Inspection on 31/05/06 for Five Acres Nursing Home

This inspection was carried out on 31st May 2006.

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

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

Other inspections for this house

Five Acres Nursing Home 16/07/07

Five Acres Nursing Home 16/12/05

Five Acres Nursing Home 21/06/05

Five Acres Nursing Home 01/03/05

Five Acres Nursing Home 26/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Five Acres Nursing Home Five Acres Simpson Village Milton Keynes Bucks MK6 3AD Lead Inspector Christine Sidwell Unannounced Inspection 31st May 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000048153.V289316.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000048153.V289316.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Five Acres Nursing Home Address Five Acres Simpson Village Milton Keynes Bucks MK6 3AD 01908 690292 01908 696244 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) Five Acres Nursing Home Ltd Terri Walker Care Home 32 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (22) of places DS0000048153.V289316.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. That as of the 21st of October 2005, the home is registered for the admission of service users over the age of 60. 16th December 2005 Date of last inspection Brief Description of the Service: Five Acres is a privately owned care home offering personal and nursing care for thirty-four older people over the age of sixty. Five Acres is an older building set in pleasant grounds in Simpson. There is a combination of single and shared rooms, although most of the shared rooms are currently used as single rooms. The home has a lift. There are dining and lounge areas. The village of Simpson is situated on the outskirts of Milton Keynes, with public transport links into the city centre. There are qualified nurses, supported by a team of carers, on duty at all times. There is an experienced management team. Fees as at April 2006 range from £540- £670. Additional charges are made for hairdressing, chiropody, personal transportation and holidays. Telephoning or visiting the home can obtain information about the home. DS0000048153.V289316.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a number of days and included an unannounced seven-hour visit to the home. Prior to the fieldwork visit previous information about the home was reviewed and the outcome of previous inspections noted. Fifteen questionnaires were sent to the home for distribution to service users and their families. Five service users and five family members returned them. Comment cards were also received from two general practitioners, a care manager and a therapist. Residents and those family members who were visiting on the days of the fieldwork were interviewed. A tour of the premises was undertaken and records held in the home were scrutinised. The care of a number of residents was ‘case tracked’ from their original contact with the home to the care that they are now receiving. Care practices and the home’s approach to quality and diversity issues were observed. What the service does well: What has improved since the last inspection? The care plans have improved since the last inspection and care staff have more information to assist them to care for residents. Infection control procedures have improved and the laundry floor is now impermeable. DS0000048153.V289316.R01.S.doc Version 5.1 Page 6 The activity programme has improved although there is still a need to devise individualised activities for all residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000048153.V289316.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000048153.V289316.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the home. The admission policies and procedures work well giving both the home and the potential resident the confidence that the home can meet their needs. EVIDENCE: The home has a statement of purpose, resident’s guide and brochure, which collectively describes the care and facilities on offer. Potential residents have the opportunity of a trial stay before deciding to move to the home on a permanent basis. The home also offers respite care. The care of four residents was followed through. All had been pre-assessed by the manager or a qualified nurse prior to moving to the home. There were copies of the appropriate care manager’s reports on file and the residents had an initial care plan based on the assessments. The home does not normally take emergency admissions but has a policy to cover this if necessary. Where an urgent admission from hospital is required the manager will assess the potential resident in hospital before admission. DS0000048153.V289316.R01.S.doc Version 5.1 Page 9 One family member was spoken to and she said that her mother had been visited before she moved to the home from and that she was satisfied with the way in which her mother’s needs were assessed. The home does not offer intermediate care. DS0000048153.V289316.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the home. The personal and healthcare needs of residents are identified and are met, with evidence of multidisciplinary input. The systems for medication administration have improved and residents receive their medication in a safe and timely way. EVIDENCE: All residents had a care plan. Four care plans were examined. Although standard care plans are used they are tailored to identify individual need. The detail and content of the care had improved since the last inspection. All had daily entries and had been reviewed monthly. Service users or their families had been involved in drawing up care plans. Residents were spoken to and observed in the lounges. All had had help with their personal hygiene and were wearing appropriate clothing. Some had dirty fingernails and this aspect of care must be monitored continuously. The home has policies and procedures in place to prevent pressure damage. The care DS0000048153.V289316.R01.S.doc Version 5.1 Page 11 plans seen had evidence that an assessment had been made to measure residents’ risk of developing pressure damage. One resident has pressure damage. This had been recorded correctly and a plan had been drawn up to promote healing and prevent further deterioration. The advice of the tissue viability nurse had been sought. Risk assessments have been introduced to measure resident’s risk of falls. The accident book showed that one resident had had frequent falls. She had been assessed by the general practitioner, had her medication reviewed and was wearing hip protectors. The local Primary Care Trust does not now provide