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Inspection on 13/11/08 for Moorfield House

Also see our care home review for Moorfield House for more information

This is the latest available inspection report for this service, carried out on 13th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Moorfield House Giddygate Lane Melling Liverpool Merseyside L31 1AQ two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lorraine Farrar Date: 1 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Moorfield House Giddygate Lane Melling Liverpool Merseyside L31 1AQ 01515492100 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) : moorfield.house@craegmoor.co.uk Park Care Homes (No 2) Ltd care home 31 Number of places (if applicable): Under 65 Over 65 31 0 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 31 Date of last inspection 0 5 1 0 2 0 0 8 A bit about Moorfield House. Moorfield House is owned and run by Parkcare Home (no2) LTD. They are owned by an organisation called Craegmore Healthcare. Craegmoor are an organisation who provide support for people across the country. Moorfield House is in Melling, a country area near to the local towns of Maghull and Kirby. Although on a country lane, there is public transport nearby. Moorfield House also has some vehicles people can use. Moorfield House provides support and a home up to for 31 adults who have a learning disability. There are three living areas. The main house and the bungalow have staff all day and night. The cottages have several hours of staff support during the day. They can get support from staff on the site at other times. Everyone can have their own bedroom if they want. Nobody has to share. Each living area has:Its own staff team, Lounges and dining rooms. Kitchen and bathrooms. There are big grounds at Moorfield House that everyone can share. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: Two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: This is what we did when we visited Moorfield House. We visited Moorfield House on 13th November 2008. This was an unannounced visit. They were not expecting us. We visited for over seven hours. While we were there we:Looked around the building. Read some paperwork Read some peoples care plans Looked at the support people get with:Their personal care Their health and tablets Going out and about. We talked with ten of the people who live there. We also talked to five staff who work there. This all helped us to find out: If Moorfield House is a safe place to live. Whether people think it is a good place to live. If people get support when they need it. Before we visited we looked at:The things we have know about Moorfield House since our last big visit in October 2007. This included:Any concerns people have told us about. What we found during three smaller visits we made to the home. The last manager completed a form we sent her before our visit. This told us about staff and about health and safety. It also told us what Moorfield House does well and their plans to make it better. All of these things helped us to plan the things we would look at during our visit. They also helped us to write this report. It costs between 334.40 pounds and 1957.84 pounds each week to live at Moorfield House. This depends on the amount of support people need. What Moorfield House does well. Before anyone new moves into Moorfield House staff work hard to make sure it is the right place for them to live. People can visit several times with their family and friends if they wish. They can stay overnight. Staff work with the person to find out about:Their support needs and choices. The ways they enjoy spending their time. This helps everyone to decide if the person will:Like living at Moorfield House Be able to get the support they need. The people who live at Moorfield House told us that they make their own decisions about things. They said staff listen to the things they say and support them with the things they decide. During the day people get support to do the different things they enjoy. This includes :Going to their day centre Having a job Going to college Doing housework Spending time with their friends chatting and socialising. People get good support with looking after their health. Staff support them to make and go to appointments and health checks. They also support people to be as independent as possible and look after their own tablets if they can. The people who live at Moorfield House told us they like the staff and the new manager. They said the get support when they need it. They also said that if they ask for things the manager does his best to do it for them. Staff know the people who live at Moorfield House well. They know how to talk with them and support them with their everyday lives. They get training to help them learn more about supporting people safely and well. People told us that they know who to talk to if they are unhappy or have any complaints. They are confident that staff would listen and help them sort it out. What has got better from the last inspection. Everyone living at Moorfield House has an up to date care plan. People told us that they are involved in what is written in their plan and staff talk to them about it. People are now getting support to look after their own money as much as possible. This includes getting money paid into their own bank account and looking after their benefits. This all helps people to :_ be as independent as possible To have as much say as possible in how their life is run. Staff and the people living there told us that they feel staff morale has got better. They said that the new manager is very helpful and they have confidence in him. The manager has noticed several ways that Moorfield House could get better and has put plans in place to do this. This will help:To make Moorfield House an even better place to live. To involve the people living there as much as possible in future plans. What Moorfield House could do better. Meals offered to people are not always as healthy as they could be. Looking at the menus with the people living there and making them healthier could help people to stay