Inspection on 12/08/08 for Moorend Place

This inspection was carried out on 12th August 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Moorend Place 30/08/07

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Moorend Place 34 Commonside Walkley Sheffield South Yorkshire S10 1GE Lead Inspector Marina Warwicker Key Unannounced Inspection 12th August 2008 10:30 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 Moorend Place DS0000069691.V367894.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. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moorend Place Address 34 Commonside Walkley Sheffield South Yorkshire S10 1GE 0114 268 0001 0114 268 4056 mplace2@schealthcare.co.uk 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) Southern Cross Healthcare (Focus) Limited Mrs Joy Denise Hardy Care Home 58 Category(ies) of Dementia (58) registration, with number of places Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: 2. Dementia - Code DE), maximum number of places: 58 places. The maximum number of service users who may be accommodated is 58. 30th August 2007 Date of last inspection Brief Description of the Service: Moorend Place is a 58-bedded nursing home for adults. It provides care to people who are elderly and affected by mental infirmity. The home is situated in a residential area of Sheffield with good access to public services and amenities. It is built over two floors and separated into three units. There are stairs and a lift to access the different floor areas. The home is surrounded by gardens, which would benefit by landscaping. There is a car park to the front of the building for visitors. The weekly fee for the service is from £373 to £580. The acting manager explained that the fees are charged according to the dependency levels of the individuals and also according to the source of funding. The people living at the home pay from their pocket money for toiletries hairdressing, chiropody and any personal items. There is up to date information available regarding the service so that the people visiting the home are able to make an informed choice of home. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. An inspection of Moorend Place was carried out on Tuesday 12th August 2008. We visited the home between 10.30 am and 4.30 pm. Eight people who use the service were consulted on the day. We also spoke with all the staff who were on duty. A further ten relatives and three professionals were contacted by post to obtain their views on the service. Comments received from the surveys have been included in the body of the report. Any comments received after the publication of this report will be shared with the management of the home. We spent time observing people in the communal areas, spoke with the visitors and the staff to get an insight into the quality of life and the standard of care and dignity given to the people. We also looked at the quality of food and how the people spend their days. The premise was inspected, which included bedrooms of people using the service, the communal areas and the service areas such as the kitchen and the laundry. The private areas were accessed with the permission of the people and/or the staff at the home so that we respected the people’s wishes. Samples of records such as the care plans, staff recruitment and training files were checked. We would like to thank the people who live at Moorend Place, the visitors, those who replied to our surveys, the staff and the manager for their contribution towards this process. What the service does well: Prospective people who wish to use the service and their representatives are able to access the information they need to make an informed decision about the home. The people have their needs assessed and agreement reached by the staff at the home before moving in. This enables the person to receive a ‘tailor-made’ service. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 6 The health and personal care, which the people who live at the home receive, in the main is based on their individual needs. The principles of respect, dignity and privacy are put into practice by the staff working at the home. The people are able to choose their life style with the help of their key workers if they are able. The people are helped by the care staff to maintain contact with their family and friends. The people at the home are offered a healthy, varied diet according to their assessed requirements. The people living at the home and their representatives have access to a complaints procedure. The people are protected from abuse by the training and awareness of the staff. The legal rights of the people are protected by the home’s policies and procedures. The management and administration show respect to those who live, work and visit the home. They work as a team to promote the health, safety and wellbeing of those who live and work at the home. What has improved since the last inspection? What they could do better: The management must encourage and support the staff to continue the delivery of the good quality of care and at the same time they must address the following areas. The staff working at the home need to be trained and competent, when delivering care and comforting those who are dying. The staff must be confident that they are able to handle people’s death with dignity and have the knowledge to observe the person’s spiritual needs, rites and help their families during this difficult time. The people using the service must be offered daily, suitable activities to keep them involved, active and give them a purpose. To achieve this there must be staff available and able to take part in activities. Ongoing requirement. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 7 The excessive usage of gates on bedroom doors must be stopped. Completion of risk assessments by the staff and the relatives on behalf of the people using the service on its own is not satisfactory. This practice should only follow when all other avenues have been exhausted. The first path the management need to follow is to make sure there is enough staff to give better supervision and take care of those who were wondering into other people’s rooms. The accommodation for the people on the top floor must improve so that they are able to live in comfort. Fittings and furniture on this floor need refurbishing and made to fit their purpose. The manager must allocate on appropriate number of staff to meet the needs of the people living at the home. Immediate, 30/08/07 With regards to ongoing requirement, Some of the supporting evidence is as follows:The lack of supervision by staff of the people using the service resulting in people wondering into other people’s rooms, People not taking part in activities and sleeping or looking bored. The lack of supervision by senior staff, which resulted in staff hanging washed clothes on the bedroom doors along the corridors. Two of the above requirements have been repeated from the last inspection i.e. lack of activities for people and the lack of staff to reflect the dependency levels of the people using the service, failure to comply will result in us taking enforcement action. 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. Moorend Place DS0000069691.V367894.