Inspection on 20/04/05 for Two Acres Nursing And Residential Home

This inspection was carried out on 20th April 2005.

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

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

Other inspections for this house

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

Two Acres Nursing And... 01/08/07

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

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

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

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

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

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

CARE HOMES FOR OLDER PEOPLE Two Acres Nursing & Residential 214-216 Fakenham Road Taverham Norwich NR8 6QN Lead Inspector Hilary Shephard Announced 20 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 & Residential Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Two Acres Nursing and Residential Home Address 214-216 Fakenham Road, Taverham, Norwich, NR8 6QN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01603 867600 01603 868886 admin@twoacres.co.uk Devaglade Limited 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 & Residential Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 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 accommodate 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. Date of last inspection 14 October 2004 Brief Description of the Service: Two Acres care home provides nursing care and 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 well designed for the wheelchair user. Two Acres Nursing & Residential Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced, and was carried out by two inspectors over 8 ½ hours. As Two Acres is so large and separated into 3 units, the inspectors worked in Rose and Fern, undertaking a tour of the premises, and inspecting care plans and staff files. The inspectors spent most of the day with the residents in Fern and Rose, and spoke with residents, staff and visitors. What the service does well: What has improved since the last inspection? The décor in Fern has been improved with murals being added to corridor walls. This unit now looks less bare and clinical, and the murals add something of interest for the residents to look at when they are walking around the unit. Two Acres Nursing & Residential Home Version 1.10 Page 6 Bedroom and toilet doors now have clear signs on enabling residents to more easily identify these rooms. Hot water temperatures are now being monitored and valves have been fitted in some areas to reduce the risk of harm to residents from scalding. The Manager has improved the way she deals with complaints. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Two Acres Nursing & Residential Home Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Two Acres Nursing & Residential Home Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed on this inspection visit. EVIDENCE: Two Acres Nursing & Residential Home Version 1.10 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 All residents have a comprehensive care plan which clearly outlines their health and care needs although these could be improved on. In Rose unit Staff did not always address residents with respect. EVIDENCE: Individual care plans are completed for each resident, but the format differs in the Heather unit. Care plans in the Heather unit contain a life history, whereas in Fern and Rose, they do not and only contain limited detail of significant life events. By completing a life history for each resident, it would enable staff to be more individualised in their approach to each person and a recommendation has been made. In each unit staff demonstrated a good verbal understanding of residents care needs, and clearly cared for each person individually, but this was not wholly reflected in the written care plans. Entries in the daily records show that the resident’s physical health care needs are met. One staff member was heard to be disrespectful about some residents in Rose unit, however, this situation does not accurately reflect the ethos of the home, and has been addressed with the staff. Two Acres Nursing & Residential Home Version 1.10 Page 10 Visitors in Fern were positive about the care their relatives were given, and gave praise about the staffs hard work, and expressed their satisfaction that their healthcare needs are met. Staff advised that residents are always provided with privacy when undertaking intimate care needs. Two Acres Nursing & Residential Home Version 1.10 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14and 15 The home provides a good range of activities and stimulation for residents in Rose and Heather but the residents in Fern need more interaction and stimulation. In Rose and Fern, staff do not always promote residents individuality by providing them with a choice about wearing aprons at mealtimes. The meals provided looked and smelled nice, and were attractively presented, however, for some residents there was a long wait at the table for the meal to be served. EVIDENCE: The home has an activities coordinator who works with the residents in Heather and Rose and occasionally in Fern, and develops activities according to the residents’ preference. Residents were participating in a quiz on Rose, and were clearly enjoying the activity. One resident said she did not like to join in the activities, and staff respected her wishes. Residents in Fern are less able to participate in group work and are in need of individual interaction with staff. These residents are left on their own for long periods throughout the day without contact or communication with staff. A requirement has been made regarding the provision of suitable activities. During the day, the TV was on constantly in one lounge, which could cause increased agitation. Staff advised that music was available that residents enjoyed. One member of staff works additional hours to be with the residents Two Acres Nursing & Residential Home Version 1.10 Page 12 on Fern, and has worked with them to produce some interesting and colourful wall murals in the corridors. Visitors advised that they are welcomed at any time and were able to see their relatives in private, this was appreciated by one resident who did not like to sit in the lounge with others. At lunchtime, the staff sat everyone down together at the same time, but did not serve them altogether. Some Residents on Rose need their meals liquidized, and are served first. The