specialist mattresses to residents in nursing homes. The home has a number of such mattresses and a maintenance schedule should be set up to ensure that they continue to function properly. Resident’s continence needs are assessed and the appropriate aids supplied by the Primary Care Trust. The management of continence has improved greatly since the last inspection. Residents are assisted to the toilet on an individualised basis rather than at set times during the day. There were no offensive odours. Nutritional screening had been undertaken and the carers spoken to were aware of residents needs for nutritional supplements. The weather was hot on the day of the inspection and all residents had a drink to hand. The staff were seen to be actively encouraging residents to have a drink. Residents are weighed regularly. One resident had lost weight and the advice of a dietician had been sought. Her weight loss had stabilised. There was evidence in the files that residents had access to specialist healthcare services. Two general practitioners returned the comment cards and both said that staff demonstrated a clear understanding of the care needs of residents and that their advice was followed. The speech and language therapist also said that she had been impressed by the fact ‘that staff went out of their way to help one service users who was having a course of treatment and to ensure that appointments were not missed and that a carer was able to attend with the resident. There are medication policies and procedures in place. The staff spoken to were aware of these. No service users manage their own medication at present. The home uses a dosette system of administration provided by a local pharmacist. There was evidence that the pharmacist undertakes regular audits of medication management. Records as to medication entering and leaving the home are kept. The medication administration charts were examined and contained no gaps. The reason why medication is not given was recorded. All charts had the resident’s photograph and a note was made as to allergies. The controlled drugs were recorded and stored correctly. Residents were observed to be treated with respect. The staff addressed them by their names and went up to them to speak. The manager said that residents could have telephones in their rooms although they would be responsible for the installation an maintenance costs. The general practitioners who returned the comment cards said that they could see their patient in private. DS0000048153.V289316.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using all available evidence including a visit to the home The homes endeavours to meet residents’ wishes for social activity, recreation and maintaining contact with people who are important to them. There is a need to develop a more individualised approach to this if resident’s personal activity and recreational needs are met on an individual, daily basis. EVIDENCE: Resident’s choice as to how they spend their day is constrained to a certain extent by the routines of the home and the staffing levels although the carers spoken to said that they tried to accommodate resident’s wishes wherever possible. The local vicar visits the home regularly. There is an entertainment programme and three of the five residents who returned the comment cards said that the home provided suitable activities although two did not. Some carers were observed to be undertaking activities with residents. One carer has dedicated time in the afternoons to lead on the activities. The activities programme has improved since the last inspection although there is still a need to incorporate activity into the daily routines and to try to devise individualised activity and recreation plans. The key workers could assist with this. The family members who returned the comment cards said that they DS0000048153.V289316.R01.S.doc Version 5.1 Page 13 could visit at any time and see their family member in private. No service users are able to manage their own financial affairs and these are dealt with by families. Information about local advocacy services is posted in the main entrance hall. Meals were seen to be a sociable occasion and most residents sat at a dining table for their meal. Carers were assisting residents sensitively. There is a four-week menu plan and the meal served at the unannounced inspection was that described on the plan. The chef had a good understanding of residents needs for a specialist diet and was providing a varied vegetarian diet for one resident of the Hindu faith. Pureed meals were presented attractively although moulds are not in use. Three of the five residents who returned the comment cards said that they liked the food, one said sometimes and one said no. The residents spoken to said that they were enjoying their lunch. DS0000048153.V289316.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using all available evidence including a visit to the home. Residents and their families have access to a robust complaints procedures and have confidence that any concerns they may have will be addressed. Policies and procedures are in place to protect vulnerable adults from abuse. EVIDENCE: There is a complaints policy. A record is kept of all complaints and written letters of appreciation. There are local advocacy groups who can help residents and their families if they wish and details of this posted in the entrance hall. The home has a copy of the local multi- agency strategy for the protection of vulnerable adults and staff had received training in this topic. The staff interviewed could describe the different types of abuse an older person may be subject to. They all said that they would always report any concerns. The Commission for Social Care Inspection has not received any concerns, complaints or allegations since the last inspection. DS0000048153.V289316.