 and 26 The standard of décor and general tidiness in this home is in need of improvement and maintenance of future planning. The general cleanliness of the home had improved since the last inspection although this will benefit from attention to detail. EVIDENCE: A tour of the environment was conducted during which all the communal areas and a selection of bedrooms were inspected. The environment had improved from the last inspection. Some areas had been redecorated and some new carpets had been provided. There were still many areas in need of redecoration and refurbishment throughout the home and the provider will need to supply the CSCI with a copy of their improvement programme. There was still some mal odour noted in the home, which will need addressing. New bed linen had Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 18 been purchased since the last inspection. Many of the bedrails had been removed with new ones purchased for residents following a risk assessment. Regular checks are made on bedrails by the maintenance person and care staff and these are documented. There were no door locks provided on many of the bedroom doors. These must be provided and residents given the choice of having a key to their door following a risk assessment. It was noted that some of the radiator covers were in need of repair or replacement. The ground floor bathroom was cluttered with too much equipment. The extraneous items need to be removed and stored elsewhere. There was a general shortage of storage space around the home. There had been new easy chairs provided for residents in the ground floor lounge. The gardens were accessible to the residents and one of the residents was seen in his electric wheelchair enjoying the garden. The garden was looking somewhat unkempt and would benefit from tidying up. One of the residents stated that the home used to employ a gardener and that in his opinion the home should employ another gardener in order to maintain the garden. The bedrooms, which had been redecorated, were attractive and welcoming. This now needs to be continued throughout the home. There were some nameplates missing from bedroom doors where bedrooms were occupied. These need replacing as per fire safety requirements. The home had been adapted to meet the needs of the residents with specialist equipment provided to help with moving and handling and promotion of independence. The sluice contained old bedpans which were in need of replacement. There were also extraneous items stored in this area, which need to be removed. On the second floor there was a hairdressing salon where the hairdresser worked every Monday. There were some residents enjoying a cigarette in the smoking room. The temperature of the hot water from the bath tap outlet in bathroom number 2 was tested and measured 43 degrees centigrade. Hot water was tested and recorded as required. The storage shelves at the end of corridor areas, which were being used to store linen, would benefit from being covered by a door. The general cleanliness of the home was up to standard with a few exceptions, one being underneath the bath hoist chair in bathroom 1. The provisions of a waste bin and the instructions for the disposal of waste in this bin in the bathroom were misleading and need revising. The laundry and kitchen areas Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 19 were inspected and found to be complying with environmental health and infection control requirements. The seals were corroding in fridge number 3 in the kitchen and this is in need of replacement. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 After a period of considerable instability in staffing there is now a good match of well-qualified staff offering consistency of care within the home. There will need to be additional staff provided during breakfast time. An intensive staff-training programme had been successfully implemented at the home. The recruitment procedure will benefit from reviewing and tightening up. EVIDENCE: Discussions with residents and visiting relatives identified that they had been worried over the past few weeks in relation to staff leaving the home. One resident stated that the staff turnover had been great and that he was never sure who would be coming into his room to look after him. A visitor was concerned that the home had lost a lot of good staff and that there had been a high use of agency staff. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 21 One of the visiting relatives was very upset about the staffing arrangements in the home. She stated that she used to know who to talk to about her relative’s care in the home but that communication had broken down and that she no longer knew who to go to as there were so many new staff and agency workers. Discussions with the acting manager and care manager confirmed that there had been a number of staff who had left, some having been dismissed by the acting manager. The registered manager and one or two trained nurses had also resigned. The acting manager stated that this upheaval was now over and that new staff had been recruited and trained. The role of manager was currently being advertised. The residents and relatives also had concerns about the number of staff on duty on some shifts although they stated that numbers had improved recently. The ratio of trained and care staff on duty at any given times on both units had not changed since the last inspection. However, observation of the procedures and workload in the mornings on the ground floor confirmed a need for help over the breakfast period as both the trained nurse and the care staff were being taken away from the floor in order to help residents with breakfast. This was also causing a delay in residents receiving breakfast. This concern had been raised previously in a complaint investigation at the home and the requirement for an extra member of staff to help in the dining room over the breakfast period had not been addressed. This has been highlighted in this report for urgent action. The kitchen was staffed from 8am-7pm daily by a cook and kitchen assistants. The home had employed a new housekeeper. This gentleman had worked at the home previously and his role included the monitoring of the domestic and laundry staff. There was a full time maintenance person and administrator on duty who had both been employed at the home for a number of years. As previously mentioned there were two part time activities co-ordinators employed at the home. Examination of the duty rota identified that there were three care staff off sick on the day of inspection. Otherwise the duty was in keeping with staffing requirements Cover had been arranged for the care staff who were off sick. There had been a great deal of staff training at the home over the past few weeks. This training focussed mainly on mandatory health and safety training. This included moving and handling, fire safety, food hygiene and resident welfare training. NVQ training was also underway at the home. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 22 The staff members spoken to felt more supported at the home recently with their training needs. New staff confirmed that they had undergone thorough induction training at the home. The staff spoken to also confirmed that they were now more aware of what their job role is and felt more confident. The recruitment procedure at the home requires strengthening. Several employee files were examined in relation to recruitment at the home. It was identified that two of the files did not contain photographs and one did not contain identification of an employee. Another file did not contain references for the employee. CRB and POVA checks are carried out on all staff before they are offered employment at the home. These findings were discussed with the acting manager at the time of the inspection. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 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 and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 and 38 The temporary arrangements for management of the home are effective. The acting manager is supported well by her senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. Health and safety is maintained at the home. The home regularly reviews aspects of its performance. The management process would be enhanced by greater communication to residents and their families. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 24 EVIDENCE: The previous registered manager had resigned since the last inspection. The acting manager on duty was a senior manager from the company and an acting care manager from another home supported her. Both were working supernumery at the home. Staff members spoken to, felt very supported by the temporary managers at the home. They stated that a staff meeting had been held and the managers were approachable and listened to the staff. Discussions with residents and visiting relatives identified a lack in communication and it was suggested that the managers organise a resident/relatives meeting to discuss concerns. There is a quality auditing process in place at the home. A company representative audits services on a regular basis. These key-point audits are done on a 6 monthly basis. These include obtaining the views of the residents. The manager of the home also carries out monthly audits and obtains figures for the company. It is required that the results of quality audits are posted in the home so that the residents and their families are kept informed. Formal staff supervision had not been carried out as required. The acting managers had been focussing on staff training and ensuring that residents received the care for which they were assessed. The inspector was informed that this formal supervision would now be commenced. Records were examined in relation to maintaining a healthy and safe environment at the home. Servicing and relevant testing of equipment had taken place as required. Accidents and incidents had been recorded and reported as required. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 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 x 2 x 3 3 4 3 5 x 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 2 3 3 3 3 3 3 3 Score Standard No 7 8 9 10 11 Score 2 3 2 2 x Standard No 27 28 29 30 2 3 2 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 x 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 1 33 3 34 x 35 x 36 1 37 x 38 3 Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 26 no Are there any outstanding requirements from the last inspection? 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. 2. 3. Standard 7 7 7 Regulation 15(2) 12(1,2,3, 4) 13(4) Timescale for action Care Plans must be reviewed and By 20/8/05 regularly evaluated together with the resident/representative The call bell must not be left Immediate ringing with residents waiting for and on long periods of time going The resident left sitting in her Immediate wheelchair must have a specially and on adapted easy chair provided going whilst sitting in the lounge Medication must be administered Immediate at or around the time for when it and on is prescribed going Staff must sit down whilst Immediate helping residents to eat their and on meals going A mobile payphone must be By 20/7/05 provided for residents on the second floor to use All staff must be made aware of By 20/7/05 local VA procedures The provider must supply the By 20/8/05 CSCI with a planned programme of redecoration/refurbishment for the home Locks must be provided to By bedroom doors and be of the 20/10/05 type recommended by the fire safety officer and residents must be given a key if they wish Version 1.30 Page 27 Requirement 4. 5. 6. 7. 8. 9 10 10 18 19 13(2) 12(4)(a) 12(4)(a) 13(6) 23(2)(b) 9. 24 12(4)(a) Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc 10. 11. 12. 13. 14. 19 26 26 26 27 15. 26 16. 17. 18. 29 31 36 following a suitable risk assessment 23(2)(l) Extraneous items seen in bathrooms and sluices must be suitably stored away 23(2) The bedpans identified must be replaced 23(2) The fridge identified in the kitchen must be replaced 23(2)(d) Cleaning schedules must include cleaning bath hoist chairs effectively 18(1)(a) An extra member of staff must be provided to help in the dining room on the ground floor over the breakfast period 16(2)(j) The procedure for the disposal of clinical waste must be made clear to staff in all areas of the home 19(schedu Employee files must contain all le 2) the information outlined in Reg 19 schedule 2 8(1)(2) The provider must appoint a registered manager for the home 18(2) Formal staff supervision must be commenced with records maintained By 20/7/05 By 20/7/05 By 20/8/05 immediate and on going By 20/7/05 immediate and on going immediate and on going By 20/8/05 By 20/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 19 32 Good Practice Recommendations The home should employ a gardener in order to maintain the grounds and gardens A better level of communication should be developed between management, residents and their families. Acres Nook E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection Stafford - 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 E51 E09 S26933 Acres Nook V234190 080605 stage 4.doc Version 1.30 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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