Inspection on 01/08/07 for Two Acres Nursing And Residential Home

This inspection was carried out on 1st August 2007.

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

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

Other inspections for this house

Two Acres Nursing And... 05/09/08

Two Acres Nursing And... 08/06/06

Two Acres Nursing And... 24/01/06

Two Acres Nursing And... 20/04/05

Two Acres Nursing And... 14/10/04

Two Acres Nursing And... 12/07/04

Two Acres Nursing And... 10/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Two Acres Nursing And Residential Home 214 Fakenham Road Taverham Norwich Norfolk NR8 6QN Lead Inspector Hilary Shephard Unannounced Inspection 1st August 2007 09:00 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 Two Acres Nursing And Residential Home DS0000015696.V347911.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. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Two Acres Nursing And Residential Home Address 214 Fakenham Road Taverham Norwich Norfolk NR8 6QN 01603 867600 01603 868886 info@twoacres.co.uk www.twoacres.co.uk Devaglade Limited 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) Lynsey Spearing Care Home 97 Category(ies) of Dementia (97), Old age, not falling within any registration, with number other category (97) of places Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. A total of ninety-seven (97) service users with nursing needs may be accommodated in three units. Heather Unit may accommodate up to twenty-four (24) people in the category of either Old Age (OP) or Dementia (DE). Rose Unit may accommodate up to forty-three (43) Older People in the category of either Old Age (OP) or Dementia (DE). Fern Unit may accommodated up to thirty (30) people in the category of Dementia (DE). Service Users with specific nursing needs may only be accommodated on Rose or Fern Units. 8th June 2006 Date of last inspection Brief Description of the Service: Two Acres care home provides nursing and residential care to people with dementia. The home has 3 distinct units, Heather, Rose and Fern. Each of the units are purpose built single storey buildings that blend in nicely with the surrounding community. The grounds are well maintained and thoughtfully designed for the wheelchair user. The home charges between £390 and £434 per week for residential care and £503 to £700 per week for nursing care. The fees do not include hairdressing, chiropody, toiletries or newspapers. The home makes information available to residents via notice boards, news letters, personal discussion and letters. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers care outcomes for people using the service. The key inspection of this service has been carried out using information from previous inspections, information from the provider, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgments for each outcome group. Two Acres is separated into three distinct units, which are all managed differently by senior nurses, or in Heathers case, a senior member of care staff. Two inspectors with specific knowledge of dementia care inspected all of the units. A total of 4 requirements and 1 recommendation were made as a result of this inspection. What the service does well: What has improved since the last inspection? Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 6 The manager has worked hard to develop a person centred culture in the home. Staffs understanding of how to deliver good, researched based personcentred dementia care has improved significantly over the past year. Care records have improved significantly over the past year. The way these are written emphasises residents’ strengths and abilities and looks at their care needs from the resident’s perspective. Care records focus on what the resident feels is important regarding how they want their care needs to be met. Late afternoon staffing levels have improved on Heather unit and staff are able to spend time assisting residents rather than preparing food. Residents are being offered choices of meals but this is not always consistently applied. The environment on Fern has improved over the past year and is a little more homely. However, more effort is needed to make residents’ bedrooms personalised to assist them in recognising their personal space. What they could do better: Staff need to properly document and justify reasons for giving particular drugs to residents for perceived behavioural problems. Improvements are needed to the way medication is administered and recorded. The home is quite noisy at times, and the nurse-call and telephone bells continue to be particularly loud and intrusive. The issue of using plastic aprons for residents has been raised at previous inspections and is not considered as best practice in the development of person centred care. Good person centred care would involve staff understanding what protective clothing people like to wear during mealtimes and making sure they are enabled to do this. Improvements are needed to the care environment on Heather unit so it enables residents to make the best use of their retained physical and psychological abilities. Improvements are also urgently required to the décor. Residents’ rights are being breached on Heather unit because some of their bedrooms are locked during the day. A better solution needs to be found regarding access for residents to their belongings on Heather unit. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 7 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. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 8 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 Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 9 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 People who use the service experience good quality outcomes in this area. Residents’ benefit from having their care needs assessed by a senior member of the nursing team needs prior to admission. This information is used to help plan how the residents care needs are to be addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspection carried out in June 2006 found little change with the way the home assessed residents before they were admitted. Previous inspections have shown the home uses a good assessment tool and visits residents to assess them before admission. The August 07 inspection found no changes made to the admission process. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People who use the service experience adequate quality outcomes in this area. Although improvements have been made to care planning, residents care needs regarding medication administration for behavioural issues are not well managed placing them at risk of receiving inappropriate treatment. Medication management and administration is not always carried out safely creating a risk of potential harm to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The June 06 inspection quality rated this outcome group as adequate because care records were not individualised and did not focus enough on residents’ strengths and abilities. Staff were good at addressing residents’ physical needs but lacked understanding of how to deliver person-centred care. A further visit made in September 06 found the manager in the process of introducing new style care plans. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 11 Care records showed some improvements regarding residents’ communication needs and social needs. Care records were being completed in a way that focused on the residents’ abilities rather than physical care tasks that staff need to do. Although these were better, most guidelines were brief and would benefit from more detail about dietary needs and other identified care needs. The August 07 inspection found significant improvements to the way care records were written. These records showed that residents’ care needs are assessed and most of that information is transferred into a plan of how their care needs are to be met. Care records were written in ways that reflected how the resident identified their care needs and included detail of how the resident wanted the needs to be addressed. For example, one record indicated how important the person’s family were to him. Daily records for that person showed that he was enabled to spend significant amounts of time with his family as he wished. Staff were having some difficulty caring for one resident who was very deaf. The nurse had found that writing information for the resident helped to significantly reduce her frustration caused by not being able to hear. This information had not been added to her care records and the nurse was writing the information on pieces of kitchen paper. More thought is needed to further develop ways of communicating with someone who is very deaf. Care records also contained good information regarding residents’ life history and again most of that information was reflected in a plan of care. Care records omitted small amounts of information relating to residents need for occupation and stimulation. For example, one record showed a resident to have an interest in gardening, but the actual plan failed to show how that was to be addressed. Observations showed this care need was being addressed. The way the records are now written makes it difficult to identify any significant GP or health professionals’ intervention. However, care records indicated that residents care needs in respect of their pressure areas was being addressed. Some, but not all, contained information about residents’ nutritional needs. Risk assessments for falls were not seen on the care records although these risks had been identified in a significant number of people. Residents who commented in the recent CSCI survey indicate that 59 feel they receive the medical support they needed and 59 said they received the care & support they needed. Relatives said the overall care has always been exemplary and they look after people very well. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 12 Medication in Rose and Fern at the June 06 visit showed that medication prescribed for residents behavioural issues (antipsychotic medication) was not always being given as prescribed. This had also been noted at the Phamacisist Inspectors visit in March 2006. At the September 06 visit, the manager said she was discussing this with the GPs involved. Improvements were also needed to the way medication was booked in and the way the administrations of some medicines was recorded. The September 06 visit showed medication was now being booked in accurately. Medication charts on Fern unit were completed correctly and an audit showed they were accurate. The August 07 inspection found some areas where medication was not always being safely managed or administered. Observations carried out during the lunchtime medicine round on Rose unit found the nurse left medication unattended whilst she assisted residents to and from the dining room. Observations of the morning medicine round on Fern unit found medicines being given safely. Residents with behavioural problems, anxiety and other psychological problems continue to be prescribed medication (antipsychotics) to help alleviate and in some cases manage these symptoms. Care records showed staff had completed a good risk assessment for these residents’ problems but the records failed to include details about why and when these medications should be given. One medication record showed that a resident was prescribed an antipsychotic drug to be given twice a day on a regular basis, plus extra doses to be given as required. Records showed this drug being administered up to 4 times a day and staff said they have been giving it for behavioural issues. This was also the case with residents on Rose unit. Some residents were being given the drugs regularly even though they were prescribed to be given “as required”. Care records failed to include reference to this and there was no justification recorded about giving the drug. The staff here said they make decisions about giving the drugs and do not record the reasons for giving. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 13 Often people who have cognitive impairment struggle to make their needs and wishes known. This often leads to people expressing their frustrations in aggressive ways and medication is not always the best way to manage these problems. If medication is being given for these issues, then clear guidance needs to be written about when and why these medications should be given. Tom Kitwood (1997) described “problem behaviour” as a persons attempt to communicate and states that “It is necessary to understand the message, and so to engage with the need that is not being met.” (Dementia Reconsidered, the person comes first). Medication being carried forward from the previous month is not always recorded making it difficult to track back to see if the medication had been given correctly. Medication was checked on Heather unit. Some gaps were noted on medication records making it difficult to see if the medicines had been administered correctly. In one case there was a surplus of tablets for one resident. Good practice was seen on Heather unit with administration of Digoxin as staff were recording the persons pulse before they gave the drug. Other medicines looked at were being administered correctly. The June 06 inspection found staff continuing to provide residents with plastic aprons and plastic cups or beakers during mealtimes. This improved by the September 06 visit as most residents in Fern and Rose units were provided with proper cups and saucers and glasses. Residents were being given a choice of wearing cloth bibs and the practice of giving blue plastic aprons to all residents in Fern and Rose had almost stopped. Staff were using pieces of blue paper towels as napkins and it was not clear why proper napkins were not available. Table cloths were also being used in all units which improved the look of the tables and made the dining room look more familiar to the residents. The manager had commissioned a dementia care consultant to complete an inspection of the entire home in July 2006. The report following that visit recommended the following regarding residents dignity: • All tables should have cloths • Only residents with a specific need should have aprons • Residents should have access to serviettes. The August 07 inspection found staff had not sustained the good practice developed in 06 regarding the way they maintained residents dignity. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 14 Many residents on Fern unit were wearing plastic aprons during mealtimes and were not offered an alternative form of clothing protection. Care staff were observed at lunch to place these aprons on residents without asking them or offering an alternative apron. Serviettes were not available and residents were provided with blue paper towels. The dining room in Rose was nicely laid out with tablecloths, cutlery and napkins and while one or two people had plastic aprons there was not total use for all. Staff were seen promoting peoples dignity. Improvements are needed on Heather unit as staff were seen giving residents biscuits straight from the tin and many bedrooms had pots with peoples dentures in. When spoken with staff said that was because they wouldn’t wear them but offered no suggestions about how they should be addressing that. Requirements have been made regarding medication, and dignity. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 15 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 People who use the service experience good quality outcomes in this area. Although there are some areas that require further improvement, most residents are benefiting because staff are making much more effort to engage with them in some kind of meaningful occupation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have found a general lack of meaningful occupation for residents in Rose and Fern units. An inspection in January 2006 showed significant improvement in the way residents were being occupied and engaged, however, this was not evident at the inspection carried out in June 2006. Some staff interacted well with small groups of residents in Rose unit, but other staff were not engaging residents in activities of their choosing. Staff on Fern unit were unaware of residents social needs although some of these had been documented in their care records. The inspection carried out in September 06 found considerable improvement with the provision of activities and occupation in Rose unit, but little improvement in Fern. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 16 Residents on Fern unit appeared bored, one said he had nothing to do. One member of staff was observed trying to engage some residents in activity, but other residents were not receiving much stimulation at all, quite a few residents were sleeping. Care records did not contain much evidence about residents’ social needs being addressed. The daily record sheets contained brief information and most written entries repeated the same information. A brief visit was carried out in May 07 on Rose unit to undertake some formal observations of the interaction, engagement and occupation carried out with residents. Three residents were observed over a period of 1¼ hours and notes were made every five minutes of their mood state. The residents spent most of their time in a state of well-being. Staff interacted well and engaged the residents throughout the majority of the observational period. The inspection carried out in August 07 found considerable