Care Home: Acacia Lodge Nursing Home

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What the care home does well The people tell us the home is `clean and has a homely atmosphere`. One person told us that `it`s lovely and likes the home. Another person said `the staff are lovely`. We were told that the `food is very good` and `have three options to choose from`. It was also said `we can choose something else to eat if we do not like what is on the menu`. It was said that the cook was `very good and very nice` We were also told that `the staff are lovely` and some people were able to tell them if they are not happy. One family spoken to said `staff have time to talk to families`. The staff also keep families informed of any thing that happens about their relative. It was also said that their family member `seems happy here`. We were told that `I can`t fault my mothers care`. It was said that during their visits to the home, they observed the person`s privacy and dignity being maintained. The people told us that they like their bedrooms and the rooms seen were individualised to meet the needs of that person. We were told that there is a good activity person who does activities and information about this is displayed each week in the home. Compliment letters read showed that families were happy with the care provided at the home. The staff enjoy working at the home and with the people. The staff work very hard to meet the needs of the people. They are getting more training to help them meet the people`s needs. They were observed talking and listening to the people and offering advice in a positive manner. What has improved since the last inspection? The home has employed a permanent manager since the last manager left. A new lead nurse has also been appointed. The lounge downstairs had a new carpet. The manager had made links with the Alzheimer`s society and they were visiting the home to discuss what they did and services they offer. A new dietician was also visiting the home next week to look at people`s nutritional needs. Monitoring food charts were introduced. What the care home could do better: The home should ensure all staff receives at least 6 supervisions per year to find out how they are working with the people and in the home. The home needs to ensure that the unit upstairs meets the needs of the people with dementia in line with nationally recognised good practice in dementia care. Up date the Statement of Purpose and Service User Guide and in a format the people will understand.Ensure that the home does not admit people who`s needs they are unable to met. Ensure the care plans are set out in detail and explain how the people`s needs are going to be met. Involve the care staff when reviewing the people`s care plans. This is to get information from them about the people`s changing needs. Ensure all complaints are addressed appropriately by management. The staff must be provided with appropriate training to meet the people`s needs. Ensure that the people`s personal and oral health is maintained. Key inspection report Care homes for older people Name: Address: Acacia Lodge Nursing Home 15 Wellingborough Road Irthlingborough Wellingborough Northants NN9 5RE     The quality rating for this care home is:   one star adequate 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: Ansuya Chudasama     Date: 2 4 0 9 2 0 0 9 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 30 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Acacia Lodge Nursing Home 15 Wellingborough Road Irthlingborough Wellingborough Northants NN9 5RE 01933651660 01933652948 thedurrantm@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd care home 40 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 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: Date of last inspection Brief description of the care home Acacia Lodge is a home situated on a main route within the small town of Irthlingborough in Northamptonshire. The home is within walking distance of Irthlingborough Town Centre where community resources include churches, shops, pubs and restaurants. The home is owned by BUPA Care Homes Limited and is registered to provide both Nursing and personal care for service users with a variety of needs, the majority of which are over 65 years of age. Accommodation to the service users is provided across two floors, there are 30 single rooms and 5 double rooms with the majority providing en suite facilities. The home has four lounge areas, one of which Care Homes for Older People Page 4 of 30 Over 65 21 5 18 5 0 0 18 0 1 1 0 2 2 0 0 9 Brief description of the care home is a designated smoking area and a dining room on both floors. Access to the first floor of the home is by passenger lift. Care Homes for Older People Page 5 of 30 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: one star adequate 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 was carried out in accordance with the Care Quality Commission (CQC) policy and methodologies which require review of key standards for the provision of a care home for older people that takes account of the peoples views and information received about the service since the last inspection. Evidence used and judgments made within the main body of the report include information from this visit. The report refers to we this is because the report is written on behalf of the Care Quality Commission. We last inspected this service on the 11th of February 09. We had not requested for an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment tool that focuses on how well outcomes are being met for people using the service. This was because this inspection was undertaken due to attending strategy meetings held by Social Services safe guarding team regarding concerns raised regarding 3 patients