Care Home: Acacia Lodge Nursing Home

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What the care home does well We have previously judged that this service provides excellent outcomes for the people who live there and we have not received any information that would make us change our minds. Many of the residents in this home have lived there for some years and all of them spoke very positively about the experience. Relatives told us how the health care of some residents had improved since their admission and everyone praised the care and expertise of the manager and her staff. Several people mentioned the warm and welcoming atmosphere within the home, telling us that it was what had attracted them in the first place. They agreed that some other homes had bigger bedrooms or en suite facilities however, they liked the way that seating was arranged in small groups instead of people sitting around the edge of the room and, despite it being a little shabby in places now, they found it very homely. Staff turnover in the home is very low and this familiarity helps residents to feel safe and secure. They told us that there were activities arranged for them to join in with if they wanted to, daily papers are delivered for them and several said how much they enjoy sitting in the gardens which are a particular feature of the home. Mealtimes are an enjoyable experience in the home with residents sitting together in the dining room. There are menu choices every day and the cooks, like all of the other staff in the home, are encouraged to become involved with residents so that they get to know about their preferences or particular dislikes. What has improved since the last inspection? Since the last inspection the staff have introduced The Gold Standard Framework into the home. This initiative is designed to improve the lives of those people who are nearing the end of their lives and also their families. They were awarded " Commend Status " in the accreditation process and received a Quality Hallmark Award. The home has found that as a result of this work, unwanted hospital admissions have been minimised and people feel confident that their choices and wishes are being respected, What the care home could do better: During our visit we did not find any particular areas of concern. However, we have recommended that staff should all be able to access training regarding The Mental Capacity Act and The Deprivation of Liberties Safeguards in order to improve their understanding of the relevant issues. We also recommended that the frequency of fire safety training should be increased for staff especially those working at night in order to ensure residents safety in the event of a fire. Key inspection report Care homes for older people Name: Address: Acacia Lodge Nursing Home 1 Stanhope Road Croydon Surrey CR0 5NS     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison Ford     Date: 2 4 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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 Nursing Home 1 Stanhope Road Croydon Surrey CR0 5NS 02086888000 02086671060 acacia@irh-homes.com www.lrh-homes.com London Residential Healthcare Limited care home 30 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 30 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Acacia Lodge is a nursing home registered with the Commission for Social Care Inspection to provide care for up to 30 Older People, aged sixty-five years and over. The property is a large detached property set in its own grounds amongst attractive, well-maintained gardens and close to a park. It is owned by London Residential Healthcare Limited. There is parking for ten cars to the front of the premises. Accommodation is arranged over two floors with range of single and shared bedrooms. There is a lounge and dining room on the ground floor and toilets and bathrooms are located conveniently on each floor. Care Homes for Older People Page 4 of 26 Over 65 30 0 Brief description of the care home Fees range from £565 to £800 . Different rates are paid by residents funded through local authority arrangements as opposed to those who are funded privately. 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: three star excellent 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 report follows an unannounced visit to the service made as part of our planned inspection activity. when writing the report consideration had also been given to other information that we have received since our last inspection in 2007. This has included information about how the service has managed any complaints, notifications that we have received and what other people have told us about the service. When we visited we were able to spend time talking with the manager, some of the staff, several of the people who live in the home and also some relatives who were visiting at the time. We looked at various records that the home is required to keep as evidence of their commitment to the health and safety of the people who use the service. We also undertook a tour of the home nd looked at some of the care plans of people that we spoke with. The home has also sent us their Annual Quality Assurance Assessment which is their Care Homes for Older People Page 6 of 26 own self assessment of how well the home is meeting its aims and objectives and also about their plans foe the future. Care Homes for Older People Page 7 of 26 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 on page 4. Care Homes for Older People Page 8 of 26 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 9 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 10 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. No one is admitted into the home without having had a comprehensive assessment undertaken to ensure that the home can meet their needs and that they will be happy living there. Evidence: During the inspection we spoke with several residents and their relatives about their experiences when they were choosing a home. They were able to tell us how helpful staff had been, showing them round and providing detailed written information in the form of a service user guide and brochure. We looked in some care plans and were able to see that there was a comprehensive assessment of peoples needs, their capabilities and the support that they would need. There was also information about their past lives and achievements which helps staff get to know them better and understand them. Care Homes for Older People Page 11 of 26 Evidence: We could see that residents or their families had been able to contribute to the