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 Moorend Place DS0000069691.V367894.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): 1,3 &5 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Prospective people who wish to use the service and their representatives are able to access the information they need to make an informed decision. The people have their needs assessed and agreement reached before moving in. EVIDENCE: Four care plans were checked; two staff and two relatives were consulted. The evidence confirmed that the registered manager of the home admitted people following a care needs assessment. As part of the admission process the staff used the assessments from the placing authorities. The relatives said that they were able to visit the home and meet the people living in the home before accepting a place. The staff and the Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 10 professionals we consulted said that the people were allowed several weeks to settle in and that they worked with the relatives to help people settle in the new environment. Moorend Place DS0000069691.V367894.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 & 11 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The health and personal care, which the people who live at the home receive, in the main is based on their individual needs. The principles of respect, dignity and privacy are put into practice by the staff working at the home. EVIDENCE: We checked four care plans, spoke with the visiting family members, the staff on duty and the manager. We also used a modified version of dementia care mapping i.e. the SOFI short observational framework for inspection. The care plans had information, which was relevant and meaningful to the individuals. The nurses had reviewed the care plans and there was evidence that relatives had been kept involved when it was possible. We observed the staff encouraging and helping the people using the service to maintain good hygiene. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 12 The manager and the staff said that none of the residents had problems with pressure sores and that they had appropriate equipment and profile beds to promote tissue viability and prevent pressure sores in people using the service. The people using the service had visits from the Community Psychiatric Nurse if required and had appointments with the general practitioner as and when needed. Four medicine administration records were checked and no gaps were found. The nurses maintained records of medicines received, administered and returned to the supplying pharmacy. The care staff said that the nurses managed the medication. None of the people using the service were capable of self-medication and this was verified in the care plans. People wore their own clothes and they were laundered at the home. On the day of the site visit we observed clean laundered clothing hanging on the bedroom door handles. This is unacceptable and the manager was made aware of this. During our visit we noted that the staff addressed the people in a friendly and respectful manner. The people were able to have visitors when they so wished and there were plenty of private areas where they could spend time. The care staff said that they would welcome training on palliative care, practical assistance and advice. One person said; “I have experience looking after someone in my family who was dying but I have not had any formal training.” “It is difficult when we see people deteriorating, we get close to them and for some we are their family. When something happens to them we have no support or counselling.” Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 13 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 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The people are able to choose their life style with the help of their key workers if they are able. The people maintain contact with their family and friends. The lack of social, cultural and recreational activities contribute to the people using the service being bored. The people at the home are offered a healthy, varied diet according to their assessed requirements and their personal likes. EVIDENCE: On the day of our site visit the activities person was not on duty and the people were sat around the rooms looking bored. The care staff and the nurses were going about their jobs delivering personal and nursing care. Two relatives made the following comment. “You would think that the people would have some entertainment everyday! But very little goes on. When you come into the home you would have seen a lot of pictures showing what the people get up to. It is like they have to do this Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 14 to convince us. We know what happens every day. We would like the care staff to spend time and take people out.” “The activities lady is usually downstairs not seen on the top floor. The quality of life for those residents is very poor. I would like an increase in the staff: resident ratio so that activities could be included in my X’s daily routine. My X would appreciate if her key worker takes her out or spends time engaging in activities with her.” Several bedrooms had gates fitted and the occupants were seen in the rooms. On questioning the staff and the manager they informed us that the gates were there to prevent other people wondering into the peoples rooms and therefore causing unnecessary upset to the occupants. We were also informed that some relatives had requested these gates to ensure the people were safe in their rooms. Our conclusion took on board the information we were given and our findings on the day; that there was an over use of gates. This was preventing people using the service coming out or accessing their bedrooms. Appropriate supervision by staff needs to be explored and the people who wonder in and out of other people’s rooms must be distracted and supervised by care staff. We saw relatives and friends visiting those people using the service. The staff were friendly and welcoming. Some of the visitors spoke to us about the care and the support given to the people by the staff at the home. Their comments have been shared in the appropriate outcome areas throughout the report. Due to the deteriorating condition of the people using the service their financial affairs were taken care of by members of their family or appointees. The relatives were able to see the care plans in order to help the people using the service and the staff review and plan care. This was confirmed by one of the relatives and two staff members. We witnessed dinner being served and the people using the service getting help and encouragement from the staff. The care staff said that during meal times they went over to help on the units where extra staff were needed. Those people who were assessed as being at risk of malnutrition were monitored and the staff maintained records of the food consumed during mealtimes by those individuals. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 15 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 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The people living at the home and their representatives have access to a complaints procedure. The people living at the home and the staff are protected from abuse by staff training and awareness. The legal rights of the people are protected by the home’s policies and procedures. EVIDENCE: Three staff were interviewed with regards to their knowledge and understanding of the home’s complaints policy and the safeguarding adults procedures. They were not only confident about what to do but also had attended update sessions recently. The manager kept records of formal complaints, the details of the investigations, the outcomes and the action taken to prevent it happening again. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 16 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, 24 & 26 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The physical design and layout of the home enables the people to be independent. But the slow refurbishment progress is having a negative impact on the comfort of some of those people using the service. EVIDENCE: We carried out a tour of the premise, which included the communal areas, the bedrooms and the service areas. The Lady-Bower unit on the first floor and part of the Rivelin unit had been updated and looked people friendly. However, the Derwent unit was in desperate need of refurbishment. A large number of the external window frames were also rotten and in need of replacement. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 17 The stair carpets emitted a stale unpleasant smell and would benefit by replacement. We noticed several gates on the doorframes of the bedrooms of the people using the service, already covered in detail. The grounds were kept tidy, safe, attractive, allow access to sunlight and accessible to people using the service. Individual accommodation was furnished to make sure that the occupants were comfortable and able to maintain their privacy. Although all bedrooms were carpeted some needed replacement due to worn out carpets and some emitting a stale urine smell. Laundry facilities were sited away from the food preparation area. We saw that the soiled articles, clothing and infected linen from the people using the service were washed at the appropriate temperature to control infection. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 18 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 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Most of the staff working at the home are trained and skilled to do the jobs. However, the allocation of staff does not reflect the actual dependency levels of the individual clients. This is due to the changing and the challenging nature of the people using the service. EVIDENCE: The manager provided us with the staffing rota showing, which staff were on duty and staffing cover over a 24 hour period over a seven day stretch. The management informed us that the ratio of staff to people using the service was determined according to the assessed needs of the people. However, we noticed that the staff were too stretched to spend time with people using the service and they were engaged in the delivery of direct care. The layout of the building was also making it difficult for the staff to make their presence seen. We had some discussions about the staffing levels with the manager on the day. Most care staff working at Moorend Place have achieved NVQ Level 2 in care award and the others have enrolled to commence training. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 19 Four recruitment files were checked with the help of the manager. They all had the information required by the Care Homes Regulations 2002 and were therefore satisfactory. We checked four staff training files and spoke with three staff about the training they had received in the last 12 months. The staff said that they had received not only mandatory training such as moving & handling, health & safety, fire safety, food hygiene, etc but also training in dementia care, nutrition and tissue viability. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 20 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 & 38 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The management and administration show respect to those who live, work and visit the home. They work as a team to promote the health, safety and wellbeing of those who live and work at the home. EVIDENCE: A competent registered manager who is qualified and experienced manages the day-to-day operations. Two relatives, two staff and one professional made positive comments about the leadership and accessibility of the manager. We have found the manager always co-operative and willing to supply us with the regulatory information we request. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 21 The company had systems to monitor the service and there were reports to evidence this. During our conversations with the relatives they requested more meetings with the management of the home so that they could verify matters. For example when the top floor was to be refurbished. The manager said that she had an open door policy and when meetings had been held not many people turned up. A suggestion had been made for the meeting to be held at a weekend rather than weekdays. The manager and the senior staff continue to risk assess and introduce systems so promote health, safety and welfare of the people using the service and the staff working at Moorend Place. The manager kept records of all accidents, incidents and the Commission for Social Care Inspection has been kept informed of these via Regulation 37 forms. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 22 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x 2 x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP11 Regulation 12 Requirement Timescale for action 28/10/08 2. OP12 16 3. OP14 12,16 4. OP24 16,23 The staff working at the home must be trained and competent when delivering care and comfort to those who are dying. The staff must be confident that they are able to handle people’s death with dignity and have the knowledge to observe the person’s spiritual needs, rites and help their families. Daily, suitable activities must be 10/10/08 offered to people. There must be staff available to deliver the activities. Previous: 23/10/07 The excessive usage of gates on 10/10/08 bedroom doors must be stopped. Better supervision of people must be organised to take care of those who wonder into other people’s rooms. The accommodation for the 09/12/08 people on the top floor must improve so that they are able to live in comfort. Fittings and furniture on this floor need refurbishing and made to fit their purpose. Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 24 5. OP27 18 The manager must allocate appropriate number of staff to meet the needs of the people living at the home. Immediate, 30/08/07 Ongoing requirement: Some of the supporting evidence is as follows:The lack of supervision by staff of the people using the service resulting in people wondering into other people’s rooms, People not taking part in activities and sleeping or looking bored. Lack of supervision by senior staff, which resulted in staff hanging washed clothes on the bedroom doors along the corridors. 10/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Moorend Place DS0000069691.V367894.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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