Inspection on 29/09/09 for Moorland House

This is the latest available inspection report for this service, carried out on 29th September 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Moorland House 20 Barton Court Avenue Barton on Sea New Milton Hampshire BH25 7HF     The quality rating for this care home is:   two star good 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: Joyce Bingham     Date: 2 9 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 29 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 29 Information about the care home Name of care home: Address: Moorland House 20 Barton Court Avenue Barton on Sea New Milton Hampshire BH25 7HF 01425614006 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Moorland House Ltd. Name of registered manager (if applicable) Mrs Linda McIndoe Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home only (PC) 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 (OP) Mental disorder, excluding learning disability or dementia (MD) Dementia (DE) Date of last inspection 0 2 1 0 2 0 0 8 20 20 0 Over 65 0 0 20 Care Homes for Older People Page 4 of 29 Brief description of the care home Moorland House is set on the outskirts of the town of New Milton, in Barton-on- Sea, with access to local amenities. It provides residential care for up to 20 elderly residents, including those who have dementia. The home is on both ground and first floors and there is a lift between these. There are a variety of aids and adaptations to allow residents to move about more independently. It offers a television lounge, a quiet lounge and a large dining room. All of the bedrooms are single, and all have en-suite facilities. There is a communal toilet, and a shower room with toilet on the ground floor, and one bathroom with a toilet on the first floor. There is a large well ordered garden around the building and off-road parking. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The purpose of the inspection was to find out how well Moorland House is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These include the Annual Quality Assurance Assessment (AQAA) completed by the home. This is the homes own quality assessment and it gives statistical information about aspects of the service. This was provided when we asked for it and was completed well. We also obtained confidential surveyed comments from five out of the seventeen residents we asked and five from among the twelve staff we asked. Two care professionals responded to the request for their comments. An unannounced visit to the home took place on 29 September 2009, starting at 09:15 and lasting over eight hours. During this time we were able to walk around part of the premises, including six bedrooms, one bathroom, the television lounge, quiet lounge, dining room, laundry and kitchen. The registered manager was on duty and assisted Care Homes for Older People Page 6 of 29 throughout the inspection. We had private discussions with two staff, observation of all the residents and contact with nine of the residents. We were able to speak privately with four visitors. We sampled staff and service user records, and policies and procedures that relate to the running of the home. All regulatory activity since the last inspection was reviewed and taken into account including the last inspection report with its requirements, and notifications sent to the Care Quality Commission (CQC). Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The manager has rethought the style of care plans in use and now uses care plans that make information easier to use and more accessible to staff, so that residents will receive more individualised care. Many of the bedrooms, the downstairs entrance and hallway, and lounges have been Care Homes for Older People Page 8 of 29 refurbished and redecorated, providing a much more pleasant place to live. A shared downstairs bathroom has been redesigned with new fittings and facilities, including an easily accessible shower. The family of residents who have been there for some time and knew the home before the current owner said, its been transformed, its been brought up so much, and so many improvements. Activities and entertainment has improved and the gardens now look cared for, well maintained and inviting for residents to enjoy. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 29 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 29 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. Residents are supplied with good information about the home before they move in and are enabled to make a judgment about its suitability from pre-admission discussion with staff and visits to the service. They are supported by a simple assessment of their overall need and a trial stay during which time their care needs can be more fully assessed. Evidence: The homes AQAA informed us that a new Service User Guide and Statement of Purpose had been produced. On the day of the inspection we saw in the entrance hall that a copy was placed in a wall-mounted dispenser, along with a copy of the most recent inspection report for people to look at or take away if they wished to. The manager said that a full colour brochure with pictures around the home is in draft and will shortly be available. The manager confirmed that assessments of residents needs are always carried out Care Homes for Older People Page 11 of 29 Evidence: involving family and, where possible, pre-admission visits to the home. We were told that residents can bring in some of their own furniture if they wish to. We sampled four files of people who have been admitted recently. We confirmed that the manager had completed and recorded a basic assessment and we were told that a care assessment from social services had also been obtained