that Care Homes for Older People Page 6 of 30 were admitted to hospital. The outcome of the investigation undertaken and their findings are included in the report. During this inspection we tracked the care of two people who use this service. This involved reading their care records and also talking to them wherever possible to obtain their views on the service. We also spoke to some of the other people who live in the home. Documentation relating to staff recruitment, training and supervision, medication administration, complaints and health and safety were also examined. We had the opportunity to talk to some of the staff who were on duty and a tour of the home was also conducted. The current weekly fees range from £550.00 pounds to £650.00 pounds for nursing care. Additional charges are required to pay for hairdressing, toiletries, visitors meals, private taxi fees, news papers, magazines, private chiropody, and dry cleaning. Information on the cost for these services can be obtained from the home. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home should ensure all staff receives at least 6 supervisions per year to find out how they are working with the people and in the home. The home needs to ensure that the unit upstairs meets the needs of the people with dementia in line with nationally recognised good practice in dementia care. Up date the Statement of Purpose and Service User Guide and in a format the people will understand. Care Homes for Older People Page 8 of 30 Ensure that the home does not admit people whos needs they are unable to met. Ensure the care plans are set out in detail and explain how the peoples needs are going to be met. Involve the care staff when reviewing the peoples care plans. This is to get information from them about the peoples changing needs. Ensure all complaints are addressed appropriately by management. The staff must be provided with appropriate training to meet the peoples needs. Ensure that the peoples personal and oral health is maintained. 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. 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 30 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 30 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. Peoples pre assessment needs are carried out prior to admission to ensure the home can meet their needs. Evidence: The homes statement of purpose with combined service user guide was not available on the day of the inspection. We were informed by the manager that this was being up dated and in a format that the people would be able to understand. We were told that the people and staff were going to be involved with this. One of the family members spoken to informed us that the home was recommended by some one they knew. The family took their mother to visit the home and looked around and said it felt nice and the manager was great. We were told that an assessment was carried out by the home prior to the persons admission to the home. They had also signed a contract with the home which explained the terms and conditions of their relatives stay at the home. Care Homes for Older People Page 11 of 30 Evidence: Concerns were raised from a hospital regarding a person who was discharged from hospital and re admitted from the home within a week in a poor physical state. This was referred to social services safe guarding team to investigate. We looked at the persons assessment and the information recorded was not very detail. Evidence read showed that the home was not coping with the persons needs. The staff spoken to said that the person should have never been admitted to the home as they were not able to meet their needs. The people living in the unit were also vulnerable because this person had challenging behaviours. We discussed this with the manager who informed us that since they have been managing the home, they have not offered a place to some one whose needs they cannot meet. Evidence of this was seen where the manager had turned down unsuitable admissions. We were also told that the manager had done a lot of work around recording information about assessments and this was on going. The manager said that they carry out all new assessments for people coming to the home. She also ensures that all admissions from hospitals are re assessed before they come back to the home to ensure their needs can still be met by them. This was because previous re admissions from the hospitals had not been re assessed by the home. Care Homes for Older People Page 12 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has in place systems for care planning but these are not always completed fully, with shortfalls in recording information and therefore do not always meet all the peoples needs. Evidence: We looked at two peoples care plans in detail and discussed the peoples care needs with staff on duty. The staff showed that they had good understanding of the care needs of the people. We were told that all the care plans are reviewed by the staff nurse and the staff writes in the daily notes. We were told that they did not get involved when the plans are being reviewed. The plans we looked at needed expanding to explain how the persons needs were being met. Some of the information we read was difficult to understand and this was confirmed by staff spoken to on duty. Some of the information discussed by staff was not recorded in the plan. One plan did not have all the sections of the plan completed and did not state how the persons challenging behaviours were being managed. This Care Homes for Older People Page 13 of 30 Evidence: was discussed with the manager and it was acknowledged that information recorded needed improving. The manager told us that they had started doing care planning with the staff. We were shown a plan that was recently