Care Home: Two Acres Nursing And Residential Home

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What the care home does well Updated statement of purpose and service users` guide provide appropriate information to potential residents. Referrals to the service are invited to visit and the manager carry out initial assessment after potential residents had seen the place. This principle helps both residents and the service make a proper decision of the suitability of the home as a future home of a resident. With this tailored initial assessment the service managed to meet the assessed need of its residents. They were appropriately housed in the unit that they liked and it was appropriate for their needs. The management of the service also considered units separately when the shift rota was created. Although staff did work across the units to get to know most residents, they were primarily engaged to work in one of the units. The staffing level was also decided for each unit separately, taking into account the needs of people living there. A robust recruitment procedure and appropriate induction and training for staff also meant that residents were not only well looked after, but also were protected. Residents` views were sought and analysed through 6-monthly quality assurance review.Two Acres Nursing And Residential HomeDS0000015696.V377052.R01.S.docVersion 5.2 What has improved since the last inspection? What the care home could do better: New care plans and the system to record the residents` needs had recently been introduced and the process to transfer older elements and record new ones was ongoing. However, at the time of the site visit, checked care plans showed inconsistencies in both the content and quality of the recorded elements.Two Acres Nursing And Residential HomeDS0000015696.V377052.R01.S.doc Version 5.2 A prescribed and labelled food thickener belonging to an individual was left out in the lounge. The service would need to establish a procedure to check for similar occasions and ensure better protection of residents by keeping all prescribed substances and medication appropriately and securely stored. With full recognition of the difficulty that most residential homes have to deal with, storage for hoists, wheelchairs and other equipment was not fully resolved and the service should try to find a permanent solution. The service arranged to keep some small amounts of money for residents who wanted this support. The account set for this purpose contained records of individual amounts, but the current arrangement and the use of this low interest account did not fully include how the interest earned would be added. Although in current circumstances this was not an issue, the potential rise of the interest paid would present a problem and the service should consider and seek the solution to pay interest to each individual. Key inspection report CARE HOMES FOR OLDER PEOPLE Two Acres Nursing And Residential Home 214 Fakenham Road Taverham Norwich Norfolk NR8 6QN Lead Inspector Dragan Cvejic Key Unannounced Inspection 3rd August 2009 09:00 DS0000015696.V377052.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 2 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 Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Two Acres Nursing And Residential Home Address 214 Fakenham Road Taverham Norwich Norfolk NR8 6QN 01603 867600 01603 868886 info@twoacres.co.uk www.twoacres.co.uk Devaglade Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Lynsey Spearing Care Home 115 Category(ies) of Dementia (115), Old age, not falling within any registration, with number other category (115) of places Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code 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 Dementia - Code DE The maximum number of service users who can be accommodated is: 115 5th September 2008 2. Date of last inspection Brief Description of the Service: Two Acres care home provides nursing and residential care to people with dementia. The home had 3 distinct units, Heather, Rose and Fern on the previous inspection and new Lilley Unit, opened since then. This is a specialised unit for people who suffer from dementia, designed and built with dementia specialists’ input. All units are purpose built single storey buildings that blend in nicely with the surrounding community. The grounds are well maintained and thoughtfully designed for the wheelchair user. The home charges a different weekly fee for residential care and for nursing care. The fees do not include hairdressing, chiropody, toiletries or newspapers. The home makes information available to residents via notice boards, news letters, personal discussion and letters. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The service was regularly informing us of the events that affected life of its residents and care processes. They sent in their AQAA, an Annual Quality Assurance Assessment, which was used for this report. We visited the service on 03/08/09. We spoke to residents, staff, the manager and the administrator. We checked several residents and staff’s files. We checked their medication process and records. A tour through the unit provided information about the environment, but also offered the opportunity to observe staff working with residents. We checked how the previous requirements were now met. At the time of this visit, the service accommodated 83 residents. What the service does well: Updated statement of purpose and service users’ guide provide appropriate information to potential residents. Referrals to the service are invited to visit and the manager carry out initial assessment after potential residents had seen the place. This principle helps both residents and the service make a proper decision of the suitability of the home as a future home of a resident. With this tailored initial assessment the service managed to meet the assessed need of its residents. They were appropriately housed in the unit that they liked and it was appropriate for their needs. The management of the service also considered units separately when the shift rota was created. Although staff did work across the units to get to know most residents, they were primarily engaged to work in one of the units. The staffing level was also decided for each unit separately, taking into account the needs of people living there. A robust recruitment procedure and appropriate induction and training for staff also meant that residents were not only well looked after, but also were protected. Residents’ views were sought and analysed through 6-monthly quality assurance review. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: New care plans and the system to record the residents’ needs had recently been introduced and the process to transfer older elements and record new ones was ongoing. However, at the time of the site visit, checked care plans showed inconsistencies in both the content and quality of the recorded elements. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 7 A prescribed and labelled food thickener belonging to an individual was left out in the lounge. The service would need to establish a procedure to check for similar occasions and ensure better protection of residents by keeping all prescribed substances and medication appropriately and securely stored. With full recognition of the difficulty that most residential homes have to deal with, storage for hoists, wheelchairs and other equipment was not fully resolved and the service should try to find a permanent solution. The service arranged to keep some small amounts of money for residents who wanted this support. The account set for this purpose contained records of individual amounts, but the current arrangement and the use of this low interest account did not fully include how the interest earned would be added. Although in current circumstances this was not an issue, the potential rise of the interest paid would present a problem and the service should consider and seek the solution to pay interest to each individual. 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. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate admission procedure ensured that residents and their representatives could make an informed decision about their choice of the home. EVIDENCE: The service reviewed their statement of purpose and a service users’ guide to present changes and provide updated information to potential residents. The reviewed document contained information about the new unit – Lilley. In addition, the service organised an Open day, allowing the general public to visit and get a picture of life in the service. Initial assessment was explained in the service’s AQAA, Annual Quality Assurance Assessment, explained by the manager and checked in 6 residents’ Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 10 files during the site visit. It demonstrated that residents were appropriately assessed prior to making a decision regarding admittance. It also provided the opportunity for residents and their relatives to see the place before they were asked to make their decision to move in. At the point of admission, any deprivation of liberty was addressed, to safeguard residents. An initial care plan was drawn up from the admission assessment details and an extended period of seven days was used to update and create a detailed care plan, at this point agreed and signed by residents or their representatives. Six week trials are used both by the service and by a resident to assess if the place was appropriate and if the assessed needs could be met. Social services were invited to the final assessment after those 6 weeks. When residents’ files were checked, there was a visible link between initial assessments and their care plans. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An appropriate approach to healthcare needs ensured that residents were assisted either by the service staff and nurses or external professionals when it necessary. Medication process was safe, but a labelled food thickener was left unattended in a communal room. EVIDENCE: A new format of care plans recently introduced was used to create a detailed description of the needs and how they could be met. The plans were agreed with residents and their families when appropriate. The Continuing Care team helped the home improve care plans since the last inspection. Six files were checked and all contained detailed assessments of needs and agreed staff action to ensure these needs were met in a way the residents wanted. Risk assessments were part of the plans and related to the assessed needs. However, some units were better than others in filling in care plans. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 12 One of the files did not have a risk assessment, as the resident assessed was rather independent, although there was the scope for recording a potential risk. Some other inconsistencies also existed, mainly in the quality of instruction to staff how to meet the assessed needs. The manager explained that only high risk was recorded in risk assessments. However, the care plans and risk assessments in different units were written inconsistently. The assessments in some files, for example “dry skin on legs”, but no risk assessment in that file, and appropriate skin care assessment in another where the risk was appropriately assessed, showed the need for all to have the same approach. Care plans were evaluated monthly and reviews were written at the bottom of each page of the care plan, demonstrating that all needs were addressed in reviews. Residents’ healthcare needs were appropriately addressed. Nurses working in the home ensured that clinical care was appropriate and that external professionals were called in when it necessary. A continence nurse visited some residents on the day of the site visit and spoke to us: “It has been much better lately. They improved many aspects of care. Residents are cleaner. The service listens to us much more and reacts straight away. Staff had a lot of training. Dignity of residents is much better respected. If two residents get into conflict, staff separate them straight away. Care is much better.” She also expressed satisfaction for seeing inspectors and encouraged better communication between regulators and nurses caring for residents. A resident