for the people who were not private referrals. We saw that a more comprehensive assessment is recorded once someone is admitted. Confidential survey returns were received from five service users. Three said they had received sufficient information about the home to enable them to decide if the home was the right place for them. Two expressed the fact they did not. The same three people were certain they had been given a contract of residence. One was uncertain and one said they had not been given a contract. One commented that there is always a friendly atmosphere. Another said we looked at several homes, and Moorlands is by far the best. We spoke with three family members who were visiting and they told us they had been given a package of information about the home and felt they had been given everything they needed to know in order to inform their judgement whether it was the right place for their relative. Intermediate (rehabilitative) care is not provided at Moorlands House, although we saw that people are welcomed for short respite stays if there are vacancies. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans define peoples broad care needs and guide staff in supporting residents in most of the important aspects of care. However, people may not receive all the help they need. The care plans could be developed more fully and individually and this would provide better guaranteed outcomes for people in some issues of care that really matter to them. Residents are protected by straight forward systems of drug administration and auditing measures. The absence of guidelines to staff on as and when needed medication may mean needs are met inconsistantly as staff attitudes and understanding may vary. Evidence: We looked at the same four care plans in detail and confirmed that plans had been made to meet the range of needs identified in the assessments. Risk assessments and nutritional reviews were recorded. Some limited strategy had been set in place for significant behavioural challenges. We saw that arrangements were made to accommodate a family pet and support the resident with its daily care. Some discussion on the day with some family members did however highlight that not all Care Homes for Older People Page 13 of 29 Evidence: basic care needs that one would expect, had been included in the care plans, leaving us to conclude the strategy for care management could be a little hit or miss. We saw that reviews were conducted regularly, sometimes noted by the key worker and sometimes by the manager. Progress has been made in negotiating with some relatives to provide a helpful personal profile of the resident to assist with understanding routines, and likes, dislikes if and when the level of dementia increases. We saw that lifting equipment was available for use. Continence products were observed and a hoist was ready for use on the first floor. An assisted bathroom with shower has been recently fitted on the ground floor. A physical exercise session had been arranged as part of the activity programme during the morning and we observed most of the residents happily engaged with it. It seemed that most of the residents were experiencing dementia to some extent; they were unable to express thoughts clearly, but most were smiling and responded well to staff and people approaching them. The manager told us that the home had established a good rapport with the local General Practices and district nursing service and specialist Becton Centre. We noted that the district nurse was regularly visiting one resident. We saw from records that full support is given to residents to access hospitals and specialist services, opticians, dentists and chiropody services. The surveys we received told us that all the residents felt the home made sure they get the medical care they need. To the question whether they receive the care and support they need, two said always, two said usually and one did not respond on this point. One close relative commented they care for all the guests very well. Another said I have always found them well looked after and fed. Two care professionals commented that the home collects the right information about service users to determine the care they need, and keeps this properly monitored and reviewed. They confirmed the home usually seeks advice and acts on the information they are given. One professional said, the home meets individual needs and goes beyond what most homes will accommodate. My clients I have placed at Moorlands are all very happy, well fed, always well dressed and tell me they cant find fault with the care provided. There is very good two-way communication between the home and Adult Services. We saw the drug cupboard and inspected the drug administration records. They were well ordered and up-to-date. A failure on one occasion to administer medicines Care Homes for Older People Page 14 of 29 Evidence: appropriately on the part of a senior member of staff had been picked up when audited and appropriate action was taken by the manager. Details were available of homely remedies and these had been approved by the GPs for assurance that they are compatible with other medications. We discussed the need for the manager to provide individual guidance for staff on as and when needed medication to ensure that all staff are following the same guidance and not using their individual judgment that may vary from carer to carer. The home currently lacks a controlled drug cupboard. When this was pointed out the manager agreed to obtain one and we discussed an appropriate location for fitting it. All rooms are single and each has an en suite toilet. Some have en suite showers. Care and support is provided in the privacy of peoples own rooms. Families confirmed that people wear