Inspection on 17/07/07 for Moor Villa

This inspection was carried out on 17th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Moor Villa 15/04/08

Moor Villa 02/10/06

Moor Villa 20/09/05

Moor Villa 17/05/05

Moor Villa 18/08/04

Moor Villa 16/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Moor Villa 53 Moor Street Kirkham Lancashire PR4 2AU Lead Inspector Denise Upton Unannounced Inspection 17th July & 23 July 2007 10:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moor Villa Address 53 Moor Street Kirkham Lancashire PR4 2AU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01772 682884 Mrs Savitree Seedheeyan Mrs Christine Harris Care Home 16 Category(ies) of Dementia (16) registration, with number of places Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st December 2006 Brief Description of the Service: Moor Villa is registered to accommodate up to 16 older people of either sex who have a diagnoses of dementia. The home is conveniently located on a main thoroughfare of the town and in close proximity to local community services and resources. Moor Villa is a detached property with communal space consisting of a large combined lounge/dining room and a smaller separate lounge area. Individual bedroom accommodation is located on the ground and first floor of the property and comprises of 8 single bedrooms and 4 shared rooms. Although en-suite accommodation is not provided, there are sufficient bathroom and toilet facilities to fulfil the requirements of the standard. Visitors are made welcome at any time of the residents choice. Aids and adaptations are provided as required and all people living at the home have access to appropriate medical interventions. The fees for residential care at Moor Villa currently range from £282.50£350.00 per week. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over the majority of a midweek day and a short period of time on a second day. In total, these sites visits spanned a period of approximately eight hours. The inspector spoke with the registered manager, deputy manager, and a member of the care staff team. In addition, individual discussion took place with two residents and a relative who was visiting at the time of the site visit. Informal general discussion also took place with several other residents in a communal area of the home. A second inspector also spent a period time observing the care needs being given to a small group of people living at the home. The time spent observing residents daily life and care staff practices found staff to be patient, spent quality time talking to residents and in the main, took time to ask residents questions rather than deciding for them. It was noted that people living at the home were encouraged to be as active as they chose, but could also sit quietly if they wished. A number of records were examined and a partial tour of the building took place. Prior to the inspection, a relative completed a Commission For Social Care Inspection comment survey form and a letter was also received from the friend of a resident. Comments made were in the main positive. This provided further information on how relatives/friends felt that Moor Villa was meeting the needs and requirements of people who live at the home. Limited information was also gained from the Annual Quality Assurance Assessment completed by the registered manager and deputy manager. What the service does well: Moor Villa has a group of staff that have worked at the home together for a long time and know the residents very well. Staff like working at the home and are keen to provide a good quality service that takes into account the individual wants and wishes of residents who live there. Residents spoken with felt that the staff were good and kind with one resident saying that “the staff are very good, I feel well looked after”. Good relationships have been formed between residents and staff which helps to create a comfortable and relaxed environment. Residents also felt that their privacy and dignity was well respected by staff and everybody spoken with including a relative spoke very highly of the personal care provided and described the staff team as “very good and caring”, and “excellent”. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 6 People living at the Moor Villa also felt that their health care needs were well met. There is a good working relationship with medical staff that either visit the home when requested or staff assist residents to visit their doctor or other health related professionals such as dentists or chiropodists when required. Residents living at the home enjoy the social activities provided. It was also observed that individual staff spend a lot of time talking with residents either individually or in a small group to make sure that people living at the home enjoy some attention. What has improved since the last inspection? What they could do better: The registered manager and staff at Moor Villa work well together to make sure that the needs of residents living at the home are met and that residents feel comfortable living at the home. However there are a number of things that were identified during the visit that must be improved. The environment at the home both inside and outside requires attention as a matter of urgency, to make sure it provides a safe and pleasant place to live. There are serious concerns especially about some radiator covers that are meant to protect residents from accidentally hurting themselves, being flimsy or not being attached to the wall securely. Some areas that are carpeted are not secure in order to provide a smooth and safe walking area and attention should be given to this. There is a requirement that the homeowner must visit on at least a monthly basis and produce a written report on the conduct of the home. These reports have not been written. Therefore nothing is known as to what the homeowner thinks about the physical environment of the home. A relative who completed a Commission for Social Care survey prior to the inspection said, “Although the home is very old (building) there is not enough money spent on anything. It is a real shame because the staff do a very good job with the residents and they are cared for well. But the outside and inside does not reflect this and would Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 7 put relatives off placing their mother/father in the home”. And. “After eight years visiting our mother not much money has been spent in the home”. The registered manager should undertake specific training to make sure she has updated knowledge, skills and abilities and management skills to run a care for older people. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. Moor Villa has a system in place to establish if a prospective resident’s current needs and requirements could be met at the home. However the information provided in some instances could be more detailed to provide a more rounded picture of the person. This judgement has been made using available evidence including a visit to this service. EVIDENCE: New residents are only admitted to the home if their individual needs and requirements can be met. It is routine policy at Moor Villa that all prospective residents are visited in their current environment in order to make an initial assessment of current strengths and needs and to provide further information in respect of the home and facilities and services provided. The pre admission assessment carried out by the registered manager, is in some instances, further supplemented by information made available from Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 10 professional assessments undertaken by a Social Services Care Manager or through hospital discharge information. However the information recorded in the pre admission assessment could be more detailed. For example, one of the pre admission assessments observed indicated that the person concerned could be ‘aggressive’. However, there was no indication as to what sort of aggression was displayed or the current strategies for managing the aggression. It is important this detail is recorded in order to determine if the home could meet current needs and if the person would be compatible with the existing resident group. Wherever possible, prospective residents are invited to make an introductory visit the home to assess the accommodation for themselves, meet staff and residents already living at the home. This enables the prospective resident to make an informed choice as to whether they would like to live there. One recently admitted gentlemen individually spoken with could not really remember who had visited him before he became resident at Moor Villa but said that he “ felt very well looked after”. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10. Quality in this outcome area is good. There is a care planning system in place with evidence of regular review. However risk assessments are not always in place to explain how or why judgements had been made. The health care needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The medication in this home is generally well managed promoting good health. Personal support is provided in such a way as to promote and protect residents’ privacy, dignity and independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection there has been some improvement to the development of a more comprehensive plan of care. However some of the Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 12 detail could still be expanded further to ensure that staff are provided with sufficient written guidance, including medication requirements, to always provide a consistent and high quality service. It was noted that although individual social activity is arranged that takes into account the wants and wishes of the individual resident, this is not always identified in the care plan. It was also noted that although two recent pre admission assessments had indicated that one person “can be aggressive” and the other person “can lose his way if out of the home alone”, there were no formal risk assessments in place to identify how those risks could be eliminated or minimized. However reference was made in the care plan that directed staff how to minimize the perceived risk. For example, one care plan identified that that particular resident “must be supervised at all times” but gave no indication as to how this decision had been reached. Unless a detailed risk assessment is in place to explain why a particular course of action is required, it could be argued that this person had had his freedom restricted without clear evidence that the action taken was appropriate or necessary. In this particular instance, the directions on the care plan were valid and necessary and appropriate action had been taken to ensure this resident was always escorted when leaving the home to enable him to enjoy social activity in the local community. There was clear evidence of care plans being routinely reviewed on a monthly basis and signed by the resident or relative. Discussion with a member of the care staff team, confirmed that they were very aware of the content of the care plans and felt well equipped to carry out the tasks required. A relative of a resident spoken with said that they had seen the individual care plan that had been explained to them and that they agreed with the content before signing the document. This same relative also said that they were “very satisfied with the level of care provided for their relative ” since becoming resident at the Moor Villa. Through discussion with a resident and staff and observation of