with an assessed high risk of falls was allocated one-to-one care and a nurse was seen sitting next to him in his room. Two staff members were observed appropriately using a hoist to assist a resident. Medication was checked regarding storage, records and administration. A staff member administering medication worked appropriately in accordance with policy. Medication was stored in each unit in the appropriate place, safely. Records were checked for 6 residents. There were no gaps on medication charts. The amount of medication was checked against the records and found to be accurate. However, there was a prescribed and individually labelled food thickener in the lounge. Staff were observed in all four lounges interacting with residents. Their attitude was respectful and dignified. A resident approached a staff member and said: “Oh, it’s you. You are so good to us. I have been here for 10 years and I love it. I look after her,” showing to another lady resident who was walking towards us. The nice, kind and calm disposition of staff made residents feel comfortable, relaxed and safe. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily routine was constructed in each unit, according to residents’ abilities, likes, dislikes and wishes and promoted their autonomy and independence. EVIDENCE: “I just had my lunch. I had about 10 slices, it was lovely”, said a rather confused resident, but with a big smile and visibly happy. Four residents in the lounge were appropriately interacting with two staff. Staff knowledgeably moved from one to another, ensuring that all present residents get appropriate attention. In another lounge in another unit, 7 residents were enjoying a manicure session. Residents in the dementia unit were talking to each other while a member of staff was present to offer assistance if needed. In one of the units we visited, the residents were very active, walking, talking, interacting with staff and among themselves. The service had employed an activity coordinator since the last inspection and significantly improved activities for residents. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 14 Records of taking part in the activities helped the activity coordinator monitor and ensure that all residents were provided with the opportunity to engage in and enjoy offered activities. “Life story” recorded on admission helped the home target residents interests and promote the continuity of activities that they took part before admission. Family members were an important element not only in the care process, but also in the area of stimulating activities for residents. Some bedrooms were locked, some not but the choice was provided for all residents to keep the key for their bedroom if they wanted. A new unit, Lilley, was a state of art building for dementia sufferers. Purpose built and designed with guidance from dementia specialists, the building itself promoting autonomy and independence. The lights were working with sensor activation. And there was an under-floor heating system with thermostats for each bedroom. Restricted access to the modern kitchen was contained in the policy. A quiet room with sensory lights and music was also available to these residents. However, the manager and staff would need to take into account that new technology and equipment that some residents might not be familiar with, could affect their confidence and would need to ensure that they felt comfortable with modern developmental technological products. The existing 5 residents in this unit coped well and enjoyed the advantages of modern technology. The older dementia unit had corridors named as old streets (i.e. Coronation Street), and older items, such as pictures, ornaments, posters and even coats hanged on the hangers, which helped residents’ orientation. After introducing a MUST (Malnutrition Universal Screening Tool) and closer monitoring of the nutrition of residents, this area of care was also improved. The production of menus in discussion with residents made meal times more interesting and more enjoyable by residents. All residents spoken to confirmed that they were happy with food. A new kitchen, where all food was now prepared, ensured better facilities for cooking various food and increased the choice for residents. Records of food consumed for those residents that needed nutritional monitoring, as seen in two files, also demonstrated how better facilities benefited residents; to eat nutritionally varied food. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good, robust procedures were in place to protect residents and the complaints procedure was available to ensure that anyone unhappy with any aspects of care or service provisions could complain and would be listened to. EVIDENCE: The service improved the access to their complaints procedure for residents by enlarging it and clearly displaying it in each unit. The manager reported that there were no formal complaints, but all informal concerns “were sorted straight away”. There were referrals to the POVA (Protection of Vulnerable Adults) register, but the staff were fully aware of how to report any potential abuse and thus protected residents well. The manager reported in their AQAA: “All external agencies that are involved with the service are made aware of the complaints procedure. We refer residents to the advocacy service if they wish so or the home feels that this would be a suitable action to take.” The robust recruitment procedure included appropriate checks of staff before deploying them to work with residents. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 16 Training on protection and safeguarding issues was regular and ensured the protection of residents. The service was helping some residents with keeping their personal allowance money safe. The account for this purpose was opened and money was kept in it. There was an individual record for each resident ensuring that everyone knew how much money was there. Restricted access to this account and regular audits ensured good protection. However, although the account was a low interest account that did not accumulate significant quantities of money, the organisation would need to address how that money would benefit residents and be given back to them. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate, purpose built buildings and good renewal and maintenance programme of the premises ensured that residents could enjoy and benefit from the provisions regarding environment. EVIDENCE: The tour through the home showed that the environmental provisions were appropriate for the needs of residents. Four units, all in separate buildings were suitable for the people placed in each. The older three units were well maintained and the new Lilley unit was well equipped to assist both staff and residents and still to provide homely feeling in certain areas of the home. Bedrooms were individualised with private items of furniture and memorable effects. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 18 Built on one level, the environment allowed all residents easy access to the well maintained and recently updated garden area with an old style telephone and post box. All bedrooms in the new unit had individual access to the garden, while the other units had communal access to the garden. Recent refurbishment in the older units affected the communal areas, so the Rose unit had got an extra space by means of a sun lounge; the Fern unit had got a new ramp allowing easy access to grounds. A new, much bigger and more equipped kitchen was created, thus improving cooking facilities and allowing a wider choice of food to be provided for all residents. Each unit had a nursing station where files, medication and other things controlled by staff were kept securely. There was a lack of storage space, especially in three older units, but the management was fully aware and constantly were searching for the best solution. A new kitchen and laundry room, when fully completed, could affect the provision of more storage space, according to plan. Supportive equipment, such as hoists, assisted baths, and good new signage also contributed to the good care offered in the service. The new laundry room, when completed, would improve aspects of infection control, although the current procedures ensured safety for residents. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriately staffed service, with properly checked staff, ensured that residents’ needs were met and that they were protected. EVIDENCE: Four staff files were checked. All contained appropriate information about preemployment checks. Staff were well organised, clear of their roles. The hierarchy was appropriately set and ensured all staff were clear of the expectations from them. This also helped the atmosphere in the service, where staff worked as a team. The rota was designed for each unit separately, taking into account different residents’ needs. Although the home reported that 19 out of 42 care staff held NVQ qualifications, the high number of nurses employed in the service meant that this standard was assessed as met, i.e. ensuring that 50 of staff hold qualifications. Not only NVQ’s, but other training was highly valued and staff attended both mandatory and training related to residents’ conditions. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 20 Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35,36,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An appropriate staff hierarchy and management structure for this large service ensured that the unitised service operated effectively, ensuring that residents needs were met and that they were protected by policies, procedures and the way staff worked. EVIDENCE: The manager was experienced and skilled, and managed the service in an effective way. Supported by the administrator and assistant manager and senior staff, she was overseeing the work across the service and knew each unit and residents. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 22 One of her assistants who accompanied us during the site visit also showed good knowledge of residents and their needs across the service in all units. The manager completed her Registered Manager’s Award and attended other relevant training. Cascaded responsibility for supervision, medication and other management tasks and direct support to staff also helped create an effective working atmosphere, team work and good service for the residents. Quality assurance review was conducted regularly twice a year and consulted residents and staff, visitors and external professionals. The home arranged meetings with the Continuing Care team on a three-monthly basis. Records of residents’ money that included all expenditures and income were correct and were audited by two senior staff regularly. One account for everything that was later individualised worked well, but there was no set procedure for interest, although amounts were very small. Supervision records and staff confirmation about regular support demonstrated that staff were supported in a planned and organised way with sufficient flexibility to discuss any potential issue affecting individuals. Staff training records and plans for their personal development showed how safe working practices were monitored and arranged to ensure good service for residents. Accidents/incidents were reported to the admin office and the records were appropriate, used to minimise reoccurrence. Staff were asked to sign that they had read the policies and procedures in each unit. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13 Requirement Care plans and risk assessments must be written consistently and contain risk assessments that would address potentially high risks, and not only those currently assessed. All prescribed substances must be stored appropriately in a safe place to ensure the protection of potentially confused residents. Timescale for action 30/09/09 2 OP9 13 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP35 Good Practice Recommendations The service should find a solution for ensuring that any interest earned from residents’ accounts is paid back to them. Two Acres Nursing And Residential Home DS0000015696.V377052.R01.S.doc Version 5.2 Page 25 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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