their own clothes; their individual personalities are recognised, and they are treated respectfully. We saw that everyone was seasonally dressed with clean attire. Their hands and hair were well care for. Care Homes for Older People Page 15 of 29 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. The residents are supported to exercise choice and control over their lives, and are encouraged to maintain contact with family and friends as they wish. The home is successfully developing its range of activities and opportunities for trips out for residents to enjoy. Sustaining that on-going improvement is necessary. The residents are satisfied with the variety of home-cooked, nicely presented meals. Evidence: The homes AQAA states that each resident is treated as an individual, taking into consideration the times they wish to rise in the morning and retire to bed; breakfast is between the hours of 7 and 9.30 am and is what the residents wish to eat. The home provides choices of meals. Residents are asked their choices the day before for lunch and the evening meal. The home has a designated chef. Comments about the food were very positive in the survey of residents. Meals were rated with unanimous top marks. The food is excellent. One close family member said they visit at least twice a week and enjoy meals in the dining room with their family regularly. Birthdays are celebrated with a birthday cake at teatime. For a special anniversary celebration Moorlands invited close family for lunch with the other residents. A staff member said Care Homes for Older People Page 16 of 29 Evidence: the home provides good home cooked meals and choices. Another said the home welcomes all its visitors, makes sure that all of the residents are well cared for and comfortable all the time. Another carer said we provide the very best of care at all times, lots of activities, lovely food and a nice atmosphere. We saw that one family member called in and asked if it was Ok to have some tea with his relative, and this was readily agreed by the manager. The home now has a quiet lounge where the residents can sit, read or just sit and relax. There is also a television lounge where people can watch a variety of programmes, and a DVD player so people can watch films of their choice. The home scored highly in the five surveys in relation to activities. Two felt the home always arranges activities you can take part in if you want to and three felt this was the case usually. Very good entertainment provided. However, a staff member highlighted the need for more daily activities which would benefit service users. Variety is needed as they can be quite bored at times. The separate dining room is used by all the residents and there is a piano which is played by one of the residents. The manager told us that this is being replaced with a keyboard. We were told that residents are encouraged to continue with their own interests such as watching football, and snooker. Moorland House has different musical entertainment from outside the home, which includes a keyboard player who sings a wide range of songs for people to join in with. He visited on the morning of the inspection and this was evidently enjoyed by everyone. There is also a violinist, and an accordion player. The notice board demonstrated the weeks programme that includes for example a church visit, nails and pedicure, scrabble, film afternoon, an interact session. We were told that the provider has purchased a six or seven seater people carrier and plans are imminent to take those who wish to go on short trips out. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents know that the home takes their comments and complaints seriously. People are protected from abuse by staffs understanding of their needs, what is appropriate and what is not, and the values they uphold. Evidence: We saw that the Service User Guide contained a comprehensive policy on residents complaints including where people can complain and to whom. Telephone numbers and addresses were given, along with the stages of complaint investigation and timing for responses. The complaints log had no entries. However, during the day we were made aware of a familys unhappiness about two issues that had not been recorded. As a result we recommended that even when the complaint is not put in writing by the complainant it should be logged by the manager. We discussed that the keeping of records helps demonstrate that the home is open to comment/complaint and open to ways to improve aspects of care for the residents. The record enables an audit trail to demonstrate action has been taken to effect these improvements. The confidential surveys told us that people knew what to do if they were unhappy about anything. Three out of five knew how to make a formal complaint if they needed to. We spoke with four relatives and they told us of a number of matters they had Care Homes for Older People Page 18 of 29 Evidence: brought to the attention of the manager or the staff. These had been attended to as far as possible. We spoke with two carers about the process of whistle blowing and their level of training in detecting and reporting abusive practice. They both expressed good values in relation to taking appropriate action. We looked at the recruitment records of employees and were able to confirm that appropriate checks had been conducted with the criminal records bureau and protection of vulnerable adults list. There is no verbal or physical aggression that requires staff to ever use physical intervention. We were told that distracting people or diverting them has proved necessary and successful at times to avoid the escalation of incident. The manager told us that, apart from supporting one resident, petty cash is not handled