Inspection on 29/01/08 for Four Acres

This inspection was carried out on 29th January 2008.

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

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

Other inspections for this house

Four Acres 07/12/06

Four Acres 11/01/06

Four Acres 26/07/05

Four Acres 07/02/05

Four Acres 05/08/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Four Acres Archer Close Studley Warwickshire B80 7HX Lead Inspector Key Unannounced Inspection 29th January 2008 11:30 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.V347108.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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.V347108.R01.S.doc Version 5.2 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 vacant post 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.V347108.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 7th December 2006 3. 4. 5. 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. At the time of the inspection the fees charged were in the range £98.60 £388.87 per week. The fees do not include newspapers, toiletries, chiropody or hairdressing. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The visit to the home was made on 21st September 2007 between 11.30am and 09.30pm. The lead inspector was accompanied by an additional inspector who undertook a 1½-hour period of observation in a communal lounge in the dementia care unit. This was to enable us to have a look at residents’ welfare and staff interaction during this period. These observations were used alongside other information gathered to assess the quality of care. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Information contained within this, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. Two people who were living in the dementia care unit and two were identified for close examination by case tracking. This involved reading their care plans, risk assessments, daily records and other relevant information, and talking to them, and where possible their visitors, about their experience of the home. Tracking people’s care helps us understand the experiences of people who use the service. What the service does well: People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. There are sufficient staff on duty to meet the health and personal care needs of people living in the home. The kitchen was clean and in good order. The home had achieved a Food Hygiene Gold Award from Environmental Health. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 6 People living in the home are referred to a doctor when a change in their health is noticed. Other health care needs were being met with evidence of visits to or visits by the District Nurse, an audiologist, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. All residents observed or spoken with during the visit were well groomed and looked well cared for. Terms of preferred address are on the residents care plan and heard to be used by staff. Observations of staff practices found staff responded promptly and sensitively to the needs of residents and residents confirmed that they were cared for in a respectful manner, ensuring that their dignity and selfesteem were maintained. Representatives of two local churches visit the home regularly, in order to provide Communion and Catholic and Methodist services and to meet the needs of the current residents. The home has an open visiting policy. People are encouraged to maintain links with their family and friends. One visitor in the dementia care unit said that they visit their relative every day and commented, “The staff are all very good, all I see is kindness towards the residents.” Residents spoken with said that their visitors were always made welcome. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives. There was gentle banter between staff and residents and the lunchtime seemed an enjoyable social event. Residents spoken with said that they had enjoyed the meal and that they “always do”. Staff interaction with residents was good and took place not just to meet personal care, but also to meet a social or recreational need. The home has appropriate complaints and Protection of Vulnerable Adults policies and procedures to safeguard residents. Staff have had appropriate training to be able to identify, and to protect residents, from abuse. Personal possessions were seen in all the bedrooms viewed, such as pictures, photos and ornaments. Robust recruitment procedures and pre-employment checks should protect the vulnerable people living in the home. The home has exceeded the required 50 of the care staff to have the National Vocational Qualification (NVQ) Level 2 in Care qualification with 75 of the staff having achieved this qualification. One of the cooks has also completed NVQ 2 related to catering. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 7 A visitor said about the staff that, “they are so good to her here”. Staff spoke very highly of the manager saying that she’s perfect. She gets the job done.” “She gets the jobs finished.” “She’s the pinnacle of managers. She will get things done.” They also said that she was approachable and that they were looking forward to a stable period with her following several recent changes of manager. The home can show that it is monitoring the service in order to enable growth and improvement, monthly visits and reports from a representative of the registered provider and a quality assurance programme provided by the Local Authority. The manager said that they were on target for all staff to have received formal supervision six times a year. Random inspection of in house fire checks, maintenance, service records and staff mandatory training attendance indicated that the home was a safe place to live and to work. What has improved since the last inspection? Care plans contain more detail in order that staff have adequate information to be able to meet the needs of the residents. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. Medication systems had improved so that residents’ health and welfare was safeguarded. • One care officer responsible for medication. • Copies of all prescriptions were now retained so that the home could confirm that the correction medication had been received. This was then checked with Medication Administration Record Sheets. • Staff checked and recorded that all new residents’ medicines brought into the home to confirm that they were the current ones taken. Two member of staff also counted the tablets in and out. • The home showed the quantity of tablets taken on the Medication Administration Record Sheets to ensure that the correct medication was given. • Medication Administration Record Sheets were not signed before medicines were taken to the resident. • Drug audits are carried out before and after a drug round to confirm staff competence. • Any medication taken purchased by a resident is checked to ensure that there is no interaction with prescribed medication. • Risk assessments and monitoring are carried out for self administration of medication. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 8 • Only one open box of each person’s tablets is available to reduce the risk of administering more than one of the same tablet. • A trolley had been purchased for each unit of the home. Staff had undertaken training related to adult abuse in order that they were able to identify abuse and to protect residents from abuse. A lounge had recently been redecorated and looked bright and cheerful, floor covering had been replaced in the corridors and the dementia unit had been refurbished and looked attractive and comfortable. The reception area was welcoming. Plans had been made for staff to attend Infection Control training. Control of substances hazardous to health (COSHH) risk assessments had been updated and the materials were now stored safely. It was noted that wheelchairs were rather dirty and a system of maintaining their cleanliness and hygiene needs to be implemented. What they could do better: Care plans were difficult to extract information from, requiring crossreferencing between sections. Reviews were carried out monthly but any revisions were made on the review sheet rather than the care plan as the format does not lend itself to be changed without rewriting the whole plan. Anyone needing up to date information therefore needed to look at these reviews as well as the care plans. Risk assessments are not always supported by an action plan to minimise any increased risk. A random audit was carried out on tablets at the time of the visit. Whilst the majority were correct there were some errors found, with several actual tablet balances not tallying with the estimated number that should be remaining. These shortfalls indicate that tablets may not have been given correctly. Ointment and eye drops were stored in the medication fridge but had not been dated when opened. This is necessary as they can become unstable after a given time and staff need to know when to discard them, in order to protect the residents’ well being. Whilst the AQAA states that all activities undertaken by residents are recorded, the current manager said that in practice this does not always happen. Some communal areas of the home were in need of redecoration and some bedrooms viewed were in need of decoration and were slightly shabby in appearance, mainly due to woodwork needing repainting. This detracted from the residents’ comfort Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 9 In order to prevent contamination disposable towels need to be in a suitably enclosed dispenser. The home has a complex system of safeguarding residents’ money, but which runs the risk of errors being made due to its complexity. The holding of the safe key is restricted to three people, which could result in residents wanting money when none of them are available. 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. The summary of this inspection report can be made available in other formats on request. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 10 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.V347108.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case files of two residents in the dementia unit, and two residents in other units, were examined to assess the pre admission assessment process. All files contained a pre admission assessment of each person’s needs and abilities. Information from medical staff was included as part of the assessment process and provided a clearer understanding of the needs of the prospective resident. This means that sufficient information was available so that the home could confirm they could meet each person’s needs and develop care plans. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 12 The manager said that it was usual practice for a senior member of staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. Some Care plans include the information required to meet the needs of the people living at the home but there are shortfalls in others. Residents have access to health care professionals and are cared for in a respectful manner. The medication process generally safeguards residents’ well being but there were some shortfalls in storage and the tablet audit. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case files of two people in the dementia care unit, and two in other units in the home, identified for case tracking were examined. Care plans were completed on the format provided by the Local Authority, which covered all areas of need. The organisation was updating their paperwork and one of the files contained both old and new paperwork. For example, one of the files contained a “This is Me” profile, which detailed how the person would like their needs to be met. This should mean that staff have good access to information about the needs of people living in the home and Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 14 the actions they need to take to meet those needs. Our observations showed us that staff were aware of how this person liked their needs to be met and put it into practice. Reviews were carried out monthly but any revisions were made on the review sheet rather than the care plan as the format does not lend itself to be changed without rewriting the whole plan. Anyone needing up to date information therefore needed to look at these reviews as well as the care plans, which is time consuming and could result in needs not being met. Each person had a care plan, daily records and monitoring records. Care plans were based on information secured during the pre admission assessment and supplemented by further assessment on the day of admission. There was evidence of monthly reviews of each care plan. Whilst the care plans mainly reflected the care given one resident’s care plan stated that the person needed to encouraged to elevate their legs when sat down but this was not the case until we pointed out this part of the care plan to a member of staff. Although sitting in a reclining chair this was not able to recline and there was no footstool kept nearby. The service uses risk assessments for falls, nutrition and pressure sores, which are reviewed at least monthly. When the outcome of the assessment identifies an increased risk, action should be implemented to minimise the risk. In practice, this does not always happen. For example, a nutritional risk assessment dated 02/12/07, for one person identified that they were losing weight and staff should monitor and weigh the person weekly. We saw that the person had actually only been weighed twice since that date. It was also documented that this person’s ‘clothes are too big for them and might be a hazard.’ There was no information on what this ‘hazard’ was or what staff should do to minimise the ‘hazard’. Each person’s case file contained a record of contact with or visits by Health Care Professionals. These confirmed that people living in the home are referred to a doctor when a change in their health is noticed. Other health care needs were being met with evidence of visits to or visits by the District Nurse, an audiologist, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. Preventative measures such as pressure relieving mattresses and cushions were in use. Risk assessments related to pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) need to be in place for each resident so that any risk can be identified and the appropriate action taken to minimise that risk. All residents observed or spoken with during the visit were well groomed and looked well cared for. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 15 Medication systems had improved. Medication was stored securely, with a locked trolley and locked cupboard on each unit, and dispensed to the home by Boots in pre-dosed bubble packs. All controlled drugs for all units were stored appropriately in one cupboard. The home has a medication policy provided by the Local authority. This was in the process of being updated. All staff responsible for medication had undertaken accredited medication training and a delegated senior member of staff oversaw the medication system in order to ensure that is was safe and appropriate. To confirm that the correction medication had been received the home retained copies of all prescriptions. The received medication was then checked with these and Medication Administration Record Sheets. Staff checked and recorded that all new residents’ medicines brought into the home to confirm that they were the current ones taken. Two members of staff also counted the tablets in and out to ensure accuracy. The Medication Administration Record Sheets showed the quantity of tablets taken, for example if one or two painkillers had been taken when this choice was prescribed, to ensure that the correct medication was given. Medication Administration Record Sheets were not signed until after medicines were taken to the resident, although on one occasion the member of staff did not check that they had been taken by the resident. Medication Administration Record Sheets were completed appropriately, with no unexplained gaps or inappropriate codes used. Previously there had been more than one open packet of the same tablets for the same person. This was no longer the case and only one open box of each person’s tablets was available to reduce the risk of administering more than one of the same type of tablet. The manager said that drug audits are carried out before and after a drug round to confirm staff competence. A random audit was carried out on tablets at the time of the visit. Whilst the majority were correct there were some errors found. Twenty-one antibiotics (Amoxil) were prescribed for a resident. The correct number dispensed was on the bottle but the record on the Medication Administration Record Sheets showed that there had been 28 received. The audit showed the remaining capsules to be correct if 21 had been received. Paracetamol tablets for one resident showing there to have been 246 tablets at the beginning of the cycle, 40 having been signed for but 212 tablets remaining instead of 206. Senna tablets for two different people showed the same error, with 60 tablets having been received, none being taken/signed for but only 54 remaining in both cases. These shortfalls indicate that tablets may not have been given correctly. Omeprazole tablets for one Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 16 resident were one tablet short. The senior member of staff was able to explain that this was because there had been one tablet short at the end of the previous cycle because it was destroyed and one had therefore been ‘borrowed’ from the current cycle. However the pharmacist needs to replace the missing/destroyed tablet to ensure there are enough for the resident and only the tablets carried over to the new Medication Administration Record Sheets should be recorded there until that is received. The registered manager was not aware of the errors before the audit took place. Timodine ointment in the medication fridge had not been dated when opened. All creams become unstable after a given length of time and need to be discarded before this happens. All creams should be dated once opened and discarded after 28 days if they contain an active ingredient or 3 months if they are used as an emollient. Eardrops were also undated. As drops too become unstable they should be dated when opened and discarded after 28 days. This will safeguard the health and welfare of the people using these medicines. Terms of preferred address are on the residents care plan and heard to be used by staff. Observations of staff practices found staff responded promptly and sensitively to the needs of residents and residents confirmed that they were cared for in a respectful manner, ensuring that their dignity and selfesteem were maintained. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives. Residents enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Forthcoming activities and events were displayed on the notice board of residents and visitors to see. These included plans to celebrate Valentines Day, Games night and Bingo sessions. Christmas and other special occasions, including birthdays are also celebrated. Christmas included Karaoke and children from the schools and Brownies visiting the home. Whilst the AQAA states that all activities undertaken by residents are recorded, the current manager said that in practice this does not always happen. Representatives of two local churches visit the home regularly, in order to provide Communion and Catholic and Methodist services. There are also links with the local schools and the local sports and social club opposite the home. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 18 The home holds residents’ meetings where discussion includes activities. The manager advised that residents’ family and friends are invited to the join activities and to join them for a meal if they wish. Residents spoken with said that they generally have enough to do but one person said that they would like to go out more often in the afternoons. She was reminded that he does go out to the shops and that there would be more opportunity to go out in the better weather. Another resident suggested trips to “Marks and Spencer” and staff said that they would plan this. staff were obviously listening to what residents had to say and intended to address their wishes. The home has an open visiting policy. People are encouraged to maintain links with their family and friends. One visitor in the dementia care unit said that they visit their relative every day and commented, “The staff are all very good, all I see is kindness towards the residents.” Residents spoken with said that their visitors were always made welcome. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. The home has four separate dining areas. An inspector spent time in one of the upper floors lounge/dining areas. The dining area was cosy and a pleasant place to take meals. Only five residents chose to use the dining room that day with several residents choosing to take their meal in their bedroom. Following lunch WRVS volunteers brought round a trolley with items that residents might wish to buy, such as toiletries, sweets and biscuits. Heated trolleys were taken to each unit from the kitchen at lunch and staff checked the temperature of the food before serving. The menu was varied and choice was offered. On the day of the visit each resident was individually asked to choose between homemade broth and roast pork. The food looked and smelt good and was well presented. Assistance was offered as required and in a sensitive and respectful manner. There was gentle banter between staff and residents and the lunchtime seemed an enjoyable social event. Residents spoken with said that they had enjoyed the meal and that they “always do”. The other inspector undertook a period of observation in the main lounge on the ground floor between 12:25pm and 2:00pm. Lunch was served during this time. The inspector used the Short Observational Framework for Inspection (SOFI) to enable us to have a look at residents’ welfare and staff interaction during this period. Staff were observed interacting with residents while they served meals or assisted them to eat. An analysis of the SOFI results showed that staff interaction with residents was good and took place not just to meet personal care, but also to meet a social or recreational need. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 19 The kitchen was visited and found to be clean and in good order. The home had achieved a Food Hygiene Gold Award from Environmental Health. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The home has appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the complaints procedure was displayed in the home so that residents and visitors knew what to do if they had any concerns. Residents spoken with knew who to speak to if they had concerns and said that they felt they would be listened to. The complaints records were looked at and there had been seven complaints recorded since the last inspection. These were about the attitude of a member of staff; a relative alleging that hairdressing had been poor value for money; behaviour of another resident; insufficient information shared with relatives on a specific occasion; clothing missing (later returned); a resident felt that the dinner plates were cold. There was evidenced to show that these complaints had been managed in a timely and objective manner and that the home takes complaints seriously. There had been no complaints made directly to us. According to training records viewed, the majority of the staff have undertaken recent training related to protection of vulnerable adults, either during induction training, by attending courses or completing a work book, thereby giving them the knowledge to be able to identify abuse and to protect people at the home from abuse. There was also information relating to abuse displayed in the reception area. The home had the local authority vulnerable Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 21 adult policy and procedure. There had been no Protection of Vulnerable Adults referrals connected to the home. All recruitment practices safeguard residents from the employment of unsuitable people. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 26 Quality in this outcome area is adequate. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour, safe and generally well maintained but with some shortfalls in the décor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides accommodation on two floors, with a passenger lift between the 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 provides living space for a small group of residents. Each of the units has a lounge/diner with a kitchenette, and there are additional communal areas, including two conservatories, on the ground floor. Parts of the home were in need of redecoration although a lounge had recently been redecorated and looked bright and cheerful, floor covering had been replaced in the corridors and the dementia unit had been refurbished and looked Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 23 attractive and comfortable. The reception area was welcoming. The home also has a hair salon for the residents’ use. A bathroom on the first floor, with a bath and shower, was quite cluttered. The bathroom on the ground floor housed an assisted bath and had been attractively decorated and tiled offering pleasant bathing facilities for the people living at the home. It was noted that wheelchairs were rather dirty and a system of maintaining their cleanliness and hygiene needs to be implemented. Some bedrooms viewed were in need of decoration and were slightly shabby in appearance, mainly due to woodwork needing repainting. This detracted from the residents’ comfort. Other bedrooms were in reasonable decorative order. Personal possessions were seen in all the bedrooms viewed, such as pictures, photos and ornaments. Paper towels were available in communal areas where residents and staff wash their hands in order to maintain standards of hygiene but the towels were kept in an open basket. In order to prevent contamination these need to be in a suitably enclosed dispenser. Protective clothing, disposable aprons and gloves, were available for staff to further maintain infection control. The laundry is located by the kitchen and had clearly defined dirty and clean areas. The hand washing facilities were not easy to access but otherwise the laundry was clean and in good order with appropriately programmed washing machines. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. There are sufficient care staff available to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection there were 12 people living in the dementia care unit, 18 permanent residents on the first floor and five in the respite unit on the ground floor. There were 3 care staff on duty on the dementia unit, three care staff on the fist floor, one care assistant working in the respite unit and three care staff on duty in the home during the night. This is the usual staffing complement for the home. The home uses members of its own bank staff team wherever possible although also uses staff from a specific care agency if necessary. The manager said that effort is made to use the same staff wherever possible in order maintain the continuity of care for residents. Ancillary staff are mainly part time and consists of two cooks and a kitchen domestic, a laundry assistant, three domestic staff, and an administrative assistant. A visitor said about the staff that, “they are so good to her here”. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 25 The home has exceeded the required 50 of the care staff to have the National Vocational Qualification (NVQ) Level 2 in Care qualification with 75 of the staff having achieved this qualification, which shows that the person has been assessed as competent in their role. One of the cooks has also completed NVQ 2 related to catering. The personnel files of three recently recruited staff were examined and all contained evidence that satisfactory checks such as Criminal Record Bureau (CRB) and references are obtained before staff commence employment in the home. Robust recruitment procedures and pre-employment checks in place should protect the vulnerable people living in the home. Training records were looked at. New staff undertake the Local Authority induction training. Other training undertaken included mandatory training moving and handling, use of the hoist, first aid, food hygiene and fire training was booked for the near future. Staff have also undertaken training related to dementia care, infection control, adult protection, Parkinson’s disease and strokes. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. A person undertaking the appropriate qualification and who has previous management experience manages the home. The service and practices are monitored and audited to ensure that all services operate in the best interests of residents. residents’ financial interests are protected although the complexity of systems could create shortfalls. Health and safety practice protect residents and staff at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had been at the home for four months having transferred from another similar Local Authority home where she was registered manager. She was undertaking the Registered Managers Award, has undertaken training during the year to further her knowledge and skills and had applied for registration with us. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 27 Staff spoken to spoke very highly of her with such comments as, “she’s perfect. She get the job done.” “She gets the jobs finished.” “She’s the pinnacle of managers. She will get things done.” They also said that she was approachable and that they were looking forward to a stable period with her following several recent changes of manager. The home had a structured quality assurance programme provided by the Local authority. The manager routinely undertakes audits of systems and practices carried out in the home. A representative of the registered provider visits the home unannounced each month and carries out a quality audit inspection and a report of this visit is then sent to us and to the manager of the home. Residents are asked to complete either general or a specific topic surveys regularly and had recently completed surveys related to meals. These had been collated and summaries were available. The home therefore can show that it is monitoring the service in order to enable growth and improvement. The majority of the residents (twenty nine) have money held for them by the home. Whilst they tend to carry small amounts of cash on them it is the policy of the home to discourage them from holding larger amount for risk of loss. They each have a secure place for valuables in their bedroom. Care needs to be taken to ensure that this does not limit their independence with their finances. The records are in triplicate and filled three lever arch files. Whilst the system is intended to safeguard residents there was potential risk of errors due to its complexity. Money is kept in a safe in a secure location. The holding of the safe key is restricted to three people, which could result in residents wanting money when none of them are available. The manager advised that staff supervision has been given regularly since she started at the home with her supervising senior staff and in turn the senior staff supervising the staff on the unit that they were responsible for. The manager said that they were on target for all staff to have received formal supervision six times a year. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. A random check of health and safety was undertaken. In house fire checks were up to date; hot water temperature at outlets where residents could access it were maintained at about 43°C by means of temperature control valves and records showed that the temperatures were checked appropriately; service and maintenance records for the hoists and passenger lift were in good order. These checks and staff mandatory training attendance indicated that the home was a safe place to live and to work. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 28 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 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 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 2 X 3 X 3 3 X 3 Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 29 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. Standard OP7 Regulation 15 Requirement Instructions in care plans need to followed by staff. This will ensure that residents receive the necessary support to meet their needs. Risk assessments devised through care plans must be supported by an appropriate action plan. This will ensure that any identified risk to the resident is minimised. Timescale for action 15/04/08 2. OP7 13(4)(b) (c) 15/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care plans should be devised in a format that allows information to be easily extracted and for updated information to be added in order that residents’ needs are met. Medication should be audited at regular intervals to monitor the competence of staff responsible for medication. DS0000036343.V347108.R01.S.doc Version 5.2 Page 30 2. OP9 Four Acres 3. 4. 5. 6. 7. 8. 9. OP9 OP12 OP19 OP26 OP35 OP35 OP35 Ointments, creams and drops should be dated when opened to enable their timely disposal. All activities offered to residents should be recorded in their personal file. The home should be in good decorative order throughout. Disposable towels should be stored in appropriate enclosed dispensers. Consideration should be given to simplifying the recording of transactions related to residents’ money held by the home. Residents should have access to their own money at all times. Residents should be supported in handling their own money if the are able and wish to do so. Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Four Acres DS0000036343.V347108.R01.S.doc Version 5.2 Page 32 - 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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