documentation, it was confirmed that resident’s health care needs are fully met. There is a good relationship with health and social care professionals in order to maintain health and social well-being. Comments on the Commission for Social Care Inspection, survey form completed by one relative also confirmed that she felt that people living at the home always received the medical support that they needed. In the main, there are good systems in place of the administration and recording of medication. Residents who wish to and have capacity to do so are enabled to self-administer their own prescribed medication. Medication administered by staff, is stored in a locked cupboard that is secured to the wall in the small office area on the ground floor. There was evidence of a clear audit Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 13 trail of medicines into the home or disposed of and the pharmacist who provides medication to the home visits on a regular basis. There was also evidence that all residents had had a recent review of their prescribed medication. Staff with responsibility for medication administration have received training to ensure the safe administration and recording of medication and are expected to adhere to the procedures for the receipt, recording, storage, handling, administration and disposal of medication. One member of the care staff team spoken with explained that for the first month after she had received the medication training she was supervised by another experienced member of staff. However on the day of the first site visit it was noted that the medication record for the whole day had been completed even though the lunchtime medication and evening medication had not been given. Observation of the medication record showed that the medication record for the lunchtime and evening medication had been tippexed out when it was realised that a mistake had been made. This suggests that the individual medication administration record is not always completed immediately after the medication has been administered to a particular resident. On no account should entries made on the medication administration record be removed. If a mistake has been made, this should be clearly indicated. A resident individually spoken with confirmed that they felt that their privacy and dignity was well respected and that “staff are very good, I am never embarrassed when staff are helping me” However during the course of observing residents in a lounge area, it was noted that one member of staff used language when talking to a particular resident that was childlike. This was not said in a way that undermined or upset the resident but never the less staff should be mindful of the words used when speaking with residents. Staff receive training in respect of maintaining privacy and dignity during induction training, National Vocational Qualification (NVQ) training and through regular supervision. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. Residents are encouraged to keep in regular contact with family and friends in order to maintain family and friendship links. The routines of daily living are kept flexible to enable people who live at the home to enjoy the lifestyle of their choice. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets people’s tastes and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As observed at the time of visits, it was clearly evident that people who live at the home can entertain visitors of their choice at a time to suit them either in a communal area of the home or individual bedroom accommodation. A relative spoken with during the course of the inspection who visits on a regular basis, stated that she is always made welcome and confirmed her Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 15 satisfaction with the level of care provided and that she was kept informed about her mother’s well being. A minister of the church also visits Moor Villa every four weeks to conduct a service and to speak with residents and at religious festivals, local school choirs visit the home to provide entertainment for people who live there. Residents at Moor Villa continue to be encouraged to remain as independent as possible with regard to their chosen life style. However as the majority of people living at the home have some form of dementia, the support of staff is often required to maintain day-to-day activities. Social activities are varied to suit the capabilities of each resident. There are a lot of informal chats with members of staff either individually or in a group situation. This was clearly seen during the period of observation with a high level of engagement and positive interactions with residents. The staff showed that they were aware of the individual’s needs and social history. The level and type of assistance given and the way in which staff engaged with people during specific tasks demonstrated this. One resident was assisted with her knitting by a member of staff, who suggested that she may like to do some knitting and then ensured that the resident had all she needed. The person then settled and knitted for almost the whole period observed, and whilst doing so conversed on occasions with the person sat next to her, and commented on goings on. This resident was relaxed and contented. Another resident had received a postcard and staff sat with her and read the card out to her. One member of staff prompted the resident by remembering the names of the relatives who had sent the card. The staff member also referred to the person’s previous skills of painting and art appreciation. The resident showed signs of well being and at times engaged in prolonged conversations with herself and referring to the card, reading what she thought it said. Another resident responded positively when in