Inspection on 11/01/06 for Four Acres

This inspection was carried out on 11th January 2006.

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

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

Other inspections for this house

Four Acres 29/01/08

Four Acres 07/12/06

Four Acres 26/07/05

Four Acres 07/02/05

Four Acres 05/08/04

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

CARE HOMES FOR OLDER PEOPLE Four Acres Archer Close Studley Warwickshire B80 7HX Lead Inspector Patricia Flanaghan Unannounced Inspection 11th January 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 Four Acres DS0000036343.V280696.R02.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. Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Four Acres Address Archer Close Studley Warwickshire B80 7HX 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) 01527 853766 01527 853766 Warwickshire County Council, Social Services Department Annis Irene Tombs Care Home 35 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (35) of places Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The total number of residents accommodated will be 35 to include up to 11 service users assessed as requiring dementia care. The entrance and exit doors to the dementia unit must have a discreet alarm system fitted so staff are aware when service users leave the unit. (1st January 2006) Services users assessed as requiring dementia care to be admitted only to the dedicated unit identified as `Warwick`. The garden to be used for the service users admitted to the dementia unit should be made safely accessible and stimulating for service users with dementia (July 31st 2006.) Four Acres may also care for a resident named in the care plan attached to the variation application dated 19th October 2005 26th July 2005 Date of last inspection Brief Description of the Service: Four Acres is a Local Authority home for elderly people, with thirty-five beds. It provides permanent care, short stays and day care. The home is situated in the village of Studley, which has a variety of shops, churches, public houses, social clubs, a library and community centre. There is a regular bus service to Redditch town centre. The home provides accommodation on two floors. There are four units, one of which provides short stay or respite care, and one of which provides care specifically for people with dementia. Each unit has a lounge/diner with kitchenette, and there are additional communal areas, including two conservatories, on the ground floor. The home has a hairdressing salon. On each floor there are bathrooms and lavatories suitable for people with physical disabilities. The kitchen, laundry and staff offices are situated on the ground floor. There is a shaft lift to the first floor. Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over three and a half hours between 9.30am and 2.30pm. This was the second visit of this inspection year. Discussions took place with residents, staff and managers. The inspection focused on the requirements arising out of the previous inspection, and the standards relating to medication, health and safety, staffing and management. A service questionnaire was completed by the home and returned to the Commission for Social Care Inspection (CSCI). The manager was asked to distribute other questionnaires regarding the service to residents, relatives and health care professionals. The completion of these is voluntary but proves useful in assessing the various views that are held. Four responses had been received by the CSCI at the time of writing this report. Comments were in the main positive, although one relative said that their relative is “very happy at Four Acres, although her room is in need of redecoration and has been for some time.” What the service does well: What has improved since the last inspection? A quality officer has also been appointed and is undertaking monthly quality reviews of the services provided by the home. Funding has been allocated to renovate the kitchen within the home as well as developing of a specialist unit. An activities co-ordinator is undertaking craft activities with residents twice a week. Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 6 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. Four Acres DS0000036343.V280696.R02.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 Four Acres DS0000036343.V280696.R02.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): None of these standards were assessed at this visit. Standard 3 was reviewed at the inspection of 26/07/05 and found to be met. Standard 6 is not applicable to this home. EVIDENCE: Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 9 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): 9 Residents are not consistently protected by the home’s policies and procedures for dealing with medicines, which could result in errors being made and risk to resident’s health. EVIDENCE: The arrangement for the management and administration of medications were observed on one unit within the home. The following issues were identified and discussed with both the manager and a senior member of staff: • • • Not all prn medications specified the reason for administration. One resident had run out of Paracetamol three days previous, there was no evidence that this had been re-ordered. Medications transcribed by hand were not always accurate, for example, Dipyridamole 100mg for a resident discharged from hospital had been handwritten as requiring administration twice a day (as per label). The hospital discharge letter for this resident specified this medication was to be given 4 times a day. A telephone call to the hospital confirmed that this was the correct frequency. Transcribing is not witnessed by another member of staff. DS0000036343.V280696.R02.S.doc Version 5.1 Page 10 • Four Acres • • • A random inspection of the number of tablets/capsules in stock for two residents did not tally with the numbers specified on the MARs, thereby making it difficult to evidence an audit trail. Eye drops for a former resident was evident in the medication refrigerator. A bottle of linctus had solidified in the fridge. The fridge requires clearing out of surplus medication and cleaning. Topical cream prescribed for a resident (AG) was not on the MAR. Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 11 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): 15 Residents receive suitable meals in pleasant surroundings, which promotes social interaction and wellbeing. EVIDENCE: Meals are served by care staff in the dining area within each separate unit presenting a homely environment which encourages socialising between residents. Meals can also be served in residents’ own rooms if preferred. Choices are available at mealtimes. Each unit has a kitchenette with a fridge, freezer, microwave and dishwasher. Meals were seen to be nutritious and well presented and the residents were seen to eat heartily and really enjoy their meals. The cook is familiar with individual residents likes and dislikes and any special meals required. A brief inspection of the kitchen found it to be clean and in good order. Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 12 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): 18 The arrangements for the protection of residents from abuse are satisfactory. EVIDENCE: The home has a policy in place with regard to the protection of adults from abuse and a copy of the local area adult protection procedure was observed to be readily available within the home. A member of staff confirmed that they would report any allegation or suspicion of abuse immediately and through discussion demonstrated their awareness of the adult protection policy including whistleblowing. The majority of staff have taken part in Adult Protection Training. This training remains ongoing and the deputy manager was aware of the need for all staff to complete this training. Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 13 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 and 26 The home is clean and comfortable. Generally the premises are maintained to a satisfactory standard resulting in a suitable living environment for residents. EVIDENCE: There has been no change to the decor since the last inspection and although this does not pose a risk to residents the home is let down by shabby wall coverings/paintwork, scuffed door frames and skirting boards in some communal areas. Some bedrooms require re-decoration with torn or faded wallpaper evident. One family has decorated their relative’s bedroom at their own expense. A comment was received from one resident’s relative stating that they were unhappy with the decoration of their family member’s bedroom. The manager said that the local authority have not allocated any funding to refurbishment of residents bedrooms. There are adequate infection control policies and procedures available for the staff. The laundry was clean and in good order and provided with liquid soap and paper towels. Protective clothing and gloves for staff were evident. Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 14 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): 28, 29 and 30 The recruitment procedure ensures that suitable people are employed to safely provide care for the residents. A strong commitment to training ensures staff have the knowledge and skills to undertake their duties. EVIDENCE: The home had a strong recruitment procedure and the records indicated that it was implemented. The files of newly appointed staff were seen at the inspection. The files were in very good order and contained the required documentation, including two written references. Criminal Records Bureau checks and POVA checks are maintained at Central Office. The home receives written verification from their Human Resources department that satisfactory checks have been obtained and this documentation is retained on individual staff files. There is a staff training plan in place and all new staff receive induction training. As well as the mandatory health and safety training, staff take part in other appropriate training, including Dementia Care, Adult Protection, Recording Skills, Bereavement and Loss and Infection Control. The home is commended on the high number of staff achieving an NVQ Level 2 or 3 in care, at present 22 carers, representing 54 of the staff. NVQ training also remains ongoing. Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 15 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 The home has an experienced Manager and is effectively and well managed. Systems are in place to monitor the quality of the service provided and identify areas in need of improvement. Residents financial interests are safeguarded. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The Registered Manager has considerable experience in managing homes for older people. There are clear lines of accountability within the home. The manager has regular supervision meetings with her line manager and said she has completed the Registered Managers Award. The manager has continued to update her own skills by taking part in Dementia Care Training, Adult Protection Training, Risk Assessment, Quality Assurance and Induction standards. Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 16 A formal quality system was evidenced. The annual quality assurance survey has recently been completed and the home are awaiting the results. The Local Authority have addressed the need for the registered provider or delegated person to visit the home monthly and write a report, which is also forwarded to the CSCI, on the conduct of the care home. Monies held at the home on behalf of residents are handled in line with the homes policy of handling resident’s money, ensuring their financial interests are safeguarded. A sample was checked and found to be satisfactory. Secure facilities are provided for the safe keeping of monies. Evidence was seen to confirm that staff receive regular training in moving and handling, fire safety, first aid, food hygiene and infection control. Fire alarm tests, emergency lighting tests and fire drills have been carried out at the required intervals. Certificates were seen during the inspection for the maintenance and service of major systems. No health and safety hazards were observed at this inspection. Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 17 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement Timescale for action 14/02/06 2 OP19 23 The registered manager shall make arrangements for the safe handling, storage and recording of medication in accordance with the home’s policy and procedure. A clear audit trail of all medication in the home must be maintained. The registered provider must 31/03/06 ensure that the home is kept in good decorative repair. (Previous timescale of 31/10/05 not met.) 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 OP24 Good Practice Recommendations It is recommended that the registered provider considers re-decoration of residents’ bedrooms on a phased basis. Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Four Acres DS0000036343.V280696.R02.S.doc Version 5.1 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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