Inspection on 05/09/08 for Two Acres Nursing And Residential Home

This inspection was carried out on 5th September 2008.

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

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

Other inspections for this house

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... 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

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Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

CARE HOMES FOR OLDER PEOPLE Two Acres Nursing And Residential Home 214 Fakenham Road Taverham Norwich Norfolk NR8 6QN Lead Inspector Kim Patience Unannounced Inspection 5th September 2008 10:00 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.V371627.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.V371627.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.V371627.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. 1st August 2007 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.V371627.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. This inspection consists of information gathered since the last inspection and information provided by the home. In addition we conducted an unannounced site visit, which took approximately 8 hours to complete. The site visit focussed on Fern unit as this is where people with high level needs associated with dementia are accommodated. However, we took a brief look at Rose unit. During the site visit we examined records relating to people who live in the home, to staff and the running of the business. In addition, we made observations of daily life in the home and spoke with some residents where possible. What the service does well: What has improved since the last inspection? Since the last inspection some of the rooms in Rose have been refurbished to create large single rooms. Heather has been redecorated throughout and an interactive games console has been purchased for residents. A new unit manager has been appointed for Fern and will be starting in September 2008. In addition, the home now has a deputy manager who covers 24 hours a week and is in the process of completing a registered managers award. The manager says that care plans are more person centred and they have introduced Jackie Pool activities specifically for people with dementia. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 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.V371627.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. People coming to live in the home do so knowing that the home can meet their needs and the accommodation and facilities are suitable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prior to moving into the home people’s needs are assessed by an experienced and qualified person. No one is admitted to the home without knowing that their needs can be met and the home has assessment tools in place to achieve this. People and their representatives are given the opportunity to view the accommodation before moving in. We looked at records relating to recently admitted people and found that there was no change to the pre-admission procedures found previously good. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 9 We surveyed people living in the home and 7 completed surveys were returned. 6 of the seven surveys indicated that people had been given a contract and had sufficient information about the service prior to moving in. one person indicated they had not. Two Acres Nursing And Residential Home DS0000015696.V371627.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 Quality in this outcome area is adequate. People living in the home have their needs assessed. However, improvements are needed in care planning, associated risk assessments and medication practices before the outcomes are good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at records relating to five people living in Fern unit, which accommodates people considered to have severe cognitive impairments. We completed some case tracking, which involves looking at care plans and associated records and making observations of the individual needs, their accommodation and daily life in the home. This enables us to see how well people’s needs are being met and if in accordance with the assessments in place. The records showed that there was personal information about people such as name, next of kin and GP and a ‘snapshot assessment’ that provides a quick Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 11 overview of the individuals needs. The snapshot also contained some person centred information such as dietary preferences. Not all records showed an identifying photograph of the resident. There were assessments in relation to health and social care needs. However, some of these assessments were not completed in full. For instance we looked at one assessment for behaviour, which stated can be ‘uncooperative and unpredictable’ but no further information was available. We saw some social history documents, which were not completed. We also found in some cases that there was evidence of falls but no falls assessment had been completed and in the records we looked at we did not see any continence assessments. In at least one file there was evidence of poor diet and fluid intake and there was no nutritional screening or care plan setting out how this need should be met. We found that fluid charts had been put in place for two people. But we could not find care plans to provide staff with guidance about how much fluid should be offered and how frequently. When we examined the fluid charts person they showed that on the day of the site visit a nutritional drink was given at 9:00, fluid was offered at 10,11 and 12 but only sips were taken, then no further entries for the rest of the day. There were similar findings when we looked at other days. Care plans were written in a person centred way telling the reader a story about the individuals needs in relation to daily routines, considering their abilities and preferences. However, this did not cover specific needs and how they should be met. There were regular evaluations but this information was not incorporated in the care plans and may be at risk of being lost. We looked at risk assessments and saw that the home has individual risk assessments in relation to daily living, which contained some guidance for staff as to how risk should be minimised. However, in one case we found that a person was behaving in a way that was a risk to their health and an assessment had been completed. It was noted in the person’s records that they would ‘eat and drink anything they got hold of’ and one day they had eaten some sudocrem. Products similar to this were still seen in the home and therefore the home has not taken action to minimise the risk and protect this person from further harm. Some people’s records contained life histories in sufficient detail to enable staff to establish what life was like for individuals before the onset