conversation with a staff member. The discussion was around the person’s family life and her experience of bringing up her family. The resident was responsive, holding eye contact and was happy to discuss her past experience. The staff member was empathetic and celebrated this resident’s success in bringing up her family. Three members of staff were observed and all appeared to have relationships based on a good understanding of each persons background and preferences. There were isolated instances when interaction could have been improved. A member of staff offered each person who was not engaged in an activity a magazine to read, and if the resident showed an interest the staff member Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 16 then selected a magazine. It would be easy to extend this choice to residents to allow them to express a preference. One poor interaction was observed where the deputy manager shouted over a number of questions to a resident but did not wait for a response. One resident at the home has a dog and this provided a focus for some interactions. The dog provided another opportunity for people to engage in their surroundings and a number of residents petted the dog and gained pleasure from this. Visits out in the local community are also planned on a regular basis for some residents. For example, two male residents go out on a weekly basis with a male member of staff to play pool. Shopping trips followed by lunch out are arranged and a trip out to Blackpool is planned. An alternative trip to Silverdale is also to be arranged for those residents who would prefer not to visit Blackpool. There was evidence of a birthday party that had taken place the day before, residents spoken with said they had enjoyed this very much. Sing songs take place and board games are available. Ball games, bingo, music, old films, knitting, writing and word games are also provided generally on an ‘ad hoc’ basis to meet individual needs. The ladies living at the home also enjoy ‘pampering’ sessions including hand and nail care and some ladies enjoy having their hair brushed. Where possible residents are encouraged and enabled to maintain control of their own financial affairs. However in reality the majority of people living at the home require some assistance that is usually provided by a family member. Details of local advocacy services are detailed in the home’s Statement of Purpose and Service Users Guide that residents or their family can access independently. Meals and meal times at Moor Villa are viewed as a social event. A varied and balanced menu is provided that is designed around the known likes and dislikes of people living at the home. Residents spoke positively about the meals served with one person describing the food as “very good”. Another resident also said that the meals were “very good” and went on to explain that there was a good choice of foods with an alternative provided if “you didn’t like what other people were having”. The lunchtime meal was observed that was enjoyed by the residents. The environment was relaxed and comfortable and there was a good rapport between residents and staff and residents with each other. Assistance was provided discretely and sensitively as required to ensure the dignity of the resident was not compromised. One resident was heard to comment, “It was a nice dinner, I enjoyed it”. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 17 Specialist diets can be provided and there was good evidence to show that the home had sought specialist advice and assistance when a resident required a specific diet. The dietician had been contacted who provided immediate advice and then three members of staff attended a course organised by the dietician that focused on foods and menu planning appropriate for rest homes. The staff that attended this course stated that they found the information informative and useful. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. The home has a satisfactory complaints system with evidence that service users feel their views are listened to and acted upon. Staff have received training in respect of adult protection issues that helps protect residents from potential abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Moor Villa Care Home has a complaints procedure and adult abuse policy that is compliant with all requirements and recommendations. As stated in previous reports, no complaints have been made for a considerable period of time. It is understood however that a record would be maintained of any complaint made that included details of the investigation and any action taken. Although the majority of residents spoken with were unsure about the complaint procedure, everybody was clear that they would speak with a member of staff if they had a concern and felt confident that “things would be sorted out”. The relative spoken with was aware of the complaint procedure. There are a variety of policy and procedures available for the protection of residents. These include an Adult Protection Policy based on the ‘No Secrets In Lancashire multi agency document and a whistle blowing policy to protect Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 19 residents from abuse or discrimination. All staff with the exception of one has received adult abuse training. Arrangements have already been made for all staff to receive updated adult abuse training in the near future. This training helps to ensure that staff have a thorough understanding of adult abuse issues to protect both residents and themselves. Through discussion with the deputy manager it is understood that the management team are in the process of developing a policy in respect of aggression. This will strengthen the policies and procedures available to advise staff and help to protect residents. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Standards 22 & 25 were reassessed in part. Quality in this outcome area is Adequate. The standard of the décor and general physical environment in this home requires substantial improvement in order to provided a attractive and comfortable place for people to live. There is little evidence to suggest that major improvement work is to take place except for attention to the building demanded by the fire service and the proposal to have the building externally painted over the next twelve months. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst there is no suggestion that people living at the home do not receive a good standard of care, the physical environment of the home does not present as an attractive place in which to live. Requirements and recommendations in respect of the accommodation have been highlighted in several recent inspection reports. Although the homeowner does make some minimum Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 21 improvements in response to the concerns raised in the inspection reports, there appears to be no proactive approach in preventing the internal and external environment deteriorating again before the next inspection. For example, it was recommended in the previous inspection report that the existing intercom system in all resident accommodation be replaced by a call bell system with an accessible alarm facility. This has not been done. In one bedroom on the ground floor of the building that is occupied by a resident with cognitive impairment who spends most of her time in the bedroom, the intercom in that room has been removed completely. It was explained that this was the result of the occupant banging her head on the unit when in bed. Rather than repositioning the intercom in a different position that would still enable the resident to summon help when necessary, the unit was removed and not replaced. This is of serious concern. There is a requirement that “suitable adaptations are made, and such support, equipment and facilities as may be required are provided for service users who are old, infirm or physically disabled”. It is also specified in the National Minimum Standards, Care Homes for Older People that, “Call systems with an accessible alarm facility are provided in every room”. The deputy manager was asked to ensure that a member of staff visit this resident every 15 minutes when she is in her bedroom and that the member of staff who undertakes this task records the event and any action required. This is required until there is an adequate call system in the bedroom to enable the occupant to summon assistance as and when needed. In addition the area of wall where the call bell was removed is now in a poor state of repair and requires attention. The recommendation that the remaining strip lighting be replaced by more domestic type lighting in resident accommodation has yet to considered. Although there was a requirement at the last inspection that a radiator in an upstairs corridor be guarded that has since been provided, other radiator covers are in some cases flimsy, in poor condition and/or not properly attached to the wall. In these situations residents would not necessarily be protected from accidentally burning themselves on the radiator. This must be addressed as a matter of urgency in order to protect vulnerable people. All radiator guards must be of sound construction, well maintained and firmly attached to the wall. The carpet by the downstairs toilet during the first site visit was observed to be worn and threadbare in places that posed a risk for residents. On the second site visit it was noted that this area of carpet had been replaced. However the replaced carpet was not close fitting and was ‘wavy’ in places. Likewise part of a carpet in an upstairs corridor was also ‘wavy’ and appeared to require stretching in order to provide a smooth and safe surface to people to walk on. Again this must be addressed as a matter of urgency. People living at the Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 22 home must be accommodated in a safe environment where risks to health and well-being minimized. Moor Villa is an older property that continues to require constant maintenance. As stated in previous reports, the outside of the building is in a poor state of repair. Attention is required to a number of windows and again it was noted that the external rendering to the home, windows and guttering all require repair and repainting to prevent further deterioration and to provide a pleasant environment for people to live. The only planned environment improvement identified on the Annual Quality Assurance Assessment (AQAA) submitted by the registered manager prior to the site visit was “To have the building painted externally”. However no date had been arranged for the commencement of this work. A number of bedrooms require redecoration and in one bedroom there was marks on the wallpaper that appeared to be damp. The wallpaper had also starting to detach itself from the ceiling. A door handle of a wardrobe was missing in one bedroom and in shared rooms there appeared to be no screening to protect the privacy of the residents who occupied these rooms. Some of the bedroom furniture seen was old, unattractive and in need of replacement. Some areas of the corridors and stairs require attention and redecoration and the laundry area and outdoor storage areas were cluttered. It is understood that this is a temporary situation. The laundry is to have a new roof and then the old equipment will be removed. The deputy manager explained that the storage area is to have the floor repainted. It is recommended that the outside shed used for storing tools be kept locked at all times when not in use. As required at the last inspection, a lock has