assessment process and they had signed the care plans indicating that they had read and understood what was proposed. The home has now adopted The Gold Standard Framework which ensures the highest standards of care for those people who are nearing the end of their lives. One of the elements of this is concerned with advanced care planning in which residents and their families are given the opportunity to discuss how their needs and preferences can be met. We were able to see that this now forms an important part of the admission process. For those people who are funded through local authority arrangements a needs assessment is provided by their care manager. Care Homes for Older People Page 12 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social and health care needs are assessed and reviewed regularly and residents are confident that staff will support them in the way that they prefer. The home has has developed a high level of expertise with regard to caring for people who are nearing the end of their lives. Evidence: We looked at a sample of care plans in the home and found them to be well organised and reflective of the care and support that people needed. We saw evidence that they are reviewed regularly in order to address any changes and that residents and their relatives participate in this process. Feedback and involvement is a continuing process with all members of staff including domestic and catering personnel being encouraged to spend time with the residents. Both residents and staff told us that the home was like one big family. The senior nurses in the home work closely with care staff to ensure that residents are always cared for in a professional and appropriate manner. Care Homes for Older People Page 13 of 26 Evidence: All of the residents and relatives we spoke with told us how well they consider that they are cared for and that they feel safe and happy. We also heard how residents general health had improved since coming to live in the home. Staff actively promote residents right of access to health care and a local GP is an integral part of the organisation of the home. They visit once a week, speaking with all of the residents even if they are not unwell. Other health care professionals also visit such as a physiotherapist, chiropodist and domiciliary dental and optical services. Specialist equipment is in place for those who may be at risk of developing pressure sores. Previous inspections noted that medication practices within the home wee always good with residents receiving all of their medication as it had been prescribed. The home has been working with the PCT who recently undertook their own inspection. As no concerns were raised by them we did not inspect this standard on this occasion. Of particular note is the work that has been undertaken with regard to end of life care in the home. They recently received Gold Standards Framework accreditation and were commended for their work. A plaque outside the front door denotes the award of The Quality Hallmark. Staff are now working with the residents and their relatives to ensure that their needs and choices are met in away which suits them. They have produced useful information leaflets explaining the concept and also about the ways that the home can offer help if a resident dies. We also saw a memorial book in the lounge with photographs and profiles of residents who have died, where people can leave words and tributes to them. We have judged that the way in which peoples health care needs are met in this home continues to exceed the minimum standards. This view is supported by the fact that, although the turnover of residents might be expected to be quite high, given their age, many of the residents have lived there for some years. Care Homes for Older People Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People finfd tha the daily lifestyle within the home suits their needs and preferences. Evidence: All of the residents that we spoke with told us that the daily life within the home suits them. They are able to enjoy their days as they wish and their routines are as flexible as they want them to be. There are activities arranged for people to join in with if they would like to although some of them told us that they preferred to watch television or sit and enjoy the garden in the warm weather. Daily newspapers are also delivered to the home. There is an activities organiser employed by the home although she was not there on the day we visited. However, in the afternoon some entertainers arrived to sing and play music. Many of the residents are able to go out with their families and we noted that there were several visitors in the home. One lady told us that she was able to bring her cat in to see her mother and that the Pets as Therapy dog visted. She also told us that she would be able to have a meal with her mother if she wanted to. Everyone told us that the food is very good in the home. The chef has been there for more than eleven years and knows what the residents like. A comment book in the Care Homes for Older People Page 15 of 26 Evidence: dining room reflects residents satisfaction with the meals. On the day we visited there were two main choices of meal and there would always be the option of an omelette or other similar snack as well. Meals are served in the dining room where tables were laid nicely with cloths and napkins. Everyone was offed a drink with their meal. From our conversations with the the people who use this service we have judged that this outcome group should be rated as excellent. Care Homes for Older People Page 16 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel able to raise any concerns that they might have and are confident that they will be addressed. There are procedures in place which ensure that residents are protected from abuse. Evidence: The home has a clear easy to understand complaints policy. There is a copy displayed in the hall and it is in the homes Statement of Purpose and The Service Users Guide. Information could be produced in alternative formats if necessary, such as large print or audio in order to make it easier for residents and their families to understand. No complaints have been received since our last inspection and the people we spoke with could not imagine that they might have any. They told us that if anything wasnt right they would tell the manager and she would sort it out. There are policies and procedures in place in the home regarding the protection of residents and staff we spoke with had a clear understanding of how they would report any concerns. Appropriate pre- employment checks help ensure that residents are protected from those who have been judged as being unsuitable to work with vulnerable people. Information that we have from people about how the home would address any concerns supports our judgement that this outcome group is rated as excellent. 