by the home on behalf of people who live there. In each case, apart from one, it has been agreed the family take responsibility for managing monies. The home has a clear policy for staff on not receiving gifts from residents and avoiding involvement in residents financial affairs. Care Homes for Older People Page 19 of 29 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. Moorland House is a safe and well maintained home. Residents are enabled to access all communal parts of the home and the garden. The home is clean, hygienic and homely and meets the individual and collective needs of the residents. Further on-going refurbishment will bring quality soft furnishings and improvement to the whole home. Evidence: Moorland House is located close to the village of Barton and near the sea. Seventeen people were accommodated at the time of this inspection. The entrance hall invites visitors to sign in and out and for security purposes access to the home is controlled by the staffed office. We were able to see round most of the rooms on the ground floor and walked around six or seven bedrooms on the first floor. Everywhere was clean and orderly. The provider has progressed with refurbishing rooms, has redecorated and redesigned the entrance hallway and stairs up to the first floor. There are now two lounges; one is a television lounge and the other a quiet room. Chairs, carpeting and soft fabric are new. There is a large dining room containing some easy chairs circling the window and five dining tables with seating placed around the room. The layout is pleasantly domestic and people moved easily between these rooms, and their own bedrooms according to their choice. People were Care Homes for Older People Page 20 of 29 Evidence: seen to choose where they wished to sit and we noticed conversation between the residents happening spontaneously without staff motivating them. The view into the rear garden from the large patio window in the dining room is spoiled by the glass being cloudy. Cleaning has not solved this problem and the manager said that the window is in the programme to be replaced. The garden has been developed and is now in good order. Tubs and baskets of flowering, colourful plants and shrubs at the front and rear invite people into the grounds. Ample seating is placed strategically around the garden. A substantial wooden decking ramp leads from the quiet lounge into the garden. The UPVC door frame with its raised lower section presents a hazard and the manager was aware of this. The second lounge has two small steps leading from the lounge into the garden. We saw the homes records about the maintenance of the physical environment and servicing equipment. A fire risk assessment had been completed and the fire log book was available and up-to-date. The environmental health report was also seen. It detailed some requirements that the provider has fitted into his annual and five yearly plan. The kitchen featured in the report as a priority needing upgrading. The communal bathroom on the ground floor has been upgraded; it is now fitted with a shower. All the bedrooms have an en-suite toilet facility, some with shower. They have a lock facility; radiators are protected; window locks provide safety from high level falls. A poor odour was detected in two bedrooms we sampled and this was brought to the attention of the manager. We saw that some curtains had broken free from the runners in one or two places and were in need of re-hooking. The family of residents who have been there for some time and knew the home before the current owner said, its been transformed, its been brought up so much, and so many improvements. From the surveys three residents thought the home was always fresh and clean and two felt it usually was. One commented that the uplift of decoration has started. We saw that one resident had been permitted to bring in a small dog with her, provided she managed the dog walking in the garden. We were told the other residents had been consulted and they also enjoyed having the dog in the house. The dog is not permitted in the dining room at mealtimes. Care Homes for Older People Page 21 of 29 Evidence: We saw that the laundry has been equipped with a large commercial washing machine and commercial dryer. There is a wash basin and drainer; baskets are provided for soiled and clean laundry items. Access to the laundry is not through a food room. Alcohol dispensers are positioned throughout the home to enable people to disinfect their hands when necessary. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported by kind and caring staff who receive regular training. The home finds it difficult to maintain a complete roster of regular staff and the morale of the whole team is hard to establish. The homes recruitment, induction and training procedures provides support and protection for the residents. Evidence: The current weeks staff duty roster was available in the office although it was not complete as an additional carer was needed to volunteer for the 2-8pm Sunday shift. It demonstrated that the home aims during the day to provide three carers and a cook, a domestic and kitchen assistant, and the manager. At night there is one member of staff awake all night and a second carer sleeping in. The roster was seen to be reduced slightly at weekends. We saw that agency staff are used from time to time. We discussed this with the manager who felt the duty roster was reasonable for staff as the resident occupancy was currently seventeen and people do go out a lot and have a good number of visitors. Even given the fewer numbers at the home we felt the Saturday and Sunday 12 hour shift (with fewer ancillary helpers) was long and heavy for staff and could reflect on the level of care the residents