been provided to the ground floor bathroom/toilet. However this room remains bleak and uninviting and does not present as a comfortable or attractive place to be. It is recommended that consideration be given to replacing the existing facilities in this bathroom to provide a more homely and inviting bathroom environment that is designed around the needs and capabilities of residents accommodated. A comment from a relative on a Commission for Social Care Inspection survey form also raised issues about the environment when stating, “Although the home is very old (building) there is not enough money spent on anything. It is a real shame because the staff do a very good job with the residents and they are cared for well. But the outside and inside does not reflect this and would put relatives off placing their mother/father in the home. After eight years visiting our mother not much money has been spent in the home. Also we have asked the owner of the home if they will decorate our mother’s room because of the ripped border which has been like this for several months. We would like him to do something about this”. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 23 As identified in the last inspection report, policies and procedures are in place for the control of infection and all staff have undertaken infection control training. Laundry facilities are sited in the yard area and do not intrude on people living at the home. However as previously stated it is understood that the laundry is to be provided with a new roof and the unused equipment presently stored in this area will be removed. A relative pointed out that she felt that the “staff should have a dishwasher and more washing machines and tumble dryers for the amount of laundry they get”. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. Staff morale is high resulting in an enthusiastic workforce that works positively with people living at the home to improve their quality of life. The arrangements for staff training are good with staff demonstrating a clear understanding of their roles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels at Moor Villa are determined in accordance with the assessed needs of residents accommodated. Additional staff are on duty at peak times of activity and there are sufficient staff employed during the night time period. A weekly staff rota was available indicating the staff on duty during each given period of the week however the weekly staff rota observed was not dated. It is important that the staff rota be dated to provide clear evidence of who is or was on duty during each shift period. Residents and staff spoken with all felt that there were sufficient staff on duty at any one time to ensure that the needs and requirements of people living at the home could be adequately met. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 25 Moor Villa enjoys a stable staff group that get to know the individual needs and requirements of each resident very well. Since the last inspection no new members of staff have been appointed. However a robust system is in place with regard to staff recruitment in order to protect residents and to ensure that any new employee will have the qualities, skills and understanding to provide a good service to residents. It is understood that any new member of the care staff team would be provided with nationally recognised induction training within the first few weeks of their employment. Staff training is given high priority at Moor Villa. Currently 90 of the care staff team has achieved at minimum a National Vocational Qualification (NVQ) Level 2 in care. This well exceeds the minimum recommendations for the number of care staff in any care home with this qualification. A number of staff have also successfully achieved more advanced levels of this award and a member of staff spoken with was clearly proud of her achievements. Staff have undertaken a variety of other training that has recently included diabetes, choices and rights, and dementia care Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is adequate. The registered manager at Moor Villa is competent and experienced and provides clear leadership throughout the home. However the registered manager should obtain a nationally recognised care managers’ qualification to ensure she has the required skills and abilities to manage the care home. The home regularly reviews aspects of its performance through a programme of self-review and consultation seeking the views of residents/relatives and staff. Although the homeowner visits the home on a regular basis, no written report is produced that comments on the conduct of the home. Systems are in place to ensure the health and safety of residents, staff and visitors. This judgement has been made using available evidence including a visit to this service. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 27 EVIDENCE: As stated in previous inspection reports, the registered manager is competent and experienced but does not wish to pursue an NVQ Level 4 qualification (or equivalent) in care and management. This potentially leaves residents at possible risk. Current best practice principles, understood through an advanced level of care and management training cannot be assimilated or cascaded to staff or staff performance effectively evaluated. The registered manager does however undertake short course training covering a variety of topics. Formal systems, to find out what residents think about living at the home and the care and support received, are limited because of the cognitive impairment of the majority of people living at the home. Residents prefer to sit and chat with staff either individually or in a small group often during or after some sort of social activity has taken place. This suits the needs of