CARE HOME ADULTS 18-65
Moorcroft Care Homes Ltd Moorcroft House 18 Laughton Road Thurcroft Rotherham South Yorkshire S66 9LP Lead Inspector
Valerie Hoyle Key Unannounced Inspection 19th June 2007 09:30 Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 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 Moorcroft Care Homes Ltd DS0000059245.V311177.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 Adults 18-65. 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. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Moorcroft Care Homes Ltd Address 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) Moorcroft House 18 Laughton Road Thurcroft Rotherham South Yorkshire S66 9LP 0114 2488650 NONE NONE Moorcroft Care Homes Ltd Mrs Maureen Elizabeth Spencer Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Moorcroft House is a 3-bedded unit for adults with learning disabilities; it is registered to and managed by Mr and Mrs Spencer. A small staff team enables Moorcroft House to provide a homely approach to care enhanced by the small size of the group and the ratio of one member of staff to one person during the daytime. This ratio includes the provision of day-care. All residents have private accommodation for use as bedrooms and share the rest of the house that includes a dining room, large lounge, a dining kitchen, patio and garden. The owners provide a minibus for the home that allows the staff team to offer a variety of day trips as well as transport for shopping, appointments and wider contact with the local community. The building is a terraced property in the village of Thurcroft about 6 miles from Rotherham town centre. The Cost of a placement at the home is dependent on individuals needs. Currently charges range from £840 to £1,000. The cost to the person is dependent on the level of Local Authority funding, benefit entitlement and whether they need one to one support. Inspection reports are available by request from the home. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for before the inspection, this is called a pre inspection questionnaire. Information from surveys that were sent to people who live at the home, their relatives, health professionals and the staff. Eight people were sent back surveys. An unannounced visit to the home. This lasted over four hours and included talking to support staff and the registered manager about their work and the training they have completed. And checking some of the records policies and procedures the home has to keep. Some time was spent talking with two people who live in the home. • • What the service does well: What has improved since the last inspection?
Staff have been provided with training which will help them care for people safely. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 People who use this service experience good quality outcomes in this area. People will be assessed before admission to the home to make sure Moorcroft is the right place for them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: This is a small home, for three people only, and the last person to move in was about ten years ago. The registered manager therefore described how a new person would be given information about the home and assessed to help them make a decision whether the home was the right place for them to live and that Moorcroft it would be able to meet their needs. Although the registered manger has not carried out an admission to the home before she was able to fully explain how she would manage the process in way which be user focused and would result in the best outcomes for the people already residing in the home and any new people moving into the home. For people moving into the home the registered manager explained when an admission occurs the care manager would carry out a referral and needs assessment. They would then be encouraged to visit the home with the care manager. Following this a full assessment of their needs would be carried out
Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 9 by the registered manager, where they would meet with them and discuss their needs and aspirations, and gather together other information from any relatives or other agencies involved. Next, they would commence visiting the home and spend at least one night in Moorcroft before they came to stay permanently. Throughout this process, staff would be sensitive to their and their relatives’ needs and the visits would occur at a pace set by them. Also, after a settling in period, a review would be held to confirm that they are happy with the arrangements, where the views of the people living in the home would be given careful consideration. The assessment would include people’s needs and aspiration their social, physical, personal, and behaviour etc. The registered manager explained she is looking at reviewing the paper work for assessments. The registered manager explained she had recently initiated the reassessment by social services when she had believed the home could no longer meet someone’s needs. The two people who have been in the home for ten years do not hold a written contract; the registered manager explained this is because it is viewed as their home. However, for anyone new she would be looking to providing them with some terms and conditions. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 People who use this service experience good quality outcomes in this area. Moorcroft helps people to make decisions about their lives, with clear care plan instructions and comprehensive risk assessments to maximise their safety. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The people who live at Moorcroft said they were able to make choices about their lifestyles and their care they said they were happy there and liked everything about it. During the site visit, staff were observed encouraging them to make choices about their lives and the records and the staff spoken to provided further evidence of people making decisions. Two peoples’ case records were looked at in order to check that a plan had been formulated which would help staff provide support to people according to their needs and wishes. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 11 There were forms completed which contained information about the person such as date of birth, GP, next of kin. The care plan gave information about individual support needs and identified personal routines, these were documented step by step to make sure support was provide exactly how the person wanted and needed. Also present were risk assessments with the purpose of supporting people to live as independently as possible with safeguards in place. The care plans and the risk assessments were reviewed regularly. There were comprehensive daily records, which helped staff to identify any new needs a person may have and the best actions to meet that need. However there were parts of these records where slightly badly chosen language had been used, the registered manager explained she had recently addressed this in a recent staff meeting and hoped it was now resolved. People who live in the home were aware of their records and staff explained how they used them to help identify and meet people needs each day. The registered manager is keen to promote that this is a ‘home’ and people who live in the home views are taken into consideration. They complete yearly questionnaires about the home and are invited into the staff meeting to discuss any issues. She also meets regularly with them to ask if they have any concerns or requests. Staff explained people’s views are regularly voiced at meal times. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17. People who use the service experience good quality outcomes in this area. People are helped and supported by the staff to make choices about their lifestyle and develop their life skills; this results in them leading a full and active life. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People have lived at Moorcroft for many years and they enjoy a full and stimulating lifestyle. The staff provides them with a family atmosphere, which they benefit from and fully promote a sense of ownership about Moorcroft. They are involved in all the household tasks, such as cooking, cleaning, and gardening. During the site visit to the home, they were being encouraged and supported to carry out these tasks. People living in the home stop in on a Tuesday to carry their household tasks, for the rest of the week they generally go out. Examples of where they go
Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 13 were, to carry out voluntary work, to the parks, shopping, swimming and hydro. They have a week’s activities plan and any outings are written about in the daily records. This enables staff to be aware of any issues that may occur in the places they have been and prevents repetitiveness of activities. Everyone explained how routines and activities are focused on the persons needs and wishes, and were easily changed dependent upon their choices and needs. The records gave details of preferred life styles and activities and of decisions being made. People in the home seemed to benefit from the small enthusiastic staff team, the size of the home and one to one working during the daytime, where they would be supported to carry out activities of their choice. People in the home are supported to maintain links with family by staff. The registered providers provide transport to assist people to maintain their links with the local community. Several staff are qualified to drive the people carrier and this is used for day care days and to drop people at work or medical appointments. Everyone in the home will generally eat together on an evening, during the day they will eat as and when they are able dependent upon their activities. On the day of the site visit, people were sitting together outside eating lunch. People in the house said the food was very good. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. People who use the service experience excellent quality outcomes in this area. People are encouraged to play an active part in making sure their personal and health care needs are fully met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People living in the home are generally independent with regard to their personal care, but where support was needed, the care plans promoted both sensitivity and respect and gave detailed descriptions of how the people preferred to be supported with personal care. Half of the staff are male, this enables people in the home to have their physical personal care needs carried out by a gender they feel most comfortable with. The registered manager explained how the people in the home generally went to the local GP. Staff explained how although staff encouraged them to visit the doctors if they believed they needed medical advice, they would generally
Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 15 make the decision themselves about the need for medical care and ask for an appointment when they needed one. The records clearly evidenced that people in the home were given choices and made decisions about their health care. Records are kept of visits by health care professionals these showed GP’s, and nurses, chiropody, physiotherapist Where the physiotherapist was no longer able to visit as regularly, a list of exercises had been prepared by the physiotherapist which the staff encouraged people living in the home to carry out each day. There was other evidence of where staff had supported people to improve their health. Surveys were returned from two health professionals both gave positive responses. The care plans showed people living in the home had made a choice of asking staff to help with their medication. The medication looked at was kept in a locked cabinet and when dispensed recorded on a medicine administration record sheet. The medication is given directly from the boxes from the pharmacist; all the medication is monitored by staff and checked by the pharmacist. All staff confirmed they had attended accredited medication training. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. People who use the service experience good quality outcomes in this area. People are able to express their views and are safeguarded from harm. We have made this judgement using a range of evidence, including a visit to this service EVIDENCE: The registered manager has recently reviewed the complaints procedure and has made it available for people in pictorial format. People surveyed said they knew whom to complain to and they would tell the registered manager. Staff were confidant people would make their views known and during the site visit people were observed to be comfortable approaching the manager and staff. There have been no formal complaints to the Commission. Moorcroft has had only one complaint about a person’s behaviour; the registered manager responded appropriately to this and recorded it in a complaints book. However, to promote good practice and follow data protection guidelines separate records for each complaint should be kept with a log to track where the details are held. Discussion with the registered manager showed she was aware of the actions to take to safeguard adults. Staff had received training in adult protection and safeguarding issues either during induction or as part of their national vocational qualifications. Also people who lived in the home said they felt ‘safe’. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 17 People were given the choice to manage their own finances. The registered manager explained they have their own bank accounts and keep some cash in locked boxes in the safe. Also, either independently or with help they account for their spending by recording the purchases in a book and keeping receipts. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30. People who use the service experience good quality outcomes in this area. People live in a clean and comfortable home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Moorcroft is a home, people are encouraged to see it as their own and take pride in it. On the day of the site visit people living in the home had cleaned their own room, washing was hung out on the line. It is clean, comfortable and decorated and furnished to a good standard. The home provides comfortable communal areas with one lounge and a dining area. The registered providers have made small adjustments to the toilet and stairs by adding handrails to assist with mobility difficulties. There is a separate domestic kitchen with a breakfast table. The grounds are tidy, and accessible, the rear garden includes a patio area and small lawn. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 19 The bedrooms were comfortable and had personal possessions, which reflected people’s interests and age. A range of checks is completed on a regular basis to make sure that the house is safe and secure. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35. People who use the service experience good quality outcomes in this area. Proper recruitment procedures and good staff training meant that peoples’ needs are met and their interests are safeguarded. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: When interacting and providing support staff displayed both good practice and the necessary skills to care for people. During the site visit, staff were observed to have good relationships and displayed warmth and understanding when talking to people. People who lived in the home said they liked the staff. Staff said they were provided with enough training to enable them to care for people in the home. A member of staff described how they had carried out a in depth two week induction, followed by accredited medication training and were now taking their national vocational qualification level two in care. At the previous inspection a requirement had been made for staff to attend Learning Disability Awareness Framework (LDAF), one member of staff had completed their LDAF and other were to commence. The registered manager
Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 21 explained breakaway training/managing challenging behaviour had been carried out but needed repeating for the benefit of new staff. Three staff records were looked at all contained the information and checks necessary to protect people in the home from abuse. The registered manager explained interviews took place in the home so that everyone could meet potential applicants and if accepted they would work supervised in the home for a trial period to find out if ‘everyone got on well’. Staff were provided with regular supervision and felt fully supported by the manager, and annual appraisals were carried out. Staff said and the record confirmed they attend regular staff meetings. The pre assessment questionnaire states over half of the staff have completed their national vocational qualification level two or above in care. The registered manager explained there is always one member of staff in the house and two who provide day care so people can be assisted with their activities, also one member of staff has the responsibility for sleeping in at the home to ensure the safety of people throughout the night. Generally, the staff spoken to and surveyed felt this was enough staff to meet people’s needs. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42. People who use the service experience good quality outcomes in this area. People benefit from a home that is managed in their best interests. We have made this judgement using a range of evidence, including a visit to this service EVIDENCE: The registered manager is the joint owner of the home. She is a registered nurse and has her National Vocational Registered Managers award in management. During the site visit people were seen to be comfortable when approaching her to discuss the home, she always listened and responded with warmth and respect. Staff said they felt extremely well supported by the registered manager. Quality assurance systems consisted of a regular survey for people in the home to complete, regular house meetings, social services care reviews, also reviews of the complaints and accidents, which happen in the home to identify
Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 23 any patterns etc. Although this is quite thorough the home would benefit from sending the questionnaire to outside agencies such as care managers, GP, or the district nurse, to obtain outside agencies perspectives of the home, this would help keep the home up to date with any new practices. A sample of maintenance and service records were examined and found to be in order. Fire safety procedures were in place and records were examined, showed equipment was maintained and staff had received the appropriate training. Accidents were recorded and reviewed by the registered manager to identify and resolve any potential risks. The home was not routinely checking water temperatures, it was recommended this was commenced to ensure peoples safety. Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 3 X X 3 X Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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 2 Refer to Standard YA22 YA39 Good Practice Recommendations To promote good practice and follow data protection guidelines separate records for each complaint should be kept with a log to track where the details are held. To improve the quality assurance system in the home annual questionnaire should be sent to health professionals associated with the home. This would help the home continue to maintain its high standards. To protect people from any risk of harm water temperatures should be checked and recorded regularly. 3 YA42 Moorcroft Care Homes Ltd DS0000059245.V311177.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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