Inspection on 16/01/08 for Moorfield House Nursing Home

This inspection was carried out on 16th January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Moorfield House Nursing Home 09/01/09

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Snydale Care Home

Hawkhills

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Beeches The - North Yorkshire County Council

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Ravensworth Lodge

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Moorfield House Nursing Home Fieldhouse Walk Off Stonegate Road Leeds Yorkshire LS17 6HW Lead Inspector Sean Cassidy Key Unannounced Inspection 16th January 2008 08:30 X10029.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 Moorfield House Nursing Home DS0000070322.V357351.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 and 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. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moorfield House Nursing Home Address Fieldhouse Walk Off Stonegate Road Leeds Yorkshire LS17 6HW 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) Care Concern (Leeds) Limited 0113 268 0528 moorfieldhouse@hotmail.co.uk Mrs Karen Lesley Price Care Home 57 Category(ies) of Dementia (5), Old age, not falling within any registration, with number other category (42), Physical disability (15) of places Moorfield House Nursing Home DS0000070322.V357351.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 categories: Dementia - Code DE, Physical disability - Code PD, Old age, not falling within any other category Code OP. The maximum number of service users who can be accommodated is: 42 New Service 2. Date of last inspection Brief Description of the Service: Moorfield House is a converted Grade 2 listed building located in a residential area north of Leeds City Centre. The home is located close to local amenities and public transport routes. There is ample parking to the front of the home for visitors. The home is registered to care for fifty-seven service users, 42 older people and 15 younger adults with physical disabilities. The older service users occupy Moorfield House and the younger people Fieldhouse Lodge, a purpose-built extension to the main house. Moorfield House provides accommodation on three floors with a passenger lift connecting each level. There are single and double rooms and some of these have ensuite facilities. There are sufficient bathrooms and toilet facilities throughout the building to meet the needs of all the service users. Two communal lounges, a dining room and an activity room are available for the service users. In Fieldhouse Lodge there are fifteen single bedrooms, 6 of these having ensuite facilities. There are two communal bathrooms and communal toilets on the first floor. On the ground floor, there is a lounge for the use of the service users. A passenger lift connects the two floors. A central kitchen and laundry serves both Moorfield House and Fieldhouse Lodge. At the time of the inspection the fees charged by the home ranged from £485 £1300. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence in this report has included: • • A review of the information held on the home’s file since the last inspection. Information obtained from residents, relatives, staff and other health care professionals. An unannounced visit to the home was conducted by one inspector and lasted two days. The majority of this time was spent speaking to residents, management, staff and relatives. The visit included a tour of the premises. A number of documents were examined which included care files, training files, and health and safety details. The information required from the provider in the form of the Annual Quality Assurance Assessment was provided prior to the inspection and information from this is also included in the report. What the service does well: What has improved since the last inspection? This is the first inspection at the service. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 6 What they could do better: All people entering the home must be provided with a Service User Guide, which provides a clear breakdown of the fees and how they are to be paid. This will help ensure that the person, or their representative, is aware of the agreement they are committing to. The Statement of Purpose and Service User Guide should also be altered so that people are provided with a clear picture of the care provided in the home. All people receiving care in the home must be provided with care plans that outline the care that is to be provided. These must have evidence that the individual or their representative has been involved with the process. This will help ensure care needs are met. People living in the home must be assessed to self-administer their own medications if they so wish. This will help to promote and maintain independence. If a person wishes the home to administer their medication then consent must be obtained. This will ensure that the home is complying with Royal Pharmaceutical Guidelines. The individual privacy and dignity of people living in the home must be promoted and maintained at all times. The report contains several examples where this was compromised. All people living in the home must be provided with a structured activities’ programme that meets their assessed needs. Evidence must be in place to show involvement with this process has taken place. This again will help to provide people a sense of wellbeing. People must be provided with suitable facilities that enable them to prepare snacks and drinks. This will promote independence in an individual. People must be provided with food that meets their personal expectations and cultural needs. This will help promote wellbeing. The safeguarding procedure must be implemented and followed correctly when the need arises. This will help reduce the risk of abuse occurring. The home must be adapted to ensure it meets the physical/psychological needs of the people that live there. This will help to improve people’s independence and quality of life. Certain areas of the home are in need of complete refurbishment. This again will help improve the wellbeing of the people that live there. The manager must ensure that there is an established quality assurance system in place that maintains and improves the standard of care provided in the home. This will help provide all stakeholders with confidence in the home. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 7 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. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. YA2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service experience good quality outcomes in this area. People are fully assessed before they are admitted. The information provided to prospective residents does not ensure they are fully informed of the care service provided within the home. We have made this judgment using a range of evidence, including a visit to the service. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 10 EVIDENCE: The manager said each resident is provided with the Statement of Purpose (SOP) and Service User Guide (SUG) when they move into the home. This was evidenced during the inspection. A resident admitted for respite care during the inspection was provided with these documents on admission. Although the home is a single registration, the manager has developed two SOPs and SUGs. One informs the reader of the service provided to Older People and the other about the service to Younger Adults. This does not provide the prospective reader about the whole home and the care provided within it. The reader, therefore, is not fully informed. The home is registered to provide nursing care to five people who have dementia but the vast majority of those over 65 have major dementia care needs. This is not reflected in the SOP. One recent admission said that he was not aware of the large number of people with dementia in the home and it was difficult for him to talk to people who understood him. The SUG does not provide the resident with a complete breakdown of the financial element of the care and who is responsible for payment. This means people are not fully informed. The care files of the most recent admissions contained evidence to show all had been assessed prior to moving into the home. The manager said that all prospective residents are able to visit the home before they move in. Two residents spoken to said they were able to look around the home but did not take the opportunity to stay the night. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9 and 10. YA 6,9,16,18,19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service experience adequate quality outcomes in this area. The health and personal care needs of people living in the home are not consistently met. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 12 We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The care files of four residents were case tracked during the inspection. Two belonged to older people and the other two were from the younger adults unit. These documents contained evidence to show each person has their needs assessed and risk assessments are carried out in areas such as nutrition, falls and pressure areas. Evidence was seen to show these were reviewed regularly. The evidence to show people were involved with development of these documents was inconsistent. Signatures of consent were not seen in all files. Evidence was seen to show people are referred to other professionals such as GPs, falls clinics and tissue viability nurses. The home is now working closely with a community-nursing matron who supports them with ensuring appropriate referrals are made to the multi-disciplinary team when needed. This is good practice. Other professionals contacted as part of the inspection stated in the questionnaires that they were generally satisfied with the care they observed whilst in the homes. One professional highlighted some concerns about standards of communication between staff and residents and also with privacy and dignity issues. The care plans of four individuals were case tracked. These showed evidence that care plans are not consistently developed to ensure the care needs of the resident will be met. Quite a number of care needs identified did not have a care plan in place to help staff meet those needs. This is not good practice. The care plans are not person centred and do not present a thorough picture of who each individual is and what their care needs are. The care plans did not consistently show evidence that people or their representatives were involved with their development. The majority of people living at this home have issues regarding their mental capacity to fully understand what is being provided to them and it is, therefore, important that they are represented when the care plans are written. This shows that there is an absence of involvement of the residents in their care. This was evidenced in both sections of the home. The carers were observed providing the care to the residents over the course of two days. People were treated with respect and their dignity was maintained. Those people who could provide feedback said that the majority of carers were very good but there were some that could be better. These comments were passed on to the manager. During the course of the inspection, there were a number of concerns identified regarding people’s privacy and dignity being compromised. People spoken to Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 13 provided some instances that made them feel uncomfortable. Examples of these are: • • • Two people identified as having strong religious beliefs were not supported to maintain these within the home. A person’s bedroom had two commode chairs in it but she did not have any continence problems. One person said that, on two occasions when he was receiving intimate personal care, staff were called away to do other things and had to leave him for a period of time, which he felt was not acceptable. This is poor practice. Some people spoken to said that they