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using all available evidence including a visit to the home. Although improvements have been made to the environment resident’s rooms require refurbishment if they are to provide a cosy and comfortable room in which to live. EVIDENCE: The home is an older building with a recent addition. There have been some improvements to the environment. There is a redecoration programme and two of the lounges and some parts of communal areas have been redecorated within the last two years and new curtains bought. There is a need to redecorate the central lounge and foyer, which acts as a thoroughfare to other parts of the home and does not provide as cosy an environment for residents as the other lounges. Many of the chairs have been replaced. The gardens are mature and attractive and a safe area has been fenced for residents who may wander. There are no CCTV cameras. The last fire officer’s inspection was DS0000048153.V289316.R01.S.doc Version 5.1 Page 16 11th January 2006 when all fire matters were deemed satisfactory. The recommendations of the environmental health officer have been put into place. Some resident’s rooms have been redecorated. Most are carpeted. The standard of decoration and furnishings in resident’s rooms is in need of improvement. Some rooms are personalised with resident’s own belongings, but not all and the standard of the furnishings for those who do not have their own furniture is poor. The rooms are individually and naturally ventilated. The infection control policies and procedures have been improved since the last inspection. All residents now have liquid soap and paper towels in their rooms. The clinical waste is collected weekly and is stored discretely. There is a sluicing facility. There is a separate laundry and new washing machines have been purchased in the last two years. Soiled laundry is washed appropriately. The laundry floor has been replaced and is now impermeable. DS0000048153.V289316.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using all available evidence including a visit to the home. Staffing levels and recruitment procedures are thorough and a competent care team cares for residents. EVIDENCE: The home employs nine qualified nurses and sixteen carers. A record is kept of the staff on duty. Resident’s needs were met in a timely way on the day of the inspection and all residents had been helped up by coffee time. Four of the families who returned the comment cards said that they felt that there were sufficient staff on duty. Of the sixteen care staff, six hold the National Vocational Qualifications in Care at level 2 or above and a further five are undertaking the course. The home does not yet meet the standard that 50 of staff hold this qualification but has made good progress towards this Three recruitment files of recently employed staff were examined. They contained the correct documentation. All staff had two references and had had a Criminal Records Bureau disclosure before commencing work. Interviews had been held and records kept. Four staff have left since the last inspection, two to relocate, one because they were not happy and one for better prospects. The staff turnover rate has reduced considerably over the last year. There are staff training programmes in place. The focus of this year’s training programmes has been dementia care training. Eight staff have completed a dementia care training course with the local further education college and a DS0000048153.V289316.R01.S.doc Version 5.1 Page 18 further twelve are undertaking this. The staff spoken to said that they had had an induction programme DS0000048153.V289316.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using all available evidence including a visit to the home. Overall the management arrangements are satisfactory although there remains a need to implement a systematic quality assurance programme and to review the health and safety policies and procedures to ensure that the care residents receive continues to improve. EVIDENCE: The manager has been in post for eighteen months. She is a registered nurse and has completed the National Vocational Qualification in Management at level4. The staff spoken to said that the manager was willing to listen and that they enjoyed the atmosphere in the home. New proprietors who have experience of the running care homes have bought the home. The home does not as yet have an agreed development plan DS0000048153.V289316.R01.S.doc Version 5.1 Page 20 although both the manager and the new owners have indicated that this will be developed. The manager said that residents and family satisfaction surveys have been undertaken in the past but not recently. A requirement was made at the last inspection that the proprietors implement a systematic quality assurance programme, which takes into account the views of residents, staff and other stakeholders. It will be for the new proprietors to take this forward with the manager. The home does not manage money on resident’s behalf. A small amount of personal allowance may be kept in safe storage. This was found to be correctly managed. There are moving and handling policies and procedures in place. The staff spoken to had had manual handling training and the training records showed that ongoing training is in place. The health and safety policy and procedures and nominated individuals will need to be revised to reflect the new management structures. The maintenance schedules showed that routine maintenance is undertaken on an annual basis. The handyman maintains weekly checks of wheelchairs, fire alarms, fire exits, water temperatures, windows and emergency lighting. Door closures and call bells are checked on a monthly basis. The last fire inspection was undertaken on the 11th January 2006 when all matters were satisfactory. Clinical waste is managed appropriately. Accidents are recorded. The generic risk assessments will need updating on an annual basis and should be reviewed by the new proprietors. DS0000048153.V289316.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 DS0000048153.V289316.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP12 OP24 Regulation 16 16 Requirement Individualised daily activity plans should be developed with residents. A programme to refurbish resident’s rooms over a period of time should be agreed with The Commission for Social Care Inspection for Social care Inspection. The remaining old divans should be replaced with height adjustable beds for all residents requiring nursing care. This is an unmet requirement of the previous report and a new timetable has been set. The proprietors and manager should agree and implement a systematic quality assurance programme. This is an unmet requirement of the previous report and a new timetable has been set. The proprietors and manager should revise the Health and safety policies and procedures in view of the new management DS0000048153.V289316.R01.S.doc Timescale for action 31/10/06 31/10/06 3 OP24 23 31/03/07 4 OP33 24 31/10/06 5 OP38 13 31/10/06 Version 5.1 Page 23 arrangements and ensure that they comply with the recommendations of the Health and Safety Executive. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000048153.V289316.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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. 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