completed by the new lead nurse and this was good. Evidence in the care records showed that there were records of general practitioner, and hospital appointments, and people have access to the opticians, dentists, and other health care professionals A family member spoken to said that they were happy with how their family members health was being monitored. We were told that their family member did not get out of bed due to having a poor upper body balance. The person needed a special chair but funding was not available. It was said that it would be nice for the staff to take the person out of bed and get them dressed in their nice cloths to make the person feel better. The manager had discussed the issue of purchasing the chair with their manager but the outcome was still not known. We were also told by a family that during their visit to look around the home, a persons dignity was not maintained because the toilet door was wide open when that person was being toileted. Two safeguarding referrals were made by the hospital regarding concerns around wound care. The out come was that the home did not get advice from a tissue viability nurse for these people. We are now told that the tissue viability nurse is involved in reviewing pressure ulcers for the people who need this service. We were told that the manager had introduced charts for recording fluids, and food intake for the people that needed monitoring. Concerns were also raised by a family at the strategy meeting that they asked the home to give their relative medication in liquid form but this took a long time to sort out. It was said that the persons mouth care was not happening. Because the person had black tar on the roof of their mouth and family had to clean this with a sponge. The family also felt that their relative was left too long in the wheel chair to the extent where a bandage was put around the persons leg because they were kicking the foot plate. The family had also not been given a full picture of their relatives skin condition. One persons information read for medication said that the person was not compliant with medication and has this with their food at the hospital. However there was no information to state how this was being managed by the home. This was discussed with the manager. It was explained that since they started working at the home, they had put a stop to covert medication being administered in the home. The nurses at the home gave out medication. The medication records checked were being completed fully and controlled medication checked was correct. Medication was Care Homes for Older People Page 14 of 30 Evidence: also being monitored by the lead nurse. Care Homes for Older People Page 15 of 30 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. Meals served are nutritious and plentiful with different choices to meet the peoples needs. Evidence: We observed some people in the home when they were having their lunch. This was eaten in a relaxed atmosphere with staff talking to the people and encouraging them to eat in a kind manner. All the people spoken to said that the food was lovely and the cook was very good. It was said that they had lovely cooked breakfast on Sundays. We were told that the people can have any thing they want for lunch. The people and the cook told us that three options are offered at meal times. The meals recorded were healthy and staff had good understanding of the peoples likes and dislikes of food. This was also recorded in the peoples files. We sampled one of the options at meal time and the food was delicious. The staff also said that the food is excellent at the home. We observed staff interaction and noticed that they talked to people in a respectful manner and were careful to preserve their dignity. Care Homes for Older People Page 16 of 30 Evidence: The people told us that they liked their bedroom, and each persons bedroom seen was individualised to their taste. Most of the people in the home maintain contact with their families and friends. We were told by one family member that I cant fault my mothers care. It was said that during their visits to the home, they observed the persons privacy and dignity being maintained. It was also said she seems happy here. The staff were said to call the person by their name and they also kept the family informed of any thing that was happening with their relative. We were told that the staff have time to talk to the families. The home had a beach party in the summer and staff, the people and families spoken spoken to said that they enjoyed this. This was because the home had a paddling pool, a gazebo, an ice cream van, and some of the staff dressed up as fortune tellers at the party. The home also had a cheese and wine evening and families were invited and given the opportunity to discuss any concerns they may have with the manager. We were told that the home had an activity organiser and they were very good and had lots of patience. They worked 17 hours per week and this was being increased to 20 hours per week from January 2010. There was a rota displayed for activities that they did. We were also told that the person was going on holiday for three weeks and hoped that the activities would be continued. This was discussed with the manager and it was said that the staff would do some of the activities. One of the people in the home was observed doing cross stitching and we were told by them that the home is lovely and staff are lovely. The manager had also made links with the Alzheimers society and they were visiting the home next week to discuss what they did and services they offered. A new dietician was also visiting the home next week to look at the peoples nutritional needs. Care Homes for Older People Page 17 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures that safe guard people were in place but improvement is needed to ensure all the people are protected and kept safe. Evidence: The home has a complaints policy, and the procedures for making a complaint is displayed on the notice board. We were told that the home has not received any complaints since the last inspection. The staff spoken to informed us that they had completed the safe guarding of vulnerable adults procedures training. This training was also recently provided by the manager. They had good understanding of this and understood the peoples behaviours to know if they were unhappy or not feeling well. Some of the people spoken to were capable of informing staff if they had any concerns. They told us that they would tell the manager or staff if they were not happy. One family spoken to informed us that they would speak to the manager if they had any concerns. Two safeguarding referrals were made by the hospital regarding concerns around wound care for two people admitted to the hospital. The out come was that the home did not get advice from a tissue viability nurse for the above two people. The concerns raised by the family with the previous manager had not been properly addressed. Another safe guarding referral made by the hospital was regarding a person being admitted with physical neglect. Evidence from the inspection showed that the home Care Homes for Older People Page 18 of 30 Evidence: had admitted a person whos needs they could not be meet. Care Homes for Older People Page 19 of 30 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 is clean and has a relaxing atmosphere and a programme of redecoration is on going to meet the needs of the people. Evidence: A tour of the home showed that the place is clean and most parts of the home are homely. This was confirmed by talking to relatives and the people. The bedrooms seen were individualised to the people and those spoken to tell us that they like their rooms. We were told that the home did not have enough storage space. This was observed on the day of the inspection because one bathroom had a trolley and bins stored, and a shower room had a hoist stored in side the room. The wheel chairs in the corridors also needed storing properly. The manager said that they were going to use the space under the stairs to store some of the equipment. The home had a pleasant lounge downstairs facing the garden, and the people in the room said its lovely. We were told us that a new carpet had been put in the room. The dementia care unit was upstairs. We were told that the corridor was being decorated as this was showing signs of wear and tear. The hand rails were also being lowered to meet the peoples needs. We observed that one of the toilet doors opened out into the corridor and this could hurt some one who was not aware that some one Care Homes for Older People Page 20 of 30 Evidence: was behind the door. We observed that the unit did not have many things that were aimed for people with dementia needs. This was discussed with the manager and it was agreed by them that this needed improving. The manager told us that she was having discussions with a mental health dementia expert to improve things in the unit. The lounge used by the people had a supporting wall in the middle of the room and this did not feel homely. We observed that the wall in the middle did not provide a positive place for the people to relax. We were informed by the manager that the dining room, which was pleasant, was going to be turned into the lounge. The lounge would then become the dining room. The manager was also going to put a bigger TV that the people could see better in the room. We were told that this was happening next week. The manager discussed some of the long term plans and this included having the dementia unit down stairs. This is so the people would be able to use the downstairs facilities and the garden as and when they want to go out. The people with high nursing care needs would then be cared for upstairs. It was also said that the big 4 double rooms in the near future could be used for people with palliative care needs and the small lounge could be used as a family room. Care Homes for Older People Page 21 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staff training are not adequate and therefore the peoples needs will not be met satisfactorily. Evidence: The staff recruitment files were looked at in detail. Evidence showed that the home was obtaining all the relevant information required to safe guard the people in the home. However the files needed to be better managed as information was difficult to find. We were told that recently the home had lots of agency staff working at the home. The home had staff vacancies for 18 hours night staff and we were told that another member of staff was coming from another home and would be working 42 hours. Some of the staff resigned their positions because they were not happy with the changes that were taking place. Some staff tell us that more staff are needed at peak times and this was more in the dementia unit. The staff say that they enjoy working at the home, and it was said that they looked after the peoples needs well. It was said that the care provided by them was very good. The staff informed us that they had worked hard the past few months and has made improvements in the home, and some of these are on going. We were told that the staff did not get good hand overs before at each shift. However this is much better now. Care Homes for Older People Page 22 of 30 Evidence: A staff training matrix was being restarted by the manager as the previous one was not good. Some staff spoken to said that they had not had much training at the home. Most of the training that they had received was from their previous employment. They asked