would like to be able to talk to more people who could converse with them. They said that they did not know that the home had so many people with dementia when they moved in. A member of staff helping a resident with her meal was seen to use the tablecloth to wipe the persons hands after she had finished. This is poor practice. People said that they were allocated bath/shower days. They said they didn’t always receive a bath or a shower on these days either. People should be able to choose when they want to bathe. Some residents’ personal care needs were not properly addressed. Some appeared unkempt due to hairstyles being very messy. People who needed chiropody involvement had not received it. Some people who would like keys to their rooms do not have them. The weights of residents and their bath times were displayed on the notice board. This is poor practice. • • • • • • These issues were presented to the manager and deputy manager who gave full assurances that they would be addressed as a matter of urgency. The records for administering medications were reviewed and these were well filled in. Controlled drugs are also held on the premises and these were also stored correctly. There were issues identified with regards to the home’s process of assessing people to self medicate their medications. There were people spoken to who wished to get involved with their own medication but had not been enabled to. Comments made were, “I haven’t been asked if I would like to look after my own medications.” “Yes, I would like to do that for myself if I am able to.” The care files contained no risk assessments to show Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 14 all are assessed to self medicate at the point of admission. This was discussed with the manager who recognised this shortfall and gave assurance that it would be reviewed so that self-administration was promoted at all times. It was also pointed that if the care home is to administer a person’s medication then they must obtain their consent to do this. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Op 12,13,14 and 15. YA 12,13,15 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service experience adequate quality outcomes in this area. The social and cultural needs of the people living in the home are not consistently met. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 16 We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: Each care file contains a social care plan which has been devised by the activities’ coordinator. There are two activity coordinators and they job share the role. They split their time on the different units. The coordinator working during the inspection said that she usually did half a day on each unit. However, she is also involved with the role as carer and helps with breakfasts and personal care up until about 10 o’clock in the morning. She was involved with a game of bingo with residents in the Moorefield House unit, which was well attended. She has been working quite hard to try and access more activities and outings for the residents living in the home, which is good. Examples of activities are Halloween party, trips out for fish and chips, garden party during the summer and a 1940’s elderly person day. The coordinator said they try to get four people out every two weeks. People spoken to said they really enjoyed the entertainment that was brought into the home. The home does not have its own transport available and rely on a local minibus service which, unfortunately, sometimes lets them down at the last minute. The units do have notices that are displayed that tell people what is planned for the week but it was found that these were not adhered to for differing reasons. These notices were also displayed at heights that were not suitable for people in wheelchairs or with bad eyesight and therefore disadvantage people with a disability. This was the case with the majority of information and notices displayed around the home. The home has recently developed a ‘snoozellan’ room in the activities’ room in the basement. This looks like an excellent development for those residents with dementia living in the care home. The staff said that people do use it but there was no evidence available to see how well it was used. It was recommended that a diary be kept in the room to provide evidence that it is being used. Although the activities’ coordinator has received training and is trying hard to meet the activity and social needs of the residents, there are large gaps in need that are not being filled. The activities provided to those residents with specialist dementia needs must be more structured than they are. More evidence is needed to show that they actively attempt to meet these needs. There are a number of residents that are unable to leave their rooms for various reasons. The daily records show very little evidence of how they have Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 17 spent their day. There are contact sheets in place for those that need regular turning and assistance with eating and drinking. These were consistently filled in. People living in the younger adult units said that they do get some opportunities to leave the home and get involved in activities. However, they felt that a lot more could be done to improve their quality of life within the home. Some comments made were, “We are not provided with activities that are focussed to our needs.” “ I should be able to get out of here more but I can’t. There isn’t enough staff.” “The activities could be revamped. I don’t even know what’s supposed to happen half the time.” “They are going out for fish and chips tomorrow and I didn’t know about it.” The relative of one resident said, “I try to come once a week. Tony does the same thing every time I am here and that’s sit in his chair doing nothing. I think he is depressed.” The notes of this person were reviewed and there was no evidence seen to show what he had done each day to prove otherwise. People said they were happy with the visiting