receive when staff are very tired. The AQAA told us that all carers are on training for NVQ level 2 and over. While we Care Homes for Older People Page 23 of 29 Evidence: were present at the home one carer was told she had achieved NVQ level 3. We obtained a full training matrix for the staff that detailed completed mandatory training and that which is planned, including moving and handling, protection, fire, first aid, health and safety, control of substances hazardous to health, food and nutrition, medicine administration, dementia, challenging behaviour, infection control. We saw the kind way the carers related with the residents. People responded well to touch and conversation. Staff were observant and took action when necessary but were not patronising or paternalistic. In relation to staffing the surveys told us that the carers do listen to the residents and act on what they say. Two felt that staff were always available when they need them and two felt they usually were. Staff are always very pleasant. The staff have done what they could. We received five confidential staff surveys and we spoke in private with two staff members. They confirmed that all recruitment checks had been processed for them. Views were mixed about the quality of their induction. Two felt the induction did not in any way cover everything they needed to know to do the job. Two felt it covered everything very well and one, that it covered most things. The vast majority of comments were positive about the relevance and quality of the on-going training. Two carers confirmed they have regular support when they meet with the manager. One felt they did sometimes and two felt they never did. We asked whether the carers feel they have enough support, experience and knowledge to meet the different needs of people who live at the home. One felt they did always, one usually, and two never. One declined commenting on this point. In relation to adequate staff on duty two felt there was always enough staff to meet the needs of the people using the service; two felt there was sufficient staff sometimes, and one felt there never was. One comment was the home employs uncaring and lazy workers and the residents get neglected. Another comment was a supper cook may be beneficial as when staff levels are low this can make strong demands on staff and less time given to service users. One felt the morale of the team was 10 out of 10; another felt it was about 5. We discussed with the manager the polarised views of the staff team and agreed that exit interviews when carers leave employment are helpful, and supervisions with a specific objective to probe their views about the level of support they receive. We saw some supervision records. We commented to the manager that they currently follow a repeat pattern of information going from the supervisor to the carer but fail to record the drawing out of feedback and comments from the member of staff, which is valuable to inform in-house training agendas. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in a responsible way with identifiable improvements taking place and further planned developments to the premises and systems of working being progressed. The residents financial interests are safeguarded within the home, and their health, safety and welfare are promoted by applying practical and reasonable policies, procedures and training. Evidence: Moorland House changed ownership in April 2008, and a new manager was recruited with thirty years of experience in residential and nursing homes. She is qualified to NVQ Level 4 and possesses the RMA Registered Managers Award. The Registered Provider is present at the home several days a week, and together with the manager they have established clear lines of accountability for their respective roles. Private discussion with each demonstrated to us the mutual respect and support given and received in these roles. We met the new part time administrator who has been Care Homes for Older People Page 25 of 29 Evidence: appointed to assist with documentation. We saw that the registration certificate was clearly displayed in the entrance hall. We were able to confirm by observing people and the inspection of records that the home is complying with its conditions of registration. The home provided an annual plan detailing the developments and improvements for the home, many of which have already been progressed. Quality monitoring systems have been put in place. The AQAA informed us that their quality assurance surveys shows that residents and their families are satisfied. The manager confirmed that the home does not hold or manage cash/money on behalf of the residents. Invoices of relevant fees and expenditure are raised monthly and billed to the residents representatives. The AQAA confirms that policies are in place ensuring the health and safety of residents and staff. Manuals were in evidence at inspection, and the file of servicing equipment and maintenance testing was sampled. The fire log book was available and maintained up-to-date. We obtained an up-to-date matrix of all the staff training, demonstrating the current status of all mandatory training, and the timescale and arrangements for refresher training. We observed the alcohol disinfectant points at the entrance and around the home. We observed that accessing and leaving the home was controlled by the staff member present in the office. A sign in and out book informs the home who is present and the timescale people have been away, and this assists with monitoring who has regular visitors and trips out. Care Homes for Older People Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 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. 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