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Inspection on 24/01/06 for Two Acres Nursing And Residential Home

Also see our care home review for Two Acres Nursing And Residential Home for more information

This inspection was carried out on 24th January 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is well managed by a competent and experienced manager. The quality of the service provided is monitored and reviewed on a regular basis. Care plans are generally good, but need further work regarding residents` social and emotional needs Staff are very caring, and demonstrate a good understanding of the residents physical care needs. The activities and interaction with residents and staff are very good on the Heather unit, and the home has a designated activities coordinator who works with the residents in all units. Staff are given plenty of training opportunities, and the home has a designated training co-ordinator. Trained care staff and nurses are available on each shift, and although recruitment of care staff is difficult the home ensures they are properly checked before starting work.

What has improved since the last inspection?

What the care home could do better:

The care plans in Rose and Fern unit need more information about residents social, emotional and communication needs. Care plans in Rose unit need to be more personalised. Although staff training opportunities are good, the staff on Rose unit need to develop a greater understanding of caring for the residents dementia care needs.

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 24th January 2006 2.20 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.V275910.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 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 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) 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 And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 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 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. 20th April 2005 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. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over 6 ½ hours during which time the inspector visited all units and spoke with 15 residents and 7 staff. The views of residents and staff, where appropriate, are reflected in the findings in the report. During the inspection, the inspector looked at samples of care plans, staff files and financial records. Because this inspection was carried out during the afternoon and evening, feedback was given to the Manager by telephone the following day. A total of 2 requirements and 1 recommendation were made as a result of this inspection. What the service does well: What has improved since the last inspection? The décor in Fern continues to improve with more murals added to corridor walls, and residents’ art work displayed in the dining room. This unit is looking less bare and clinical and the home must continue its development. The care plans in Rose and Fern now contain a brief life history and information about social interaction, but this needs expanding on. The residents on Fern now benefit from better and more frequent interaction with staff. By fitting control valves to hot water taps in all resident areas the home has improved residents safety. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 A senior member of the nursing team assesses residents’ needs prior to admission and the home is careful not to admit anyone whose needs they cannot meet. EVIDENCE: Staff confirmed that all residents have their needs assessed before admission, and the information obtained is used to devise their care plans. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 7 Care plans in Fern unit have improved, care plans in Heather unit are good and those in Rose unit need more information about residents social and emotional needs. All care plans except those on Rose unit were personalised and tailored to individual care needs. EVIDENCE: The home uses standard formats for their care plans, however, Fern and Heather units have added information making the identified care needs and guidance for care staff much more individualised and person centred. Care plans on Rose unit need to be personalised as they focus only on physical needs and omit to address residents’ social, emotional and communication needs. The manager has implemented the recording of residents’ life history and social interaction. This is done very well in Heather unit, where residents’ life stories have been expanded to produce lots of information enabling the care staff to give personalised care. Fern and Rose unit need to expand on this to enable care staff to have a greater understanding of residents’ social and emotional needs. A requirement has been made regarding care plans. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12 Interaction has improved significantly in Fern unit, but needs to improve in Rose unit. Residents find their lifestyle in Heather unit enjoyable. EVIDENCE: Staff have worked hard to improve interaction and stimulation for residents in Fern unit, and they enjoy more one to one with staff and group activities such as craft work and games. One resident said he didn’t often get bored and enjoyed watching TV, painting and playing games. Heather unit provides many activities and stimulation for the residents and they were happy to be there. Staff on Rose unit are good at identifying and meeting residents physical needs, but not at addressing their emotional and social needs. Staff interacted briefly with residents but this happened mainly around mealtimes and when they were seeing to residents physical care needs. Many residents have communication difficulties and staff were unsure how to manage this. A requirement has been made regarding stimulation and interaction with the residents on Rose unit. The home has an activities co-ordinator who works in all of the units. One member of staff on Fern unit also takes responsibility for arranging activities. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 and 18 Staff would protect residents by reporting issues, staff on Fern and Heather would enable residents to make their feelings known and staff on Rose would be aware of problems with their physical health needs. EVIDENCE: Generally staff were clear about reporting concerns and had received training in adult protection. Because most of the residents have dementia, staff need to act as advocates for them, and staff said they would soon know if something was wrong as they knew their residents well. Staff on Rose focussed mainly on issues around their physical health care needs, and need to have a better understanding of how to recognise residents emotional issues. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19 The environment on Fern unit has improved significantly and is more homely and less clinical. EVIDENCE: This standard was only assessed on Fern unit. More work has been done to make Fern unit a much less clinical environment and it is more welcoming and homely. Improvements have been made in the dining room and the corridors, with the addition of more murals and pictures, and displays of the residents’ artwork. The lack of carpets in this unit detracts from the homeliness, but the home is clearly making an effort to address this. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 13 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 28, 29 and 30 Significant improvements have been made to recruitment procedures and the home is making every effort to protect residents from harm. Dementia care training has improved staffs understanding with the exception of staff on Rose unit. Trained staff are deployed on all shifts which ensures residents receive care from qualified staff. EVIDENCE: Two files of newly appointed staff were inspected. These staff have been recruited from overseas via an agency. The home is careful not to allow staff to commence without proper checks being made. The manager advised that a new training co-ordinator has been employed who has started to deliver more in depth dementia care training. Some staff have attended this training, and more training is scheduled. The requirement made at the previous inspection regarding dementia training has not been repeated as the manager is currently addressing this. The home provides lots of in house training, including induction based on the new induction standards shortly to be introduced by Skills for Care. Many of the staff are trained overseas nurses and the home has identified this as being equivalent to NVQ level 3. Staff have a good understanding of basic care practices and training opportunities are good. At the time of the inspection, two of the staff were attending a course about preventing falls in people with dementia. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 14 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 Residents’ benefit from living in a home that is well run by a competent manager and also by making sure their finances are safely managed. The home is good at monitoring the quality of service provided and makes every effort to provide a safe environment. EVIDENCE: The manager, who is also a trained nurse is working towards achieving the Registered Managers Award and is currently studying for the diploma in dementia care. Records of residents’ finances were inspected and were in good order. The administrator manages and audits these accounts. Yearly formal quality surveys are undertaken, and feedback is provided in a report format. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 15 Quality is also monitored by the manager who holds regular staff meetings and makes sure the care plans are regularly reviewed and updated. The manager has recently reviewed and updated the use of bedrails on Rose unit, and although these are used for many residents, their use is monitored. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 16 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 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 X 28 4 29 3 30 2 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.V275910.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? One 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 12 Requirement Timescale for action 30/06/06 2. OP12 16 The Registered person must ensure that social and emotional care needs are identified in a plan of care and guidelines are in place instructing staff in how to meet these needs. This particularly refers to residents in Rose and Fern units. The Registered person must 31/03/06 ensure the residents on Rose unit are provided with suitable and proper stimulation, interaction and meaningful occupation. 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 The Registered person is recommended to continue with the life story work for each resident. Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Two Acres Nursing And Residential Home DS0000015696.V275910.R01.S.doc Version 5.1 Page 19 - 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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