of dementia. It was not apparent how the home supports people to live a life that is consistent with their previous experiences and this information was not necessarily translated into meaningful care plans. For instance, it was difficult to see how and what activities are provided to individuals. However, the nurse in charge said that she thought the activities person maintained records of activity but they could not be found. We looked at the medication practice in Fern unit. Medicines are stored in the nurse’s office in locked storage cabinets. There is a fridge for medicines that require refrigeration and a controlled drugs cabinet, which was securely fixed Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 12 to the wall. The home has a lockable trolley for the safe transportation of medicines around the home when they are being administered. Nurses said they administer medicines and are the only staff who have access to the medicines at any time. We looked at Medication Administration Record (MAR) charts and crosschecked these with medicines remaining in stock. We also checked the use of medicines against people’s records such as care plans and risk assessments. We found that the home use a Boots medication system comprising of pre printed charts and a metered dosage system (MDS). The individual MAR charts were held in a folder, we did not see any dividing cards between the charts with a name, identifying photograph of the resident or any special requirements. However, we noted that on some charts, allergies had been recorded at the top. The charts appeared in good order and there were no gaps in the records. When examining some of the charts we found that where PRN (as required) medicines were prescribed with variable dosages, the exact dose was not always recorded. We also found that some PRN medicines were given consistently. In addition, in at least one case there was nothing to indicate why the medicine had been given and what steps had been taken before making a decision to administer the medicine. However, on another chart where a PRN was given consistently nurses had made a record indicating the reason but again not the steps that had been taken before making the decision to administer the medicine. When we looked at the MDS and compared it with the charts we found that some medicines remained in the MDS when they had been signed as administered. When we looked at the controlled drugs and compared this with the controlled drug register we found that there was one tablet that could not be accounted for. The nurse on duty said that this was due to the tablet being wasted. However, the records did not reflect this and the home has not investigated this. It was noted that liquid medicines had been prescribed for at least two people when they did not appear to have any physical reason for having liquid medicines. Records showed they were able to eat a normal diet. We asked the nurse in charge if they were administering medicines to any residents covertly. She stated there was one resident who had medicines placed in his food. There was a letter from his GP alongside the chart agreeing to his medicines being administered in this way. However, there was no assessment in accordance with the Mental Capacity Act (2005) or any reference to the person’s capacity. In addition, the decision did not appear to have been made by a multi-disciplinary team. During the visit observations of people were made. It was noted that some people’s dignity was not being promoted. For instance, we saw one person with Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 13 their trousers undone and underwear showing, it appeared they may have had some difficulty redressing themselves. We also saw people after lunch with food on their clothing. We surveyed people using the service and seven completed surveys were returned. All seven of the surveys indicated that people have their health and care needs met. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 14 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 adequate. The service is making efforts to provide people with a lifestyle that matches their preferences and expectation. However, improvements are needed in the areas of care planning, provision of person centred activities and choice, before the outcomes are good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As already written in the health and personal care section, care plans setting out people’s social needs were not seen in people’s records. However, there was life history information and details about how people lived their lives before coming to live in the home. This information did not appear to have been used to form meaningful plans of social activity. On the day of the visit there was little or no activity taking place. However, the nurse in charge said the activities coordinator was on leave that day. We asked the nurse where activities undertaken by each individual would be recorded and we were told in the daily progress notes. However, when we looked at the records there was little evidence of activity taking place. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 15 We observed the mealtime experience in Fern unit. Lunch is divided into two sittings, the first for people who need support to dine and the second for people who can eat independently. Lunch started at approximately 11:50 and some people were seated in the dining area and some in the communal lounges. The dining tables were not set with placemats and cutlery and did little to aid people’s memory and recall in respect of creating an environment conducive with dining. We saw staff handing out cutlery at the same time as the meals. People were provided with drinks in frosted, coloured plastic beakers and it was difficult to see the fluid within. Some people were wearing plastic aprons and some wearing cloth tabards. The meal choices for the day were displayed on a board in the dining area. People were asked what they wanted to eat. In some cases staff showed people the plate of food so that they could make a meaningful choice. In other cases we saw staff just giving verbal choices or showing one plate of food and asking people if they wanted the meal. We observed staff assisting people who needed support with their meals and this was done in various ways. Some staff sat by the side of the resident and some stood by them. One member of staff was assisting two people at the same time, two members of staff swapped over part way through assisting someone with their meal. In the lounge we saw one member of staff assisting another person and the help was given in a sensitive manner. We noted that there was a plate of softened food on a chair next to a resident in the lounge. We asked the care assistant why it was there and she replied ‘it was for a resident who can eat independently but tends to fiddle with the food so they provide softened food and do the task for them’. The meal was on the chair