Care Home: Acacia Lodge

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What the care home does well The people that wish to use the service benefit from a pre-admission assessment and the care plans are then generated from this initial assessment. The pre-admission assessment is kept in the person`s individual care plan folder. Care plans and risk assessments contained enough information about the people using the service to allow staff to care for them appropriately. Regular training takes place and this includes the NVQ (National Vocational Qualification) which all staff have access to. What has improved since the last inspection? Three requirements were made following the inspection in May 2007 and these have now been met. All people using the service have now received an assessment to determine if they can or cannot handle their own medications. The maintenance, refurbishment and repairs identified in the home`s audit have now been completed and Mrs Tharani said this is on going work. A quality audit tool has now been developed to allow people using the service to take part in the process of commenting on the quality of the care and facilities provided. What the care home could do better: One requirement was made following this inspection and can been seen at the end of the report. People who use the service are to be consulted about the programme of activities arranged by or on behalf of the care home, having regard to the needs of the people using the service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Acacia Lodge Rookery Road Staines Middlesex TW18 1BT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 3 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Acacia Lodge Rookery Road Staines Middlesex TW18 1BT 01784452855 01784441743 acacia@chessbroadband.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Metro Care Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 36 Number of places (if applicable): Under 65 Over 65 0 36 learning disability old age, not falling within any other category Additional conditions: 1 0 The maximum number of service users to be accommodated is 36 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Learning disability (LD) Date of last inspection Brief description of the care home Acacia Lodge is a large detached property located in a quiet residential road not far from the main town centre of Staines. The home is owned by Metro Care Ltd and provides accommodation and nursing care for up to 36 older people, one of who may also have a learning disability. The home also offers respite care. The accommodation is arranged over three floors and consists of a dining room, two Care Homes for Older People Page 4 of 26 Brief description of the care home lounges plus a garden room, a well-equipped kitchen, utility room, three sluice rooms, a main office on the ground floor and the managers office on the first floor. There are three bathrooms and six toilets, all with adapted facilities to accommodate those with mobility problems. The majority of bedrooms are single occupancy, however there are some double rooms available. Most bedrooms have en-suite toilet facilities and those that do not have a hand basin in the room. The property has undergone extensive refurbishment over the last two years and plans further extension and improvements subject to planning permission. There is a good size, well kept garden to the rear of the property that is accessible to the service users and parking for several cars in the car park to the side of the building. Access to public transport is close by. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an unannounced Key Inspection. Mrs Lesley Garrett, Regulation Inspector carried out the inspection. The Assistant Operations Manager represented the service and we were also assisted by the training manager for the company and two of the homes nurses. We arrived at the service at 10:00 and were in the home for five hours. It was a thorough look at how well the home is doing. It took into account information provided by the home and any information that CQC has received about the service. The manager for the service supplied CQC with an AQAA (Annual Quality Assurance Assessment) and this document was used to assist with the inspection. The inspector also spent time talking with some of the people using the service and staff members. Care Homes for Older People Page 6 of 26 We looked at how well the service was meeting the key national minimum standards and complying with the regulations and have in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, staff files, training records, and the homes safeguarding and complaints policies and procedures. From the evidence seen by us and the comments received, we consider that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service benefit from a pre-admission assessment from a suitably trained person from the home to ensure that their needs can be met. Evidence: All people wishing to use the service have the benefit of a pre-admission assessment by a suitably qualified individual. This ensures that their needs can be met on admission. The nurse then told us that the person who does the assessment then hands over to the other staff so that everyone is aware of the care needs of that particular individual. Documentation was sampled which confirmed that the assessments had taken place and that the home used an assessment sheet that was thorough. Risk assessments are also written at the assessment stage. Care Homes for Older People Page 10 of 26 Evidence: The home does not offer intermediate care. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care of people using the service is a good quality with staff knowledgeable about their needs. Care plans were well written with enough information available to allow staff to care appropriately for the people using the service. Evidence: Two care plans were sampled and all contained information about each person using the service. Risk assessments were detailed with clear instructions for staff. The documents were user friendly and allowed staff to identify easily the care needs for a particular person using the service. It was clearly documented, by the staff, that reviews had taken place and that the care plans had been agreed by the people using the service following a consultation. Staff spoken to on the day were knowledgeable about the care needs of the people using the service. One person using the service told us the staff really take care of all of my needs. Another person who completed a survey told us that the thing the home does Care Homes for Older People Page 12 of 26 Evidence: best is the level of care that is given. Aids and equipment are provided to encourage maximum independence for people using the service and for the prevention of pressure sores. A range of profiling beds, overlay and replacement mattresses, adapted bathrooms and equipment to aid manual handling was all seen during the tour of the home. The home has the services of a local GP who will visit the home when called. These visits are all documented in the care plans. Other healthcare professionals also visit the home and these include optician, chiropodist and physiotherapist. A completed survey from a healthcare professional told us that the home only calls the GP surgery when necessary and that the person in charge is very efficient. There are medication policies and procedures in place. All medicines are delivered monthly and are in blister packs. Some medication administration records were sampled and they were clearly written and no gaps observed in the signature box. During a tour of the building it was observed that staff were speaking appropriately to the people using the service by their preferred name which had been documented in their care plan. All people were dressed in clothes appropriate for the weather with hair well groomed and nails clean. Staff were knocking on peoples bedroom doors prior to entering. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to take part in a limited social activity programme but are able to exercise choice in their daily lives. There is good standard and variety of meals served at the home. Evidence: On the day of the inspection is was observed that many of the people using the service were in bed or in their room. There were two lounges available but few people were using this facility. We spoke with some of the people using the service who told us they chose to stay in their room and another said they had chosen to stay in bed. The Assistant Operations Manager told us that an outside activity provider came to the home but there was very little take up of the activity. We were informed on the day of inspection that a carer is taking the lead in the home to organise the activities and has started by organising card making over Easter, card games and exercises. People using the service would benefit from a more organised programme of activities so a requirement will be made to consult with the people using the service to seek their views and interests. One person who returned a survey form to us said the home could encourage more hobbies and interaction with the people Care Homes for Older People Page 14 of 26 Evidence: using the service. Visitors were seen to be in the home during the course of the inspection. The Assistant Operations Manager said that there is no restriction on visiting and they are welcome at any time. One relative told us the staff provide a good standard of care. Another told us we are always greeted warmly and offered tea or coffee on arrival. We spoke to the cook on the day of the visit who told us she has a good knowledge of the people who use the service and knows their likes and dislikes. Choices are offered and if they do not want the meal on offer they can be offered an alternative. People who use the service told us the meals are lovely I am really fed well. Another said the home is good on the quantity and quality of meals. One completed survey returned to us on the question what could the home do better? commented a variety of different meals to cater for people without dentures or teeth which is not liquidised. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their complaints are listened to and that they are protected from abuse from a staff team that have received training in safeguarding adults. Evidence: The Assistant Operations Manager said that during the last year they had received one complaint an element of which was dealt with under the safeguarding adults procedures.This complaint is still on going. The complaints policy is available to people using the service. In the completed surveys returned to us from people using the service and their relatives they told us that most knew how to complain but two people were unsure. The provider should ensure that all people using the service has access to the complaints policy to refresh their memory. People spoken to on the day of the visit were happy with the home and confirmed they would know who to talk to if they had a concern. The home has not had any safeguarding referrals during the last year. The training manager confirmed that training takes place regularly for all staff. The training records confirmed this and staff were knowledgeable about the procedure. The homes policy on safeguarding adults is in line with the local authoritys policy and procedures. CQC have not been made aware of any complaints about the home or any referrals Care Homes for Older People Page 16 of 26 Evidence: under the safeguarding procedures. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables people who use the service to live in a safe, well maintained environment. Evidence: During the tour of the building it was observed that people using the service have access to a variety of communal areas but that most people stayed in their rooms. There are two lounges, a sun room and dining room. The dining room is small but again we were told people eat either in their room or in the lounge. The Assistant Operations Manager said that this home was a difficult space as it was a converted house and requires continual updating and decorating. On the day of the visit the maintenance person was decorating a bedroom. The downstairs bathroom had been completed since the last inspection and this room was now a wet room. Since the last inspection air conditioning units have been fitted in both lounges which are also heaters in colder weather. All bedrooms that we visited had been personalised by the people using them. One person told us that the home had recently supplied them with a new armchair and another said the owners have bought me a new television I feel like I am in the cinema. The garden is currently undergoing major redevelopment. A pergola is being erected Care Homes for Older People Page 18 of 26 Evidence: and, together with free standing parasols, The Assistant Operations Manager hopes it will also provide plenty of shade in the summer for the people using the service. The Assistant Operations Manager said it should be completed for this summer. Infection control procedures are adhered to in the home with aprons, gloves, paper hand towels and soap dispensers supplied. The training manager confirmed that infection control training also takes place for all staff. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers at the home on the day of inspection were sufficient to meet the assessed needs of the people using the service. The service provides training for all staff to ensure staff care appropriately for the people using the service. Evidence: We sampled the staff rotas and spoke to the nurses who confirmed that the home has a number of empty beds at the moment. They told us that they are staffed to the numbers of people using the service. The Assistant Operations Manager confirmed that should dependency levels increase then staffing levels will also increase. Staff that returned completed surveys to us said, when asked, are there enough staff to meet the individual needs of all the people who use the service? replied always. The AQAA told us that staff at the home mostly cover any unfilled shifts which reduces the need to use agency staff. The training manager said that well over 50 of the care staff have NVQ certificate and some at level three. The training at the home is on going and records confirmed this. Staff confirmed that they had received an induction when they joined the staff team and the Assistant Operations Manager told us that this was linked with a national organisations induction programme. Care Homes for Older People Page 20 of 26 Evidence: Two staff employment folders were sampled and were found to have all the necessary paper work to enable the home to employ those people safely. This ensures that the people who use the service are protected by the homes recruitment procedures. The home benefits from a training manager who works at both homes and ensures that all training necessary for staff takes place. Records showed that mandatory training takes place which includes fire awareness, safeguarding adults, food hygiene and first aid. Staff spoken to on the day told us that they had received lots of training and that the owners of the home are very supportive with the training that is provided. Completed surveys also confirmed that plenty of training is provided. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements at the home ensures the staff team is adequately supported and there are clear lines of managerial accountability. Quality assurance systems are in place which improve the quality of care offered to the people who use the service. Evidence: The person who is in charge on a daily basis is the deputy manager. The home does not currently have a registered manager. The Assistant Operations Manager told us that the home is supported by herself and the responsible individual and that there is a clear and accountable management structure. The Assistant operations Manager told us that they closely monitor the home and are present there nearly every day. We were also told that they are available at any time if the staff need them. The Assistant operations Manager told us that questionnaires are sent to the people Care Homes for Older People Page 22 of 26 Evidence: who use the service and their relatives/representatives to seek their views on the quality of the service and care provided. These have not been sent out this year as people have just completed the commissions surveys so they will be done later in the year. No personal money is held by the home. All invoices are passed to the relatives, representatives or to the person using the service for them to settle the bill themselves. Lockable drawers are provided in each bedroom for people who use the service to store valuables if they need to. All necessary health and safety certificates are in place and we also observed a range of policies and procedures relating to health and safety. The Assistant Operations Manager told us that they appoint experts in the area of fire risk assessment, employment law, health and safety and a nursing consultant to ensure that the home is compliant with statutory health and safety legislation. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 People who use the service to be consulted about the programme of activities arranged by or on behalf of the care home. Having regard to the needs of the people using the service. To ensure that people using the service are not socially isolated and can engage in meaningful activities if they choose to do so. 15/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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