times that were in place and that they were unrestricted. Two professionals said that they sometimes found it difficult to make contact with the home as the number was either engaged or put onto messaging. The inspection team, when trying to contact the home, has also experienced this. The manager said that they have only one line in and they would look to remedy this as soon as possible. One person’s care needs are no longer the same as when she came into the home. Her care plan does not reflect what she is able to do for herself. More evidence is needed by the home to show action has been taken to provide her with assistance to enable her to meet some life goals if possible. It was also recommended that this person be reassessed as she is no longer a ‘young disabled person’. The manager said that she would refer the person to a social worker to work with the person. The mealtimes were observed in both units. People in the dining room were supported with eating their meals. A member of staff sat with each individual and helped. The interaction between the staff and the people needing assistance was good. There were some issues identified with meals and food that were passed on to the manager to ensure action could be taken to improve. One resident was left in the lounge to manage on her own when it was apparent that she needed assistance. A member of staff said that this person was able to eat independently. The care plans for that person were examined and they did not say whether this was the case. She was eating her dinner with her fingers, which was not appropriate to do so as it was not buffet food, the result being that she got food on her clothes, fingers and face. The nurse did say that there was a person floating in the lounges to assist. Her needs were not met. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 18 The mealtime was not a very social experience. The dining tables were bare and lacked condiments and other appeal. People were moved very quickly out of the dining room after their meals. On lady was moved when she still had a drink in her hand, which startled her. The room was cold and in need of redecoration. The carpet in the dining room was very dirty and in need of replacement. The manager confirmed that action had already been taken to replace the carpet. People in the younger adult unit were unhappy about the standard of the food. “The food is often cold when we get it.” “The food leaves a lot to be desired!” This was evidenced when staff were observed heating food up in a microwave in the lounge. This is dangerous practice. People said they were not involved with the menu development within the home. They only knew what was on the menu when they were asked what they wanted that day. One gentleman has been having an ongoing problem about the home being able to meet his cultural food needs. Another person who had specific cultural food needs did not have these explored by staff in the home. This is not good practice. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16 and 18. YA 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service experience adequate quality outcomes in this area. People living in the home are generally well protected but there were concerns about how some complaints and safeguarding issues were not properly investigated. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The home does have a safeguarding policy and procedure that helps the manager identify any possible abuse that occurs. This has recently been put into practice and the policy has been adhered to. This has been the only safeguarding issue recorded by the CSCI since the home has been registered in August 2007. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 20 Staff spoken to provided a good account of what signs they are looking for in order to identify possible abuse. They were aware of the procedure to follow if the need arose. Residents in the Older People’s unit that were able to give feedback at the inspection said that they were generally pleased with the way that they are treated by the staff and others and that they had a good relationship with them. Two safeguarding issues were identified on the Younger Adults unit that were passed to the manager to investigate through their internal safeguarding procedures. One resident said that he had already spoken to the manager about this and that she had said that she would look into it but he has heard nothing. This was discussed with the manager. These issues were followed up after the inspection and further advice was provided, which the manager acted upon quickly. The complaints procedure is displayed around the home at various points. People spoken to said they were able to make a complaint and felt that they could approach the manager or the deputy manager at any time to make a complaint known. Two people in the younger adults unit said they have complained about some issues but they have not heard a response to them as yet. The complaints records were seen and two complaints have been made since the home was registered. These were correctly investigated following the internal procedure. However, the complaints made by the people previously mentioned were not seen. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19 and 26. YA 24 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service experience adequate quality outcomes in this area. Not all people living in this home are provided with an environment that is suitable for their needs. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 22 We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The environment of the home was inspected over the course of the inspection. A full environmental inspection was not carried out but random areas were inspected. The bedrooms seen were well decorated and pleasantly furnished. Those people in the older people’s unit that could give feedback said that they were happy with their rooms but the overall environment was ‘tired looking’. One person said, “It is a lovely building. It just needs a good lick of paint and nice furniture.” One wheelchair user had been moved out of his spacious double room and into a smaller room that was very restrictive for him. He said, “I am not as independent as I was because I can’t wash myself due to the restrictive space in my en suite toilet.” This was poor practice and restricted that individual’s choice. This was discussed with the manager who gave assurances that this person would be moved to a bigger room that would promote independence The Younger Adult unit is in need of a complete refurbishment. This unit is very drab and dreary in appearance. The hallway next to the lounge/dining room is very dull as is the paintwork and carpets. The lounge/dining room has been recently refurbished and the people who live there were involved with the process. The furnishings in this room are in need of replacement, as they do not give the home a homely feel. Three people spoken to said they would like to see the place refurbished. The lounge room is also used as a dining room. It is acknowledged that the home is restricted with regards to space, however, at meal times, there is no sociability about the occasion. There are no dining tables set out for people to sit at. One person asked, “Why are we not able to have dining facilities?” There was no evidence seen to show that home has been assessed to identify and provide any specialist equipment to assist people with a disability. Examples of comments from people spoken to were, “You could put anyone in this room without a disability and they would live here with no problems. I have problems because it has not been adapted for me.” “There are a lot of things I am not able to do because I cannot access stuff.” “I can’t make a drink in the lounge because the area has not been specially adopted for me to do this.” This is not good practice. The manager agreed that it was essential to get someone in to assess the home so that they could make it more adaptable for people with a disability. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 23 The home is very clean and tidy. Six people spoken to gave positive comments about this area of the home. The domestic staff were observed going about their duties. The person responsible for the laundry on the day of the inspection showed a sound knowledge of infection control and how to minimise the risk of infection in relation to laundry. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29 and 30. YA 32,34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service experience good quality outcomes in this area. People receive their care package from a staff group that are appropriately recruited and trained. We have made this judgment using a range of evidence, including a visit to the service. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 25 EVIDENCE: The staffing levels observed in the older people unit suggested that there were sufficient numbers on duty to meet people’s needs. Staff spoken to said that they were happy with the numbers that were normally on duty. They said that they usually used internal bank staff to fill shifts that were vacant. The questionnaires received as part of the inspection supported the above and confirmed that there was sufficient staff on duty. The manager has now developed a training programme that sets out the training available for the coming year. Staff said that they were given regular supervision and that these meetings helped identify what training they would like to go on. A significant number of carers have recently undergone dementia awareness training with a local college. Those staff spoken to were able to show a good awareness of the needs of people with dementia. The recruitment files of the two most recent employees were inspected and these showed that the correct procedure was adopted and that all the necessary information needed before an employee could start work was obtained. The records also showed that there is a structured induction process in place in the home. A conversation with a new member of staff confirmed that she had been put through this process and she found it quite helpful. Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31,33, 35 and 38. YA 37,39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service experience adequate quality outcomes in this Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 27 area. The manager is adapting to her new responsibility of having overall control of all management systems and processes relating to the home. There is still work needed to ensure these systems improve the quality of care provided within the home. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The home has recently been taken over by new owners. Although the management structure remains the same, the roles of the registered manager and the deputy manager have changed quite significantly. The manager is now responsible for areas of the home that were not part of her role under the last owners. This new challenge is one that she has taken on with confidence. Both herself and her deputy manager have had to use their time to prioritise certain work. They recognise the concerns that have been highlighted in this report and they are already developing their action plan to ensure these concerns are appropriately dealt with. They have given firm assurances that improvement will be made. Residents and staff were very positive in their feedback about the management support within the home. They said they were helpful and approachable. The home does have a some quality tools in place and there are regular Regulation 26 visits carried out by the Responsible Individual for the home. Discussions were held with the manager about quality assurance and what that process involves. Although the manager had some evidence that residents and relatives were asked for their views on the home, there was no evidence to show that there is a an annual development plan that continually self monitors the service and makes these findings known to all stakeholders. The absence of a