Inspection on 23/08/05 for Moorcroft Care Homes Ltd

This inspection was carried out on 23rd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Moorcroft Care Homes Ltd 27/05/09

Moorcroft Care Homes Ltd 19/06/07

Moorcroft Care Homes Ltd 17/01/06

Moorcroft Care Homes Ltd 15/03/05

Moorcroft Care Homes Ltd 17/08/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 MOORCROFT HOUSE 18 Laughton Road Thurcroft Rotherham S66 9LP Lead Inspector Valerie Hoyle Unannounced 23 August 2005 11:00. 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 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 Stationary 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 HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Moorcroft House Address 18 Laughton Road Thurcroft Rotherham South Yorkshire S66 9LP 01709 548129 None None Moorcroft Care Homes Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Maureen Spencer PC Care Home only 3 Category(ies) of LD Learning Disability: 3 registration, with number of places MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mrs Spencer to register on an appropriate management qualification course within the next 5 months to attain the qualification by 2005. Date of last inspection 15 March 2005 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 of seven 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 service user during the daytime. This ratio includes the provision of day-care. 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. All service users 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. MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over 4 hours where a partial tour of the building was undertaken. The inspector examined three service users care plans and supporting documentation. Three service users and two staff were spoken to during the visit. The registered managers assisted with the process while examining records, policies and procedures. What the service does well: What has improved since the last inspection? The registered provider continues to improve the environment by decorating areas as required and service users are encouraged to participate in choosing colour schemes for their own bedrooms. The registered manager has increased the number of staff employed at the home since the last inspection, ensuring service users are able to continue with their leisure and educational interests. MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 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 HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 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 standard(s) 2 Service users are not admitted into the home without a full needs assessment taking place by the registered manager, to ensure their needs can be met. EVIDENCE: All service users have lived at the home for a number of years, three service users files examined demonstrated that assessments have taken place to ensure staff are able to meet complex care needs. Service users care plans have been developed using information from social care agencies, which includes documentation regarding the restrictions to freedom of movement based on treatment plans. Staffing levels reflects the need for one to one staffing to enable service users to participate in leisure activities. Service users continue to be supported by the learning disability health team where therapeutic intervention is needed. MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 9 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 standard(s) 6, 7, 8, 9. The home promotes philosophies to enable service users to meet their full potential, with clear care plan instructions and comprehensive risk assessments to maximise their safety and protection. EVIDENCE: There is a comprehensive individual plan for each service user, that is user friendly. They are well written with a daily entry made recording any significant events. These plans describe in detail the intervention required to meet their needs. Staff are aware of restrictions for one service user who requires one to one support while taking part in activities in the community. Risk assessments have been developed to ensure the safety of others when one service user uses his motorised scooter in the community and while being involved in shopping trips to the supermarket. There is clear evidence that service users care plans are regularly reviewed and annual reviews take place involving the placing authority. Each service has a weekly plan of activities including days when they attend college, and day care days when they have a choice of leisure activities MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 10 supported by staff. Service users said that they had started a new activity of going horse riding and said that they really enjoyed the experience. Regular house meetings are held to discuss issues relating to the running of the home and to agree activities. One service user is able to manage his/her own finances with support and the manager acts as appointee for the other two service users. Documentation supporting the financial arrangements was examined and was found to be accurate. MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 11 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 standard(s) 12, 13, 16, 17 Social and leisure activities are provided at the home for service users, to maintain and develop independent living skills, supported by an informed staff group. Dietary needs of service user are well catered for with a varied selection of food available that meets service users tastes and choices. EVIDENCE: Service users are encouraged and supported to maintain links with the local community. Two service users attend college and take part in woodwork and craft courses. Staff described the social activity programmes and service users said that they enjoy trips out with the staff including the gym, swimming and visits to the coast. Service users described a recent holiday where they stayed in a caravan. They particularly enjoyed the trips to the zoo and amusement arcades. MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 12 Tuesdays at the home is classed as a training day and service users are encouraged and supported to undertake routine tasks around the home including cleaning their own bedrooms and doing their own washing and ironing. Mealtimes are organised around the routines of the service users and the main meal is provided at teatime when it is expected that all service users will be at home. Packed lunches are provided for those service users who are out for the day and some service users are encouraged and supported to make their own lunch. MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 13 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 standard(s) 18, 19, 20. Staff provides sensitive personal support to ensure privacy dignity and independence is maintained for all service users. Medication policies and procedures are well managed and staff have the necessary skills to administer the medication to service users, ensuring the safety and protection of service users. EVIDENCE: Service users are generally independent with regard to their personal care, although staff provide support where needed with health care issues arranging appointments and escorting to doctors appointments. There were many examples of good practice by staff and on many occasions there were good interactions between staff and service users. Service users were referred to by their first name and