improvements made on Fern unit to the way staff interacted and engaged with residents. Two residents on Fern unit were spoken with and both said they were happy to be there. One spoke about his love of gardening and was seen to be tending the newly developed courtyard garden. Residents who commented in the recent CSCI survey indicate that “I don’t want to participate in activities, I attend what I want to”, “I have been here a long time and I made friends here that help me all the time”. Relatives indicate the staff try hard to stimulate those in their care, they have seen many activities being offered such as painting, and have joined in activities where someone talks about past times. For the early part of the morning on Rose unit, there was little occupation and engagement for residents but this improved during the morning. The layout of the lounge area on Rose can restrict some residents view of the TV and could lead to isolation as many residents are confined to special chairs that are all placed in one area. People at the back of the lounge are unable to view the TV and the way the chairs are placed around the TV makes access to that area difficult. The appearance of the lounge areas looks institutionalised and some thought needs to be given to improving this layout to meet residents social care needs. The majority of staff interacted well with residents on Fern and Rose units and good practice was observed. Care staff were gently and patient and allowed residents plenty of time to communicate. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 17 One carer on Rose was observed to be abrupt and lacked patience and understanding. Two care staff were found sitting with residents in the small lounge on Rose unit but not interacting with them. One resident was loudly expressing herself and the TV had a very fuzzy picture which staff had not addressed. Information taken from the Homes recent annual quality assurance assessment indicates that: • Service users are given choices and respected in all aspects of daily life as documented in their care plans. • Service users are able to facilitate their interests by undertaking leisure activities by helping in the garden or kitchen if they desire. The way the care environment on Heather unit is currently utilized is compromising people’s choices and dignity. This is because staff are locking some residents bedrooms and have put child locks on some residents wardrobes to prevent access by other residents. This practice prevents the occupier of the bedroom from entering and also from being able to access their wardrobe. The manager needs to consider how to improve this practice without infringing residents’ right of access to their property. Previous inspections have found the food to be good, but little choice was offered. Residents who needed finger food were not always provided with this. Lunch was observed during the August 07 inspection on Fern unit and staff were seen to assist residents in a gentle and respectful way. Verbal choices of meals were offered to residents and the majority understood what meal was being offered. Staff were not offering choices in any other way. Residents said they enjoyed their meals and the food looked nice and appetising. Lunch was observed on Rose unit and staff assisted residents well, but needed to describe the food that was being given. Staff also need to talk to residents during meal times to make this experience more enjoyable. Staff on Rose unit were seen making an effort to offer meaningful choices to residents about their daily lives. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 18 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 People who use the service experience good quality outcomes in this area. The manager makes every effort to deal with concerns and to protect residents from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspection carried out in June 06 found the home was good at dealing with peoples concerns and complaints. Since that inspection, CSCI received one complaint and two adult protection referrals. The complaint was made about care practice on Heather unit and was referred to the manager for investigation. The manager found it to be partly upheld and subsequently made some changes to how the unit was managed. The two adult protection issues were referred to the Norfolk Adult Protection teams who investigated with the manager and addressed all the issues raised. This resulted in changes of staff responsibilities and extra training and support. A brief visit was made to the home in May 07 to discuss the recent adult protection incidents. The manager had previously written to the Commission but had not included enough detail about how she had addressed the issues. However, this visit showed the manager had dealt with the issues appropriately and in a timely way. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 19 Residents who commented in the recent CSCI survey indicate that 88 knew how to make a complaint and 94 said that staff listened & acted on what they said. 100 of relatives said they knew how to make a complaint, and 78 said the home had responded appropriately to their concerns. Concerns, complaints and allegations were explored briefly during the August 07 inspection with one senior member of staff. The staff demonstrated she would take appropriate action in any allegations of abuse. The staffs aid she felt confident staff would report issues to her and she would have no hesitation about reporting to the manager. Staff have also received training in protecting vulnerable people. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 20 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): People who use the service experience adequate quality outcomes in this area. Although significant effort has been made improving the care environment and gardens on Fern and Rose, the poor environment on Heather compromises residents’ well-being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have identified the care environment, particularly on Fern has not been helpful for people with dementia. People with dementia need an environment that enhances their retained physical and mental abilities and Two Acres has put in a lot of time and effort over the past year to improve this. Because the home is split into three units, evidence gathered from the August 07 inspection has been reported separately. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 21 Fern Unit: Some further improvements have been made regarding assisting residents to find toilets more easily. More toilet doors including resident’s en suites have been painted a bright colour and many have signs of a toilet placed on them to further help residents find their way. Toilets in some of the en suites were white making them blend in with the walls. This makes it difficult for people with cognitive impairment and poor sight to clearly see the toilet. Some effort has been made to put a contrasting seat in some en suites and this needs to be considered for all toilets in all units. Some of the bedroom doors had residents’ names and pictures on and some didn’t. Corridors have been painted pleasant pastel colours and the name of the corridor painted on, but this was too high for people so see easily. No unpleasant odours were noted and the unit was clean, however, noise levels from the phone were high and intrusive to residents. There is a small courtyard garden, which has been thoughtfully developed into colourful raised beds for residents to enjoy. There is also a large garden accessible via the dining room with chairs and tables. One resident was seen there, but others were not being encouraged to use it. The gardener spoke of how he plans to develop that area further. There are also rabbits out here which residents enjoy looking at. Rose Unit: Small raised flower beds have been created in the garden area offering residents a pleasant view. Murals have also been painted on the walls making this area pleasant and enjoyable. Residents enjoy sitting out there and often take their meals there. Cards and craftwork and pictures created by residents have been displayed in the dining area which again creates areas of interest for residents. The older part of the unit needs some redecoration and would benefit from a replacement carpet as this area is looking a little worn. Some areas smelled unpleasant, particularly some of the toilets where bags of waste were left open. However, the unit was clean. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 22 Heather Unit: This unit is usually the most comfortable and homely, however it now appears tatty and poorly maintained. Very few signs are in place to help guide residents around the home and this unit has not been developed to maximise residents’ retained mental abilities. It is understood that plans are being developed for a complete refurbishment of this unit, but some areas are in urgent need of improvement. One of the toilets smelled unpleasant. The garden area is also tatty and unkempt and does not now offer a pleasant place to sit. The manager has become involved in a social services project regarding assistive technology. This means that equipment and technology is used to help manage risks created by peoples cognitive impairment. Subsequently the risks of injury to residents is reduced and in some cases eliminated. The technology currently in use at the home consists of special beds and mattresses to prevent injury to anyone falling from their bed, mats on the floor linked to the call bell system to alert staff, and bed and chair leaving alarms, also to alert staff. Staff spoke of how this has significantly reduced the number of falls the residents have. This is considered as excellent practice. A requirement has been made regarding the environment. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 23 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): 27,28,29,30 People who use the service experience good quality outcomes in this area. Staff are provided in sufficient quantities to meet the needs of the residents. Residents’ benefit from a person centred care culture being developed in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspection carried out in June showed good staffing levels in Fern and Rose units but the afternoon staff were struggling in Heather unit to meet the residents’ needs during the teatime meal. This visit also showed staff were good at meeting residents physical care needs but lacked understanding of how to provided good dementia care. A further inspection carried out in September 06 found staffing levels on Heather unit had been reviewed and improved. This visit showed staff were interacting much better with residents and the home has now started to develop a person centred ethos. This was particularly evident on Rose unit. Further improvements were needed on Fern. Following the two adult protection allegations another visit was made to the home in May 07. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 24 The training coordinator spoke of how she has implemented a mentorship programme for new staff and those who she feels needs some extra support. Staff involved in the allegations have received extra training and support and two spoke of how much this has benefited their care practice. Both staff gave very good examples of how they maintain person centred care and observations showed they are practicing good person centred care with the residents. An observational programme has also been commenced for staff. This involves staff being mentored by a senior who observes their care practice and makes recommendations for improvement. So far this seems to be working very well and is an excellent scheme. Staff records showed home continues to practice safe recruitment procedures, often using an agency to recruit staff from overseas. The manager advised the Home Office had recently visited and were satisfied the home was employing overseas staff in accordance with legislation. Staff raining records showed that the home continues to use a good induction programme and provides plenty of training in all aspects of care practices, dementia care and health and safety to all staff. Catering and domestic staff also received training in dementia care and in addition to their own dementia training programme, the home has introduced the Alzheimer’s Society video training package called “Yesterday, Today, Tomorrow” which most staff have completed. It is really good practice that other staff are provided with dementia care training and the home recognises the importance of involving all staff with the care of their residents. Eleven staff have also completed Dementia Care Mapping which will enable them to observe the experience of living in the home from the residents perspective and make recommendations for improvement. Again, this is seen as excellent practice. Staff were briefly spoken with on each unit during the August 07 inspection and observations of staff interaction with residents were made on Fern and Rose. Staff on all units were clearly making an effort to engage with residents in occupations of their choice. One resident on Fern was observed enjoying her paper. Staff recognised how important that was to her and interacted with her throughout the morning regarding the news. This shows how much staff now understand about providing good person centred care. Changes have been made to the staffing levels on Heather unit, which have improved the numbers of staff on duty in the late afternoon. A kitchen assistant now helps with the tea time meal so staff are able to spend more time with the residents. The Heather unit also has a new coordinator who has NVQ 3 and experience in looking after people with dementia. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 25 Staffing levels on all units were good and were sufficient for the needs of the residents. Residents who commented in the recent CSCI survey indicate that 59 thought there were always staff available when needed and 41 thought there usually were. One said “I like being here, they are very kind all the time”. Two Acres Nursing And Residential Home DS0000015696.V347911.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): 31,33,35,38 People who use the service experience good quality outcomes in this area. Residents benefit from being in a home that is well managed by a competent person. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have shown the home to be well managed by a competent manager. The manager has undergone training and keeps her skills up to date, however, has yet to complete the Diploma in Dementia Care studies, which she has been studying for some length of time. The manager successfully completed her Registered Managers Award in May 07 and is currently studying to become an assessor for NVQ 4. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 27 Previous inspections have found good practice regarding the management of residents’ finances and a good quality assurance system. Previous inspections identified some inappropriate use of bedrails where these were being used without satisfactory risk assessments or justification. The Homes annual quality assurance assessment indicates that they home have successfully achieved the Investors In People award and have carried this award for the last eight years. This process offers the chance for an external agency to monitor and review the quality of the home. The August 07 inspection found residents’ finances continue to be safely managed. Quality monitoring continues on a regular basis and a quality review of the whole home has been conducted. It was not clear however, from those records how the information gathered during the survey was being used. A fire risk assessment has been completed and reviewed by an outside company and other safety records seen showed the home is managed safely. Bed rails risk assessments were not reviewed or seen on any of the care records looked at during this visit. However, the increased use of specialist technology seems to have reduced the need for bedrails. Two Acres Nursing And Residential Home DS0000015696.V347911.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 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 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 3 X 3 X X 3 Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? None 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 (2) Requirement Residents’ health and wellbeing should be promoted and protected by safe and appropriate management and administration of medicines. Residents’ dignity should be respected, particularly during mealtimes. Residents right to access their bedrooms and belongings should be managed appropriately to meet their individual needs. Residents should benefit from a care environment that meets their individual physical and psychological care needs. Therefore the Provider needs to improve the care environment on Heather Unit. Timescale for action 30/09/07 2 3 OP10 OP14 12 (4, a) 12 (2) 30/09/07 30/09/07 4 OP19 23 (1, a) (2, a, b, d) 31/12/07 Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 30 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 OP19 Good Practice Recommendations In order to promote a supportive care environment, noise levels should be reduced throughout the home. Two Acres Nursing And Residential Home DS0000015696.V347911.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Two Acres Nursing And Residential Home DS0000015696.V347911.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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