structured quality assurance system means stakeholders are not provided with sufficient evidence that backs up the home’s commitment to high quality care. People in the Younger Adults unit said that they were not aware of any quality methods used to maintain and improve the quality of their care. They said that they had not had any meetings in the home since July 2007 to discuss their views on the standard of care and service in the home. One relative spoken to said that she did not recollect being invited to any joint resident/relative meetings. The absence of these meetings prevents people having the ability to have their say about the day-to-day running of the home. The manager has acknowledged this and gave full assurance that meetings would be planned in the very near future. Contact made with the manager after the inspection Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 28 confirmed that this had already been instigated and that a resident had been identified as a lead spokesperson. This is good practice. The information contained within the Annual Quality Assurance Assessment (AQAA) showed that the residents’ monies are dealt with in the correct manner. The manager at the inspection also confirmed this. Information contained within the AQAA provided evidence to show that the home carries out the necessary health and safety checks to ensure people are properly protected. There were workmen in the home during the inspection. They left a manhole cover open and a member of staff fell down it. The manager on duty dealt this with correctly and a report was sent to the appropriate agencies. Discussions were held with the manager about ensuring the environment of the home is assessed from a health and safety perspective. She agreed that they would identify and train a person in the areas of health and safety and risk assessment. This would help to ensure risks to all those entering the home could be reduced. Moorfield House Nursing Home DS0000070322.V357351.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 2 x 3 3 4 x 5 x 6 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 ENVIRONMENT Standard No Score 19 2 20 x 21 x 22 x 23 x 24 x 25 x 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 x 33 2 34 x 35 3 36 x 37 x 38 2 Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 30 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 OP1 YA1 Regulation 5(1) Requirement All people entering the home must be provided with a Service User Guide, which provides a clear breakdown of the fees and how they are to be paid. This will ensure that the person or their representative is aware of the agreement they are committing to. All people receiving care in the home must be provided with care plans that outline the care that must be provided. These must have evidence that the individual or their representative has been involved with the process. This will ensure care needs are met. The individual privacy and dignity of people living in the home must be promoted and maintained at all times. The report contains several examples where this was compromised. All people living in the home must be provided with a structured activities’ programme that meets their assessed needs. Evidence must be in place to show involvement with this DS0000070322.V357351.R01.S.doc Timescale for action 31/03/08 2 OP7 YA6 15(1) 30/04/08 3 OP10 12(4)(a) 31/03/08 4 OP12 YA12 16(2)(m) 30/04/08 Moorfield House Nursing Home Version 5.2 Page 31 5 OP15 YA17 16(2)(h) 6 OP15 16(2)(i) 7 OP18 YA23 13(6) 8 YA24 OP19 23(2)(n) 9 OP33 23(1) process has taken place. This again will help to provide people a sense of wellbeing. People must be provided with suitable facilities that enable them to prepare snacks and drinks. This will promote independence in an individual. People must be provided with food that meets their personal expectations and cultural needs. This will promote wellbeing. The safeguarding procedure must be implemented and followed correctly when the need arises. This will reduce the risk of abuse occurring. The home must be adapted to ensure it meets the physical/psychological needs of the people that live there. This will help to improve people’s independence and quality of life. Certain areas of the home are in need of complete refurbishment. This again will improve the wellbeing of the people that live there. The manager must ensure that there is an established quality assurance system in place that maintains and improves the standard of care provided in the home. This will provide all stakeholders with confidence in the home. 30/05/08 31/03/08 29/02/08 31/05/08 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations It is recommended that the Statement of Purpose and the DS0000070322.V357351.R01.S.doc Version 5.2 Page 32 Moorfield House Nursing Home 2 3 OP7 OP9 Service User Guide be altered to ensure the person wishing to live in the home and their representative have an up to date picture of the services provided within the home. The care plans used in the home should incorporate a more person centred care approach. This will enable carers to care for the individual holistically. People living in the home should be assessed to selfadminister their own medications if they so wish. This will help promote and maintain independence. If a person wishes the home to administer their medication then consent should be obtained. This will ensure that the home is complying with Royal Pharmaceutical guidelines. The home should ensure that there are suitable telephone systems in place that allow relatives and professionals to make contact at all times. People should be provided with dining facilities that make the occasion a more sociable event. The lounge area in the young disabled unit should be better adapted to make the dining facilities better for those that use them. 4 5 OP13 OP15 Moorfield House Nursing Home DS0000070322.V357351.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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. 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