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Inspection on 22/06/05 for Moorgate Residential Home

Also see our care home review for Moorgate Residential Home for more information

This inspection was carried out on 22nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Moorgate is a comfortable and clean home. The home provides a good standard of food, cooked from fresh ingredients, that Service Users said they enjoyed. Service Users said the staff are caring and responsive to their needs.

What has improved since the last inspection?

Mr and Mrs Shadrick took over Moorgate in 2004, and have started a programme of improvements in the building, including: replacing the heating system and all the windows. These improvements are much needed and will make the home a pleasanter and more comfortable place to live. A new programme of training has been set-up; this will ensure that staff have the skills to help Service Users. Recording systems have started to be improve though Mrs Shadrick confirmed that further improvements are to be made. These records help staff to understand and meet care needs, and keep people safe.

CARE HOMES FOR OLDER PEOPLE Moorgate Residential Home Bedford Bridge Horrabridge Yelverton Devon PL20 7RZ Lead Inspector Helen Tworkowski Unannounced 22 June 2005 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 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. Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Moorgate Residential Home Address Bedford Bridge Horrabridge Yelverton Devon PL20 7RZ 01822 852313 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) Shadrick Care Limited Mrs Noreen Shadrick Care Home 15 Category(ies) of Dementia (15), Dementia - over 65 years of age registration, with number (15), Old age, not falling within any other of places category (15) Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: One Service User under 65 Date of last inspection 21 March 05 Brief Description of the Service: Moorgate Care Home is a large detached property that is set in its own grounds in a rural location near the village of Horrabridge and the town of Tavistock. The property was originally built in the 1920s and was previously used as a hotel. Moorgate Residential Home accommodates 15 older people who may have dementia. Bedrooms are on the ground and first floor. The home has a passenger lift and is fitted with ramps and hand rails. One bedroom is a shared room, and the remainder are single rooms. One bedroom has en suite facilities. The Registered Providers – Mr and Mrs Shadrick, took over the home in 2004 and are in the process of upgrading and improving the facilities in the home. Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was unannounced, and took place on Wednesday 22 June 05 from 8.45 am till 1.30pm. The Inspection included a tour of the building, examination of some of the documents, discussion with staff, the registered manager and two of the Service Users. What the service does well: What has improved since the last inspection? What they could do better: Further improvements are planned at Moorgate by the new owners to bring the home up to standard for a care home. These include a new call system and other items to keep service users safe. It was of serious concern that fire doors are wedged open. The system for recruiting staff, needs improvements to ensure that the right staff are recruited to work in the home. Improvements are also required to the medication system, so that service users can be confident that they will receive their own medication as prescribed. Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 7 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 Standards Statutory Requirements Identified During the Inspection Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Service Users needs are assessed before they move to the home so that they can be assured that these will be met. EVIDENCE: Service Users who move to Moorgate are assessed by Mrs Shadrick, Registered Manager. This is in addition to assessments carried out by Social Services. These assessments provide information for staff and are used to plan how care needs will be met. Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,and 10. Service Users needs are recorded and provide sufficient information to staff that they can be assured that their needs will be met. The system of management and recording of medication is not reliable, and could potentially place service users at risk. EVIDENCE: Each Service User has a plan which describes how needs will be met. These plans help ensure that staff know what they are doing and that needs are fully and consistently met. There are risk assessments, which help ensure that Service Users are kept safe. Mrs Shadrick, the registered manager, confirmed that the system is to be reviewed and improved. A blister pack system for medication is used in the home. This system has the advantage that it is checked by a pharmacist. Staff in the home do not dispense medication from the blister packs, but into small pots, the medication is then administered. This process known as secondary dispensing, must be reviewed. Service Users do not have their own bottles of lactulose but are Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 10 administered doses from a bottle deemed a communal bottle. Service Users must only ever be administered their own medication. The record of medication administered had gaps where medication had been omitted or not signed for, or given at the wrong time. Poor recording of medication administered could place Service Users at risk. Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 Service Users enjoy a good standard of meals that are freshly prepared in the home. Service Users are given opportunities to make choices about how they spend time, although some service users felt that there was little choice about what time they got up. EVIDENCE: Service Users spoken with said that they were no specific rules about what they had to do or not do at Moorgate. Two service users felt that they were not offered the opportunity to have a lie in, if they wanted to. The manager could see no reason why this was the case and will be reviewing the situation . Service Users said that the food was very good, and that the there was plenty to eat and drink. There is rolling menu that includes “traditional” meals such as cottage pie, beef stew and dumplings and bubble and squeak. All the ingredients used are fresh, and service users are offered fresh fruit. Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected at this unannounced inspection. EVIDENCE: Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 and 26 The house is clean, comfortable and in satisfactory order, and there are plans make improvements in the home however there are concerns regarding safety in the home. EVIDENCE: The house is clean, comfortable and most areas were well decorated. There fresh flowers in the communal room, which Service Users said they appreciated. Many of the Service Users have brought their own furniture and bedrooms reflected individual tastes. One bedroom had a hook and eye fitted to the outside of the door, though no one in the home knew why this had been fitted. It could potentially be used to confine a service user to their room, and must be removed. Further concerns were that fire doors were wedged open. Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The home has sufficient staff to care for service users however improvements need to be made to the recruitment system to ensure that service users are in safe hands. EVIDENCE: The files of people recently recruited to the home showed that not all of the checks required had been completed, before the staff started work. There was no system of induction in place thought Mrs Shadrick had started to develop plans for training in the home. Service Users confirmed that there were sufficient staff to help care for them, and if they rang the bell to call for assistance then they only had to wait a short time. Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Service Users health and safety is not fully protected. EVIDENCE: Previous inspections have identified that risk assessments must be developed and implemented. Mrs Shadrick said that work had started though was not complete on these risk assessments. Risk assessments help protect service users by identifying risks and identifying how these will be managed and mitigated. Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 16 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 1 x x x x 1 2 2 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 1 Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 17 Yes 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 OP24 Regulation 12 Requirement Timescale for action 30/7/05 2. OP25 12 3. OP26 12 4. OP26 12 5. OP38 12 Bedroom doors must be fitted with locks that can be overridden in the event of an emergency. (This requirement was made at the last inspection with a timescale of 30/7/05). Design solutions must be in 30/8/05 place to control the risks from hot surfaces including pipe work on the upper landing. (This requirement was made at the last inspection with a timescale of 30/8/05) Design solutions must be in 30/8/05 place to control the risks from hot water. (This requirement was made at the last inspection with a timescale of 30/8/05). The laundry walls must be 1/7/05 repaired to ensure that they are able to be easily and thoroughly cleaned if the building of the new laundry room is significantly delayed. (This requirement was made at the last inspection with a timescal of 1/7/05). Design solutions must be in 31/8/05 place to control the risk of Legionella. (This requirement was made at the last inspection with a timescale of 31/8/05). D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Moorgate Residential Home Page 18 6. OP38 12 7. 8. 9. 13,23 13,23 13 OP19, OP38 OP19, OP24 OP10 10. 11. 13 13 OP10 OP10 12. 12 OP12 13. 14. 18 19 OP29 OP29 The registered individual must ensure that risk assessments are carried out for all safe working practice topics, and that significant findings of the risk assessments are recorded.(This requirement was made at the last inspection and has not been met). Immediate Requirement: Fire Doors must not be wedged open Immediate Requirement: The hook and eye on a bedroom door must be removed. The Registered Manager must review the system for dispensing medication so that the system of potting up or double dispesing is minimized. Service Users must only be administered their own medication. All medication administerd must be recoreded and if not adminsitered then a reason given. The Registered Manager must carry out a review to ensure that Service Users must be given choice about the time they get up. All new staff must receive induction and foundation training. The Registered Manager must ensure that 2 written references on staff are received before starting work in the home. 30/8/05 22/6/05 22/6/05 30/8/05 30/7/05 30/7/05 30/8/05 30/8/05 30/7/05 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 D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 19 Moorgate Residential Home 1. Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 20 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI Moorgate Residential Home D54-D07 S62402 Moorgate V221564 110505 Stage 4.doc Version 1.20 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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