well. Staff should support people to manage their money for food. This will help people to: Always have a choice of meals available Learn how to manage their everyday lives well. At times people cannot get support with getting up when they want to. This could be because there are a lot of different living areas at Moorfield House. The manager should look at staffing levels and times staff work to see if they could change. This would help to offer people more choices and decisions about their everyday lives. The cobbles outside Moorfield House are slippy. These should be looked at to see if they are dangerous and if the area can be made safer. If you want to read the full report of our inspection please ask the person in charge of Moorfield House. If you want to speak to the inspector please contact Lorraine Farrar 4th Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ 01772 730100 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 . Sufficient information is provided to and obtained about people considering moving into Moorfield House. This helps everyone to decide if Moorfield House is the right place for the person to live. Ensuring information is easy to understand for people would help them to be as informed as possible about the service they can expect. Evidence: We talked with one person who had recently moved into Moorfield House. They explained that before deciding whether they wanted to live there, they visited a couple of times and staff met with them and asked about the support they need. Records showed that before anyone new moves to Moorfield House they are invited to visit with their family. Staff carry out a full assessment of the persons needs and choices. This helps to ensure that Moorfield House can provide the right type of service for the person. It also provides a good basis for staff to plan how to meet the persons needs and choices. A copy of a service user guide to Moorfield House is available. This tells people about how the home runs and the support they can expect. We looked at a copy and found that since our last big inspection in October 2007 this has been updated so that it is in an easier to read format. However the guide had not been updated with information about the new manager. We also noted that although in an easier to read format the guide used italic writing, which is not always easy for people to read. The manager acknowledged this and displayed an awareness of how to provide information in a way that is as easy to understand as possible for everyone. During a visit we made in December 2007, we gave the home a requirement that they Evidence: should assess and review living arrangements for some of the people living at Moorfield House, as they had told us they did not always get along with the people they shared their accommodation with. When we visited in March 08, this issue had been dealt with and the people living there told us that they were happy with proposed changes. During this visit, people told us that they are pleased with the new living arrangements and that they feel happier living there. Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 needs and choices of the people living at Moorfield House are identified and staff work in partnership with the person to meet these. Evidence: Individual care plans are in place for everyone living at Moorfield House. We spoke to several people living there, all of whom told us that they are aware of their care plan and involved in writing it. One person explained, It keeps getting redone. You get things to sign. They go through it with you so you understand everything in it. Another person told us, we do that one to one with staff. The level of involvement people have in their own care plans helps to ensure that they can have a real say in the support they receive. We looked at care plans for three of the people living at Moorfield House. These contained information about the support people need and choose with their health, personal care, money and communication as well as the support they need and choose with their everyday lives. The plans we looked at had been reviewed regularly, which helps to ensure that they remain up to date with any changes to the persons needs or choices. One plan contained minutes of a monthly meetings between the person and their key worker. These meetings are good practice as they provide a formal way for the person to discuss their support as well as anything they may like to achieve in the future. Up to date risk assessments were available in the plans we looked at. These provide a good way for the person and staff to assess any risks involved in their daily life and Evidence: look at how these can be minimised without impacting too much on the persons needs and choices. The people living at Moorfield House told us that they make their own decisions about things, with support from staff if needed. One person told us, We get listened to. If we ask for something it is being pushed for, sorted. I make my own decisions, before I do I ask staff what they think. At out last big inspection of Moorfield House in October 2007 we identified that most peoples money was being managed by the organisation and this practice did not support people to learn everyday living skills. Since then the organisation has liaised with the benefits agency to support people to manage their own money wherever possible. Clear financial care plans and risk assessments have been completed to support people with this. One of the people living there explained that his money was now sorted. He explained he was asked if he would like to manage his own bank account and pay his fees via direct debit and is pleased he is now able to do this. Another person told us, we watch our own money. Much better. The support offered to people in this area provides them with opportunities to have more direct control over their lives as well as to learn more everyday living skills. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 . People are supported to live a lifestyle of their choice. At times staffing issues can impact on this, as there may not be enough staff available to make sure that people can do the activities of their choice. Evidence: During our visit the people who live at Moorfield House were engaged in a number of different activities. Some people attend local colleges or resource centres whilst others have part time jobs. Those at home were spending their time on hobbies, household tasks or socialsiing. In discussion with some of the people living there it was evident that they are engaged with their local community through the classes and churches they attend as well as through everyday use of local shops and public transport. However people did tell us that there are times they cannot do the things they would like due to staffing or a lack of driver availability. For example one person told us they like going to church and would go every week but there are not always the staff to support them. Two other people told us they no longer attend a local slimming class as again there are not always the drivers to support them. The variety of activities people are involved with also provides them with a way to make and sustain relationships with people other than those they live with. People told us that they can have visitors when they wish and they get support to stay in touch with their families. People told us that they had enjoyed a recent party at the home Evidence: and also that they get to go out and about at other times. One lady explained, I help clean, go shopping, to restaurants and the pictures. Other people told us that they enjoyed going on holiday with staff support. Routines are different in all areas of the home. For example, the people who live in the cottages look after their own home and meals with minimal support, whilst those who live in the bungalow have more support to achieve these things. Throughout our visit we noted that staff spent time chatting and socialising with the people who live at Moorfield House as well as proving support to them with the things they need. Routines appeared flexible depending on the persons plans for the day. Mealtime arrangements are different throughout the home. In the bungalow people told us that they shop for food, with one person describing meals as, good food. We noted that menus for the bungalow included a high use of convenience foods. For example, in a ten day period, chips were served six times along with food such as pies, burgers and hot dogs. In discussions with the home manager he told us that he had recently become aware of this and intended to work with people to alter the menu. This would be good practice as a high use of convenience foods may mean people are not getting the opportunity to eat a diet that supports their health. In the main house staff prepare meals and we noted that there was only one choice on the teatime menu. However people described the food as, nice and one person told us, I decide what to have for lunch. Ask for something else if I dont like tea. She also explained that people can have a drink whenever they wish and we observed that the people living there are familiar with the layout of the kitchen and where food is stored. We noted that adequate stores of food including fruit and vegetables were available for the people living in the main house. Each cottage has its own budget for food and the people living there shop, plan and cook their own meals. One person explained, we did the menu and do the shopping lists whilst another told us, I do the cooking and shopping. However we noted that in one cottage the people living there were not following the menu they had written. They explained this was because they had a larger meal whilst out that day and wanted a lighter tea. However they also told us that they find it difficult to manage on their food budget and that by shopping day they were often low on stocks. They explained that they intended to have a cheese spread sandwich for tea and that they planned to shop for food the following day. We looked in their fridge and found it contained seven eggs, two cheese triangles and two yoghurts. Although their cupboards had some stocks such as pasta and cereal there was nothing to provide an alternate sandwich filling. Had they wished to have the main meal from their menu of omelette and salad they would have been unable to do so from their own supplies due to a lack of sandwich fillings or salad ingredients. Whilst people should be supported to live as independent a lifestyle as possible it is important that staff ensure they receive support to budget and manage their food supplies and also support them to monitor whether their food budget is adequate for them. Personal and health care support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported to be as independent as possible with their health and personal care, with staff support available if needed. although at times people may have to wait a short while for this. Evidence: The people living at Moorfield House told us that they get support from staff to meet their personal care needs. One person described staff as, kind and explained that they help her when needed, another told us, staff help me. During our visit it was evident from meeting the people living there that they receive support when needed to look after their personal care and their appearance. However one person explained to us that she had to wait to get up on the morning of our visit as staff were busy elsewhere. She explained, I dont like that and although she can choose when to go to bed there are not always staff available to support her to get up when she wishes to. This was confirmed in our discussions with a member of staff who explained that as there are several living areas at Moorfield House, staff are sometimes busy elsewhere. People told us that they always get support to look after their health care. One person explained that if they are unwell staff, check on me, go with me to the doctors and other people we spoke with confirmed this. Care plans contained information about how to support the person with their personal and health care needs. They showed that staff support people to attend routine health appointments such as the dentist and the optician. They also