for more training. The manager acknowledged that training for staff has not been good and this was being sorted by her. The manager had started refresher training on doing safe guarding of vulnerable adults procedures. We were told that the home did not have many staff meetings before. However these were recently restarted and changes taking place in the home were discussed at the meetings. Care Homes for Older People Page 23 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed for the benefit of the people and management is aware of the areas that need improving to meet the needs of the people. Evidence: The home has a new manager since the registered manager left in July 09. The manager of the home is qualified and has many years experience of running a home. She has good understanding of the areas that needed improving in the home. Discussion with the manager stated that changes were being introduced slowly so every one is involved in the process. It was also said that they have an open door policy where any one can talk to them about any concerns or what is happening in the home. The manager stated that they received good support from her management. The manager was also applying to CQC to become the registered manager of the home. The staff tell us that the manager will do a good job and she keeps you up to date Care Homes for Older People Page 24 of 30 Evidence: and not do it without telling you of the changes. It was also said that the manager is supportive and listens to them. We were also told that the new nurse lead and staff nurse are very good and staff are able to get advice and support from them. Discussion with staff and staff records showed that they were not all receiving supervision on a regular basis. The manager acknowledged that supervision was not happening often but it was said that they had to prioritize important things that needed doing first to ensure the peoples needs were being met. The accident and incident records show that these were being recorded appropriately. Regulation 26 visits were being undertaken to monitor the home. The last survey for the people was carried out in 2008 but the date this was done was not stated. It was said that 10 questionnaires were dispatched but the survey does not state if the people or their families had completed the information. The analysis was difficult to understand and not in a format the people could understand. A survey for 2009 was not available. The staff and peoples files needed to be better managed because information was difficult to find. This was acknowledged by the manager. The fire alarm system was being tested on a weekly basis. The emergency lighting was done on a monthly basis. We were told that fire drill practice was also happening regularly. The environmental health officer had visited the home in October 08 and gave five stars, which is excellent. Care Homes for Older People Page 25 of 30 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 26 of 30 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 3 14 Needs assessments of people comming to the home must be robust. This is to ensure that the home can meet all the needs of the person being admitted to the home. 27/11/2009 2 7 15 The peoples plans must be 25/11/2009 detailed and explain how the persons care needs are being met. This is so the staff have the information needed to meet the needs of the people. 3 8 13 The peoples personal and oral health care must be maintained. This is to ensure staff have the information needed to meet the peoples health needs. 26/11/2009 4 30 18 Staff must be provided with appropriate training. 17/12/2009 Care Homes for Older People Page 27 of 30 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 This is to ensure staff have the skills and knowledge to meet the specialist needs of the people being care by the home. 5 38 13 Undertake a risk assessment 24/11/2009 for the toilet door in the dementia unit that opens out into the corridor. This is to ensure that the people are kept safe when walking through the corridor. 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 1 Up date the information in the statement of purpose and the service user guide in a format that the people in the home can undersatnd. Ensure that the toilet door is kept shut when a person is using the toilet. This is to maintain their dignity Ensure all complaints are dealt with appropriately by management. This is to ensure all concerns are resolved satisfactory and ensure peoples needs are met. Provide signs and activities in the dementia unit that meets the needs of the people in line with good dementia practice. Provide storage space to accomodate hoists, wheelchairs, and bins and other items being stored in bathrooms and in corridors. This is to maintain peoples safety. Review the staffing rota to ensure there are adequate number of staff on the dementia unit at peak times. This is to ensure that all the peoples needs are being met. Page 28 of 30 2 3 10 16 4 5 19 19 6 27 Care Homes for Older People 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 7 30 Provide an up to date staff training matrix. This is to show the training the staff have undertaken and gaps where training is needed to meet the needs of the people. Provide a quality assurance that takes into account the views of all the people, families, staff and professionals involved with the home and provide the analysis in a format the people can understand. Provide six supervisions per year. This is to monitor how staff are meeting the needs of the people. Ensure staff recruitment files are better organised. This is so information is easier to find. 8 33 9 10 36 37 Care Homes for Older People Page 29 of 30 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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