remaining residents were left waiting at the tables for 30 minutes, becoming increasingly agitated, as they did not understand why their meal was not being served. The manager explained that meals on Rose are usually served in two sittings. At lunchtime, all residents in Rose were wearing plastic or cloth aprons. When asked, they responded that they had not chosen to wear them and had been given them without a choice. Some residents said they would not choose to wear aprons and would prefer a serviette and a recommendation has been made. Two Acres Nursing & Residential Home Version 1.10 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards not assessed at this inspection visit EVIDENCE: Two Acres Nursing & Residential Home Version 1.10 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home smelled pleasant and was clean. Fern unit, although improving, could look more homely and domestic and give more clues as to the function of the communal areas. EVIDENCE: Rooms on Rose and Fern unit were inspected, and were clean with no unpleasant odours. The lounges and dining room on Fern are very bare and plain without carpet, offering the residents no clue as to their function, with the exception of the dining tables, armchairs and television. People with dementia often need a range of visual cues to remind them of the functions of certain areas and to help them find these areas and a recommendation has been made. The home has placed signage on toilet and bedroom doors enabling residents to easily identify them, and this principle needs to be continued throughout the unit. Relatives said that it was bare, but over time they had become accustomed to it. Two Acres Nursing & Residential Home Version 1.10 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The home is experiencing difficulties recruiting nurses and care assistants. Training is provided, however the dementia care training is basic and needs to be more in depth. EVIDENCE: Some problems are experienced with staff’s lack of understanding of peoples dementia care needs and a requirement has been made regarding dementia care training. The home uses a lot of agency staff, and 10 of staff have left since the last inspection. Staff work long hours to ensure that continuity of care is maintained, however, some communication difficulties have arisen between relatives and staff causing some residents to receive a poor service. Other residents and relatives made very positive comments about staff, saying, “the staff are lovely, they are a smashing lot and look after father very well.” A resident commented, “They are always coming in to see you are alright.” All staff receive a good induction, which includes a workbook and shadowing of an experienced member of staff, and staff receive training given by one of the nurses. The training in general health needs is good, but the dementia training is basic, which provides a good introduction to dementia care but needs to be more in depth. Two Acres Nursing & Residential Home Version 1.10 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The home is generally safe and well maintained, but by not controlling hot water temperatures in resident areas, the home is compromising the residents’ safety and wellbeing. The use of bedrails in some areas could increase the risk of injury for some residents. EVIDENCE: Records for maintenance and checks were inspected, and these indicated that regular maintenance and safety checks are carried out on systems and equipment. Hot water temperature records were checked, and indicated that in resident areas, the hot water was very hot. The manager advised that safety control valves had been installed in Heather unit, and there was a programme to install these in every resident area. A requirement has been repeated regarding controlling hot water. Two Acres Nursing & Residential Home Version 1.10 Page 17 The home uses bedrails to prevent people falling from their beds. All beds on Fern and some on Rose had been fitted with rails and cushions, and a risk assessment had been completed. The risk assessments did not indicate the reason for the residents having an increased risk of falling. One indicated that the rails were no longer necessary, but were still in place, and one person’s relative confirmed that a bedrail was unnecessary. A complete and proper review of the use of bedrails for each individual needs to be carried out and a recommendation has been made. Two Acres Nursing & Residential Home Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION x 3 x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 2 Two Acres Nursing & Residential Home Version 1.10 Page 19 Are there any outstanding requirements from the last inspection? One requirement is outstanding 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 12 Regulation 16 Requirement The Registered person must ensure the residents on Fern are provided with suitable and proper stimulation, interaction and meaningful occupation The Registered person must ensure that proper preemployment checks are completed and received into the home prior to staff commencement. The Registered person must refer to Schedules 2 and 4 to ensure that all staff files contain the correct information. The Registered person must ensure that all staff receive regular dementia care training to include nutrition and meals, respect and dignity, person centred care planning, activities and meaningful occupation. The Registered person must ensure that control valves are fitted to hot water outlets in all resident areas. (Timescale of 30/11/04 not met) Failure to comply within the timescale will result in enforcement action being taken.. Timescale for action 31st May 2005 2. 29 17 and 19 Prior to commence ment of stafff 3. 30 18 From 31st May 2005 and ongoing 4. 38 23 30th June 2005 Two Acres Nursing & Residential Home Version 1.10 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 7 14 19 38 Good Practice Recommendations The Registered person is recommended to include a life history for each resident The Registered person must ensure that all residents are given a choice about wearing aprons at mealtimes The Registered person is recommended to continue to improve the environment on Fern, paying particular attention to the lounges and dining room. The Registered person must review all of the risk assessments for the use of bed rails. Two Acres Nursing & Residential Home Version 1.10 Page 21 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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