showed that staff support people by keeping a check on any changes to their health and seeking advice from health care professionals. Assessments have been carried out with the people who live at Moorfield House to establish whether they can look after their own medication. One persons told us that they did not wish to do this. Another persons records showed that following Evidence: discussions between them and staff it had been decided they should not look after their own medication. In discussions with two people who live there, they told us, I look after them myself and my tablets are in my cupboard. This process of assessing and discussing with people the possibility of them looking after their own medication helps to ensure that people can be both as independents as possible and as involved as possible in making decisions about their everyday lives. Staff who support people with their medication have all had recent training. In discussions with a member of staff she displayed a good knowledge of how medication is managed and the support they had recently provided to one person to reduce their medication under medical guidance. Records of medication received into the home and given were completed correctly and guidance was in place for staff to follow when giving medication preserved as, as required. This all helps to reduce the risk of errors occurring and to ensure peoples medication is managed safely. We checked samples of records and medications stocks and found these to tally. We also found that most medication was stored correctly. The exception to this was a liquid medication stored in the fridge that should have been stored at room temperature. This could reduce the effectiveness of the medication, however staff rectified theirs during our visit. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 . The people living at Moorfield House are confident any concerns they have will be listened to and acted upon to make sure their views are taken into account and they are protected from possible harm. Evidence: During the visits we have made to Moorfield House since our last big inspection in October 2007 and during this visit, the people living there have told us that they know who to talk to if they are unhappy or if they have a complaint. They told us they would talk to staff, with one person explaining, tell a member of staff I trust. I would definitely tell the manager and another person, tell carers if not happy. They help. An easy to read complaints procedure is also available to advise people how they can raise any concerns they have and people we spoke with knew how to contact ourselves if they had concerns they did not feel where being addressed. Policies and procedures are in place to guide staff on how to deal with any complaints or concerns that arise. Staff have training on safeguarding adults and a member of staff we spoke with was able to explain the indicators she would look for and the action she would take to ensure people are as safe as possible living there. In the past twelve months three complaints have been made directly to Moorfield House; all of these were dealt with by the organisation within twenty eight days and a response sent to the person. In addition seven adult protection referrals were made to social services under the local safeguarding procedures. Of these two resulted in investigations, in which the organisation cooperated. The open approach to dealing with concerns or complaints helps the people living at Moorfield House to feel safe living there. We checked how money is managed for two of the people living at Moorfield House and found that records and receipts tallied with the amounts held. Evidence: 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 . Moorfield House provides a clean, comfortable home for people to live in and they are involved in planning future changes. However parts of the home could be better adapted to make sure that they are suitable for the people who live there. Evidence: Moorfield House is situated on a country lane in Melling. However there is public transport nearby and shops and local facilities a short drive away. The home has extensive grounds, which provide space for several garden areas, a wild flower field and small woodland area. The main house has living and dining rooms, a large kitchen, which the people living there were seen to use, and thirteen bedrooms. Of these, all but one are single bedrooms. The remaining room is now used as a single room, with one of the people living there telling us,nobody shares a room now. Each cottage has a living and dining area, single bedrooms, kitchen and bathroom and either their own laundry facilities or a small laundry shared between two of the cottages. In the bungalow there is a large lounge, two bathrooms, a dining area and separate garden along with a laundry and domestic kitchen. All of the six bedrooms are single rooms. Three are on the ground floor for easy access for people with mobility difficulties. Although parts of the bungalow are adapted for use by people with physical disabilities, other parts are not. Hoists are available to help lift people and the downstairs bathroom and shower are adapted so people can be supported easily. Since our last big inspection in October 2007, doors in the bungalow now have automatic fire Evidence: closures. This means that they can be left open during the day so people with mobility difficulties can get around easily. However the kitchen remains a domestic style kitchen, which means that the sink and some work surfaces are too high for people using a wheelchair to reach. We identified at our last big inspection in October 2007 that the original cobblestones outside the front of the buildings have become uneven and potentially slippery, a concern that had also been raised by the people that live there via their meetings. Although the information we received from the manager before our visit stated that that work was scheduled to start on the cobbles, no action had been taken at the time of our visit. One of the people living there told us, we are waiting to hear and we read in minutes of service user