for at least 20 minutes before it was given. Some other people needed support and prompting with their meals but there were not enough staff available to provide it. Therefore we saw some people have difficulty managing their food and some who did not eat their meal. There was little interaction between staff and residents. Some staff were talking to residents during lunch and the cook was engaged in lively banter with people. The whole experience of dining could be enhanced by staff engaging with people in a more meaningful way. For example describing the food that is offered and talking to people when assisting them with meals. During the second sitting there were two residents looking for somewhere to sit in the dining area so that they could have a meal. They were told by staff that there was not enough room and would have to wait. They continued to look for a table in the lounge but again were told that there were not enough tables and would have to wait. They were eventually seated when some others had finished their meal. The two nurses’ in charge during the day were asked if the home maintains records of people’s dietary intake so that nutritional intake and sufficiency can be monitored and they said they did not. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 16 Due to the flooring in the dining and adjoining areas the noise levels are greater and could potentially increase agitation and confusion. We surveyed people who use the service and five people indicated there were always activities they could take part in and two indicated usually. Three people indicated that they always like the meals in the home and four indicated usually. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 17 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 and 18 Quality in this outcome area is good. People living in the home can be assured that their complaints will be dealt with appropriately and there are systems in place to safeguard them from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at how the home deals with complaints and safeguarding issues. One complaint has been received by the home since the last inspection and this was dealt with in a satisfactory manner. The home has a complaints procedure that is displayed in each unit and a record of comments and complaints is maintained. There has been one safeguarding issue since the last inspection, which was dealt with appropriately by the home. Staff are provided with safeguarding training and are aware of the whistle blowing policy. The seven people who returned surveys indicated they knew who to speak to if they were not happy. People also indicated they knew how to make a complaint if they needed to. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 18 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 and 26 Quality in this outcome area is adequate. The home provides accommodation of an adequate standard for the people that live there. However, there is a plan to improve the environment and work is in progress with a focus on the needs of people with dementia. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We completed a tour of Fern unit and looked at part of Rose unit. The manager said improvements have been made in Heather unit such as redecoration and there are plans to convert three rooms to singles. In Rose 5 rooms have been converted to single rooms and redecorated to provide nice bright homely rooms. The home is engaged in an assisted technology project and has introduced items such as key finders, pressure mats and wall clocks. In Heather unit, an interactive gaming machine has been purchased and the manager said that residents are enjoying this activity. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 19 The external grounds have been developed to provide small pleasant outdoor areas with seating. There is a sensory garden and staff have placed squirrel and bird boxes in the grounds to encourage wildlife. In addition the home now has real pets such as guinea pigs and rabbits. In Fern, some further improvements need to be made to make it more homely and to promote the needs of people with dementia. Some effort has been made to add items of interest to the corridors and to paint doors so that they are easier to distinguish from others. Some memory aids have also been added to people’s private accommodation. However, further improvements are needed in order to assist people to orientate independently around the home and to their rooms. The dining room needs to be improved to make it appear more homely and comfortable. In addition, the home must have adequate space for people to sit and eat in the dining room at a time of their choosing. We observed two people who wanted to have their meal but could not find a table to sit at. When looking at the communal facilities it was noted that bathrooms and toilets were locked and residents did not have access to the facilities when needed. We observed one person in the corridor wishing to use the toilet, they had tried the doors and found they were locked but were unable to find their own room where they could use the en suite. We went to find a member of staff to assist the person. When looking in people’s private accommodation we found that rooms were homely and contained personal items such as pictures and memorabilia. In the en suites we saw products such as toiletries and razors that were not secured. This is of concern as we saw a risk assessment for one resident saying he had eaten a cream used external application to the body and was at risk of consuming other products such as shampoo and shower gels. Overall the unit appeared to be clean and tidy. However, some areas looked as though they would benefit from a thorough clean, such as the dining room floor. All seven people who returned surveys indicated that the home was kept fresh and clean. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is good. People living in the home can be assured that staff are trained to meet their needs. However, staffing levels need to be reviewed to ensure they are adequate at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We assessed staffing in the home by taking copies of the staff rosters for analysis, by observations in Fern of how well people’s needs are being met and through discussion with the training manager and other staff working in the home. The manager said the target staffing levels in Rose are 9 in the morning, 7 in the afternoon and 4 at night. In Fern, they are 6/7 in the morning, 5/6 in the afternoon and 4 at night. In Heather, they are 3 in the morning, 2 in the afternoon and 2 at night. In Fern unit the manager said there are currently 30 people accommodated. The rotas show that the staffing levels have been maintained at 6:5:4. The best practice guidance on staffing levels in care homes for people with dementia is a ratio of 1 member of staff to 5 residents throughout the waking day. Observations at lunchtime show that the