current residents. Likewise informal verbal discussion when relatives visit the home is the preferred way to elicit the views and opinions of friends and relatives about how the home is achieving goals for people living there. The relative spoken with said that she had a good relationship with the staff team and often spoke with them about the care of her mother. The deputy manager also stated that other visitors such as doctors or district nurses are also occasionally informally asked for their views when visiting the home. Although the registered manager said that the homeowner does visit the home on a regular basis, there is a requirement that following these visits, the homeowner must produce a written report on a monthly basis about the conduct of the home. This has not been happening. Monthly written reports must be produced covering a range of topics including the views and opinions of residents or their representative, what staff feel about the home and the outcome of the inspection of the building and some of the records held at the home. Very recently Moor Villa has achieved the ‘Investor in People’ award that is only given when a home has reached a certain standard. There remains a good system in place to ensure residents financial interests are safeguarded. Wherever possible residents are encouraged to remain financially independent. However in reality, because of cognitive impairment, the majority of residents require assistance with their financial affairs and an independent attorney is appointed. Where the home retain small amounts of personal monies in safe keeping for day-to-day needs, written records of Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 28 financial transactions are maintained that were accurate and up to date with receipts kept. Secure facilities are provided for the safe storage of resident’s monies and valuables. Staff supervision arrangements are in place. All staff receive formal one to one supervision on at least a monthly basis covering a variety of topics. Moor Villa ensures safe working practices are maintained through implementation of the home’s policies and procedures and staff training in respect of health and training issues. All members of staff receive mandatory health and safety training that includes manual handling, first aid, infection control, fire safety and food hygiene. Arrangements have been made for all staff to receive annual updated health and safety training within the next few weeks. Currently one member of staff has also achieved the more advanced ‘First Aid at Work’ course and it is understood that a further two members of staff are to undertake this award. Observation of documentation including maintenance records confirmed that various routine health and safety checks are maintained and environmental risk assessments are in place. There is a system in place for recording health and safety issues and it was evident that equipment is regularly serviced and a number of up to date certificates were evidenced that included fire safety equipment and a small appliance testing certificate. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X 2 X X X 2 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 13(4)(a) Requirement Timescale for action 24/08/07 2. 3. OP22 13(4)© 13 (4)(a) OP25 4 OP31 26(4)© Carpets in the home must be smooth and close fitting in order to provide a safe area for people to walk. All resident accommodation must 24/08/07 be provided with an adequate call bell system. All radiators in resident 24/08/07 accommodation must be provided with a radiator guard that is of sound construction, well maintained and firmly attached to the wall. The registered provider must 24/08/07 produce a monthly written report as to the conduct of the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations Sufficient written detail should be included in the pre admission assessment to ensure an informed decision DS0000009722.V341033.R01.S.doc Version 5.2 Page 31 Moor Villa 2. OP7 3. OP9 4 OP10 5 OP19 6 7 8 OP24 OP25 OP26 could be made to establish if presenting needs and requirements could be met taking into account the existing resident group. Formal written risk assessments should always be undertaken when a risk has been identified. Outcomes of the risk assessment should be incorporated in the care plan. Written care plans should be in sufficient detail to enable staff to provide a consistent, holistic service. The medication administration record should always be signed immediately after the individual resident has been provided with their medication. Any mistake to the drug administration record should not be tippexed out. All staff should be mindful to ensure that the words actually used when talking with residents are appropriate for an adult. Time should always be given for the resident to respond to any question asked. Serious attention should be given to both the internal and external environment of the home to ensure a comfortable, attractive and well-maintained environment is provided. Some old bedroom furniture should be replaced to provide a homely and attractive bedroom environment. The outdoor tool shed should always be kept locked when not in use. Screens should be provided in twin bedroom accommodation to ensure privacy. The remaining strip lighting should be replaced with more domestic type lighting especially in bedroom accommodation and communal areas of the home. It is recommended that the ground floor bathroom/toilet facilities should be replaced and the room upgraded to provide a homely and inviting facility that is designed round the needs of residents accommodated. Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Moor Villa DS0000009722.V341033.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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