meetings that they had raised this issue again with the organisation. As some of the people living at Moorfield House have mobility difficulties, the cobbles could present a trip and fall hazard for them and need to be made safe. We also observed one of the people living in the main house being supported on their return home. Although using a wheelchair when they arrived at the front door, they had to be helped out of their chair in order to negotiate the steps there. This could present as a risk to both the person and those supporting them. Each living area has its own laundry facilities. These were clean and well organised with staff having access to disposable gloves and aprons if needed. This helps to lessen the risk of an outbreak of infection occuring. All areas of the home that we visited were clean and tidy. One bedroom in the bungalow felt colder and the person living there told usI think it needs to be warmer. We advised the manager of this during our visit and he told us that he would look into it. Several areas of the home have been improved in the past year. This includes replacing bathrooms in the main house, fitting laminate flooring to a bedroom in the bungalow to make it easier for the occupant to get around and some decoration. The people living at Moorfield House were fully aware of work planned; one advised us that they were waiting for radiator covers to be fitted. Others told us that they choose the decor and furniture for their bedrooms, with one person telling us, its good Ive got my own room and explaining they choose their particular colour scheme. A large wooden hall in the grounds is currently not in use. One of the people living there told us they were unsure of plans for it and they would like to see it back in use as a social hall, as they feel it provides a good place for parties and also lots of space for people who use a wheelchair. 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 people who live at Moorfield House are supported by a staff team who they like and have confidence in. However at times they feel that there are not enough staff on duty to make sure their needs and choices can be met in the way they would prefer. Evidence: At the big inspection of Moorfield House we carried out in October 2007 and a visit we carried out in December 2007, we found that although some of the people living at Moorfield House are funded for 1 -1 support hours, it was not easy to establish whether these hours were provided. During this visit we saw records to show clearly the number of 1-1 hours people have and how they were supported during these. This helps to ensure that people are getting the service they are assessed and funded as requiring to meet their needs. At the visit we made in December 2007 we found that staff rotas did not always reflect the staff who were on duty and did not provide full information about who staff were or their role within the home. At this visit, and when we visited in March 2008, we found that rotas are now fully maintained with required information recorded. This helps to provide a clear record of the support available each day to people who live at the home. During this visit the manager advised that the home has a full staff team at present and that he was in the process of finalising a new rota system. However some of the people living at Moorfield House told us that they sometimes think there are not enough staff to support them. Several people who live in the cottages told us that sometimes the member of staff assigned to support them is taken to drive others or to support people in the bungalow. One person explained, we have to go looking. Sometimes dont see them all day until they do the medications. Youre waiting to see them to talk to them. A senior manager from the organisation advised us that the people living in the cottages are funded for support with semi independent living. Evidence: Therefore they are encouraged to use public transport and not have a designated driver at all times. She also advised that as people are supported with semi independent living the home is not expected to have a member of staff for each cottage and that support can be provide from the main house in the day, when many of the people living there are out. During our visit to the bungalow there were two members of staff working and supporting four people. However some of the people living there receive 1-1 support and others need support from two staff at certain times of the day. A member of staff explained that when an extra staff are needed they get support from staff in the main house. However on the day of our visit, this meant one person had to stay in bed until 10.30am when someone became available to help them. In discussions with the person concerned they told us that they do sometimes have to wait to get up and, I dont like that. A staffing review was carried out by the organisation following our previous visits to the home and they found that new rotas ensured sufficient staff were on duty. However the fact that there are five separate living areas at Moorfield House appears to be impacting on peoples access to support when they want it. All of the people who live at the home whom we spoke with, told us that they like the staff team describing them as, good and nice, they talk to me. During our visit staff we spoke with showed a good understanding of the support needs of the people living there and were seen to take time to talk with people and treat them with respect. Staff told us that they feel morale in the home has been low but is now improving. One member of staff told us, morale is rising whilst one of the people living there expressed the view that staff relations are improving. We looked at some files for staff who work in the home. These showed that before anyone starts work in the home a series of checks are carried out, such as obtaining references and a CRB (Criminal Records Bureau) check. These checks help to ensure that staff are suitable to work with the people living there who may be vulnerable. Over 50 percent of the staff team hold a national qualification in care, with others telling us they plan to work towards obtaining this. One member of staff described the training they are offered as, absolutely brilliant. Records show that staff have had training in basic areas of care such as moving people safely, protection of vulnerable adults and food hygiene. as well as in more specialist areas such as supporting people who challenge and supporting people who have epilepsy. The manager has drawn up a list of basic training and identified dates to deliver this to all staff who need it. He also advised that he has arranged for extra training in areas such as the Mental Capacity Act and equality and diversity. The training provided and planned helps to ensure that staff are up to date in how to support people safely and well. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 . Moorfield House has a strong management team who work with the people living there to make sure the service they receive is improved and the home is run in their best interests. Evidence: Mr Phil Pitchford is the manager of Moorfield House. He started working there in September 2008 and is experienced in working with adults who have a learning disability and in managing care services. In the short time he has been at Moorfield House, Mr Pitchford has undertaken training in various aspects of care including medication and safeguarding adults. This helps to ensure he remains up to date with good practice in supporting people safely and well. Mr Pitchford is aware of the need to apply to the commission to become registered with us as the manager of Moorfield House. This process helps to ensure managers are suitably qualified and experienced to manage a care service. The people living at Moorfield House were very positive about the manager and his management style. One person described him as, brilliant. Does what he says. We are getting loads done whilst another of the people living there told us, really nice. I trust him. Staff we spoke with also felt that the new manager was effective, with one explaining he is, driven to get service users what they want. There are several systems in place at Moorfield House to check on the quality of the service provided. Care plans are reviewed and updated regularly to check that peoples needs and choices are being met. A representative of the organisation that runs the home carries out regular visits to the home to speak with staff and the people living there to find out what they think about how it is being run. The organisation also Evidence: carried out a large audit of the service in August 2008. Following this, any areas for improving the service were noted. The manager is aware of these and told us that he is working towards meeting them. We also saw that in the short time he has worked at Moorfield House the manager has noted several areas that could be further improved and taken action to do so. For example, he has audited staff training and made arrangements for additional training to be provided where needed. He has also noted areas that need maintaining and taken action to deal with this. The process of assessing the service provided and implementing changes helps to ensure that the people living at Moorfield House are getting a suitable service to make sure their needs and choices are met. Records and certificates showed that regular checks are made on the building and equipment to ensure they are safe. A health and safety meeting was held in October 2008; this identified that an overall audit of health and safety would be carried out with the involvement of the people living there. This will provide the people who live at Moorfield House with further opportunities to become involved in how their home is run and to influence changes. Are there any outstanding requirements from the last inspection? Yes No 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 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 Description 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 Description Timescale for action 1 18 A documented review of staffing support available must be carried out. This must include obtaining and recording the views of those living there. It must also include taking into consideration the number of different living areas the home has. 27/02/2009 This will help to ensure that people have access to the support they are assessed as needing within reasonable time frames. 2 24 13 A risk assessment must be carried out on the cobblestones at the front of the house. Action must be taken to rectify any risks identified. 16/02/2009 This will help to lessen the risk of slips, trips and falls for people living, working and visiting Moorfield House. 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 The service user guide should be revised so that all the information in it it is up to date. Consideration should be given to the way the information is presented to make sure that it is as easy as possible for people to understand. This will help to ensure people can understand as much as possible about how the home runs and the service they can expect. Additional support should be offered to people to monitor and manage their own budgets. This will ensure they can manage well and also support them to increase their lifestyle skills. Menus should be assessed and if needed altered, to ensure people have access to a healthy diet. 2 15 3 29 Consideration should be given to adapting the bungalow kitchen. This would make it easier for people with mobility difficulties to take part in everyday household tasks. A review of staffing levels needed to make sure that the needs and choices of the people who live at the home can be met should be carried out in consultation with the people who live at the home. This is to make sure that people living in the home have access to the support they need. The home manager should commence the process of becoming registered with the Commission for Social Care Inspection as soon as possible. This will help to show he is a suitably qualified and experienced person to manage the home. 4 33 5 37 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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