home needs to review the Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 21 staffing levels at peak periods to ensure they are adequate and they are able to meet people’s individual needs. However, training needs and deployment of staff may also be an issue. People who returned surveys indicated that staff listened to what they needed and were available when they wanted needed support. We spoke with the training manager who was able to provide a record of training for each individual member of staff and a training programme for the coming year. The records show that staff are provided with a good range of training from various sources and using various training methods. For instance, some training is carried out by external trainers and some in-house. Training is appropriate to the work people are to perform and includes all the mandatory training such as fire safety, health and safety and moving and handling. In addition, all staff are trained in dementia care. Some members of staff are also trained in dementia care mapping. Staff are offered the opportunity to undertake an NVQ and the home has its own NVQ assessors. The training manager said they are about to offer staff the opportunity to undertake NVQ training specifically in dementia care. We surveyed staff but at the time of writing this report only one completed survey had been returned. The survey indicated that staff were provided with good training and support. The person indicated that staff working in the home were friendly and cared for people to the best of their abilities. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 22 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 and 38 Quality in this outcome area is good. People living in the home can be assured that it is well managed and has management systems in place that aim to promote their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an experienced and well-qualified manager who keeps her knowledge and skills up to date with regular training. The manager has not yet completed advanced training in dementia care but said that she has explored the options available and will be registering for a course early next year. She is supported by a deputy manager who is completing a registered managers award and is registered to start a course in dementia studies with an accredited provider. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 23 The home has a system in place for monitoring the quality of the service and this includes stakeholder surveys. The results of the surveys are collated and the findings and any action taken are published in a report that is made available to people who contributed. The manager was asked if the providers undertook any visits under regulation 26 and she told us that they had not been requested before and therefore the visits and subsequent reports had not been undertaken in accordance with regulation 26. At previous inspections, the way in which the home supports residents with their finances has been good. We have no information to suggest this has changed. We looked at fire safety and health and safety and apart from those relating to products in people’s rooms no issues arose. The home has a maintenance programme in place and employs a maintenance man to carryout any work needed around the home. Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 24 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 3 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 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 17.1(a) Requirement Records relating to people living in the home must be maintained in accordance with schedule 3 of the Care Homes Regulations. Care plans must be written in respect of all assessed and identified needs. They must also be written for identified health risks, so that care staff have clear guidance as to how people’s needs should be met. Risk assessments must be completed in respect of people’s health needs and other risks to their health and welfare. Proper provision must be made to promote people’s health and welfare. Medication arrangements and practice must safeguard people’s health and welfare. This is a repeat requirement Medicines must only be administered covertly when residents are deemed to be without capacity to consent to their medicines being administered and this must be part of a multidisciplinary DS0000015696.V371627.R01.S.doc Timescale for action 24/10/08 2. OP7 15.1 24/10/08 3. OP8 13.4 24/10/08 4. 5. OP8 OP9 12.1(a) 13.2 24/10/08 24/10/08 6. OP9 13.2 24/10/08 Two Acres Nursing And Residential Home Version 5.2 Page 26 7. OP12 16.2(m) 8. OP10 12 (4, a) agreement. (Mental Capacity Act 2005) People must have an individual plan of activities based on their preferences, hobbies and interests. People’s dignity should be respected, particularly during mealtimes. This is a repeat requirement. People must be provided with adequate nutrition and fluid intake. So that their health and welfare is safeguarded. People must be provided with an environment, which promotes a positive experience of dining and aids memory and recall. So their health and well is promoted. The home must maintain records of people’s dietary intake so that it can be determined whether the diet is satisfactory. People must be provided with sufficient space in the dining room so that they can be seated to have their meal at a time of their choosing. People should benefit from a care environment that meets their individual physical and psychological care needs. Therefore the Provider needs to improve the care environment. This is a repeat requirement. Monthly visits must be made to the home as part of the organisations quality assurance process. Results of the visits completed in accordance with regulation 26 must be written in a report that is made available to the Commission on request. So that people can be assured the service is self-monitoring. 24/10/08 24/10/08 9. OP15 16.2(i) 24/10/08 10. OP15 16.2(i) 24/10/08 11. OP15 17.2 schedule 4 (13) 23.2(g) 24/10/08 12. OP19 24/10/08 13. OP19 23 (1, a) (2, a, b, d) 24/10/08 14. OP33 26 24/10/08 Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP19 OP27 Good Practice Recommendations 1. 2 In order to promote a supportive care environment, noise levels should be reduced throughout the home. In order to promote people’s well being and enhance people’s enjoyment of experiences in the home staff should be given further guidance and training in how to engage with people in a meaningful way. People should have access to facilities and toilets in communal areas of the home. Staffing levels or the deployment of staff should be reviewed to ensure that there are sufficient staff on duty at peak times. 3 4. OP19 OP27 Two Acres Nursing And Residential Home DS0000015696.V371627.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V371627.R01.S.doc Version 5.2 Page 29 - 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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