this was with the approval of service users, and was also stated in their care plan. An audit of medication stocks and records was examined and were found to be correct. Staff have received accredited medication training provided by a local college, to ensure they have the necessary skills and knowledge to undertake this task. The registered manager must ensure that new staff employed at the home attends the accredited medication training. MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 14 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 standard(s) 22, 23. Service users are provided with information to enable them to raise concerns about the home and their care. Adult Abuse Policies and procedures and training of staff on abuse ensure the protection of service users from abuse EVIDENCE: The home has a complaints procedure that is available to service users and visitors that is kept in the home. The procedure is also referred to in the service users guide, identifying the stages to follow; this includes the time scales to respond to complaints. The address and telephone number of the Commission for Social Care Inspection is included in the procedure. The registered manager has a copy of the Local Authorities Adult Protection procedures. They also have an Abuse Policy, which has been prepared by the owners and is incorporated into the homes policy and procedure manual. The registered manager reiterates the procedures at staff meetings and supervision and staff training files also confirms that they have attended training in adult protection. The registered manager ensures that all the necessary checks are carried out on new staff for the protection of vulnerable adults. MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 15 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 standard(s) 24, 30. The home provides a well-maintained safe environment suitable for service users. The home provides a clean and hygienic environment to maintain the health and safety of service users. EVIDENCE: A partial tour of the building found it clean and free from odours. The home provides comfortable communal areas with one lounge and a dining area. There is a separate domestic kitchen with a breakfast table. The grounds were tidy, and accessible to the service users, the rear garden includes a patio area and small lawned area. Service users enjoyed having their lunch outside and said that they enjoyed helping with the gardening. The home is close to local amenities, and service users are able to access Rotherham town centre using the homes transport. Individual bedrooms are personalised to service users own interests and hobbies and are furnished appropriately including music centres and televisions. MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 16 One service user has had his room decorated in the colours of his favourite football team. MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35, 36 Staff have the necessary skills and knowledge to meet the needs of service users. There is an effective staff team with regular meetings and supervision ensures staff are kept informed about the services provided. Recruitment policies are followed ensuring the safety and protection of service users. EVIDENCE: Staff rotas were examined and theses are divided into day care hours and hours to provide support to the three service users while they are at the home. This appears to be sufficient to ensure service users can maintain social and leisure pursuits. One member of staff has the responsibility for sleeping in at the home to ensure the safety of service users throughout the night. The inspector discussed the rotas with the registered manager, with regard to the staff gender mix to ensure sufficient cover to enable service users to maintain leisure activities. A number of new staff has recently been employed at the home and they are expected to enrol on a NVQ Level 2 course as the home currently has less than the required 50 NVQ 2 qualified staff MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 18 Discussion with the registered manager indicated that staff have not received any formal training to deal with challenging behaviour, therefore staff must attend a behaviour management course to ensure they have the necessary skills to deal appropriately with service users. Regular house meeting take place and service users are encouraged to attend these meeting. The inspector was able to examine the minuets from recent meetings held at the home. The registered manager was able to provide clear evidence that staff are recruited using the homes policies and procedures. Two staff file was examined and found they contained the required employment checks of two references and satisfactory CRB check, ensuring the safety and protection of residents. A selection of supervision files were examined, and these were comprehensively completed, demonstrating training and development is a high priority. MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 42 The home is well managed to ensure the safety and protection of the service users. Staff and service users follow health and safety procedures and records provide evidence of servicing of essential equipment. EVIDENCE: The registered manager, who is also the joint owner of the home, has knowledge and experience of working with the service users. The manager is working towards achieving the registered managers award and holds a nursing qualification. The registered manager has the required Health and Safety policies and procedures and maintenance and service records examined were up to date and current to the services provided. Fire safety procedures are in place and service records were examined and were current. Staff training records examined indicated that fire training has taken place. MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x 3 3 Standard No 31 32 33 34 35 36 Score x 2 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 MOORCROFT HOUSE Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 3 x 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 21 NO Are there any outstanding requirements from the last inspection? 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 YA20 Regulation 13 Requirement The registered manager must ensure that all staff who administer medication attends accredited medication course The registered provider must ensure the staff have the necessary knowledge and skills in behaviour management. The registered manager must ensure that staff accesses the Learning Disability Award Framework training which provides underpinning knowledge for staff working with people with learning difficulties. Timescale for action 1 January 2005 2. YA35 18 1 January 2005 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 YA32 Good Practice Recommendations The home must achieve 50 NVQ level 2 trained staff in 2005 MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 22 2. 3. YA33 YA37 The registered manager should continue to monitor the staff gender mix to ensure service users can continue their leisure pursuits. The manager must achieve the required NVQ Level 4 qualification in management and care in 2005 MOORCROFT HOUSE 20050831 Moorcroft House X00023 UI Stage 4 S59245 V187293 J55.doc Version 1.40 Page 23 Commission for Social Care Inspection First Floor, Barclay Court Heavens Walk Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 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. 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