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 suits the people who live there although it would not meet some of the standards expected of a newer builing. Evidence: The home is an large older style detached house that has been extended with an annexe. It would not meet the standards expected from a newer build; it has some shared rooms, few en-suite facilities and some bedrooms are smaller than would now be acceptable. However it is pleasant and welcoming and of particular note is the spacious entrance hall which gives people an excellent first impression of the home. There were plans to rebuild part of the home, although these have been deferred for the time being, and when we walked around we noted that in places the home is looking a bit shabby now. Some of the paintwork is damaged and carpets are worn. The manager told us there are also issues with the roots from nearby trees causing cracks in the walls. However, it is very homely and suits the residents and their families told us that the decor was not the most important issue for them, being outweighed by the atmosphere and the care. We will monitor the situation to make sure that it remains well maintained. There is a large lounge with chairs in small groups which relatives told us they found particularly nice, rather than seeing them around the edge of the room. There is also a Care Homes for Older People Page 18 of 26 Evidence: separate dining room. Residents have a choice of bathing facilities with showers and assisted baths and there are sufficient toilet facilities around the home. Hand rails and ramps help those with limited mobility. Of particular note are the lovely gardens which are enjoyed by many of the residents in the warm weather. On the day we visited the home was,as usual, warm, clean and free from malodour. Residents have been encouraged to surround themselves with their own possessions in order to make their rooms more homely and these are comfortably furnished. Residents told that there is always plenty of hot water for a bath or shower and they are pleased with the way that their clothes are laundered for them. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a stable experienced staff team in the home in order to meet the needs of the residents. Training will need to be arranged with regard to The Mental Capacity Act and Deprivation of Liberties Safeguards. Evidence: On the day that we visited, the Registered Manager was on duty with her deputy and sufficient staff, both carers and ancillary, to meet the needs of the residents. People told us that there always seemed to be enough staff, they never had to wait too long for any help and they were kind and caring. Relatives said staff were always very welcoming when they came into the home, happy to talk to them and they kept them informed. We noted that all of them, including those undertaking domestic, kitchen and laundry tasks chatted and passed the time of day with residents as they went about their work and acknowledge the role they play in maintaining the atmosphere in the home. All of the staff are able to access training which helps them to meet the needs of the people that they are supporting; those we spoke with were able to tell us about sessions that they had attended. Much of the training is delivered by the deputy manager who also supervises the carers. We did discover that staff, other than the manager, have not as yet had training Care Homes for Older People Page 20 of 26 Evidence: regarding the Mental Capacity Act and Deprivation of Liberty Safeguards. We strongly recommend that this training is provided for all of the staff in the home. The home has a good recruitment procedure in place in order to protect residents although staff turnover is very low. This helps to make people feel safe and provides familiarity. This stable and experienced staff team is a particular area of strength in this home. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is well managed in the best interest of the people who live there. Evidence: The manager of this home, Mrs Ellen Ryan, has been in post for some years. She has always displayed a commitment to her role and an understanding of the need for continuous improvement and development of the service. Several people we spoke with commented on her kindness and they told us they particularly liked the fact that her door was always open and they could pop in for a chat. We asked about how residents and their families would be encouraged to contribute their views and ideas about the home and were told that there are regular meetings for them and that and satisfaction surveys are distributed twice a year. Results from the surveys are collated and displayed for people to see. The home does not take responsibility for the finances of any of the residents, they all have families or representatives to undertake this role. Advocates could be arranged if Care Homes for Older People Page 22 of 26 Evidence: it was necessary. With regard to health and safety practices in the home, the information that we have been given tells us that equipment and services are all properly maintained. The last Environmental Health visit awarded the kitchen a five star rating. We are told that policies and procedures are all reviewed regularly and the home always informs us of any incidents that happen. We asked about fire safety and saw that, in line with current legislation, a risk assessment has been undertaken and there is an identified Fire Marshall. Alarms and systems are tested regularly however, we have recommended that the frequency of fire drills for staff should be increased especially for this working at night when staffing numbers would be reduced. We have judged that the management arrangements in this home exceed the minimum standards. 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 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 1 30 It is recommended that training should be arranged for staff with regard to The Mental Capacity Act and Deprivation of Liberties Safeguards. It is recommended that the frequency of fire drills should be increased especially for those staff working at night. 2 38 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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