Inspection on 03/11/05 for Moorhaven

This inspection was carried out on 3rd November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Moorhaven 12/11/08

Moorhaven 14/11/06

Moorhaven 28/07/05

Moorhaven 30/09/04

Moorhaven 20/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Moorhaven Normandy Drive Taunton Somerset TA1 2JT Lead Inspector Victoria Stewart Announced Inspection 3rd November 2005 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 Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 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. Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Moorhaven Address Normandy Drive Taunton Somerset TA1 2JT 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) 01823 331524 01823 323529 Somerset Care Limited Diane Allen Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named person under the age of 65 years. Date of last inspection 28th July 2005 Brief Description of the Service: Moorhaven is a care home owned by Somerset Care Limited and is situated in a convenient residential area in Taunton, Somerset. The home is within walking distance of local amenities and not far from the town centre. It is registered to provide personal care for up to 50 residents over the age of 65 years. It is a purpose built unit on one level, apart from four rooms on the first floor for which there is a passenger lift for access. Moorhaven is well adapted for its purpose allowing easy access to all areas for wheelchair users. Private rooms are grouped together in several small units in the home. At the time of inspection the home was in the process of having a further 3 rooms registered for resident use with the Commission for Social Care Inspection. Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second announced inspection of the current inspection year. The inspection took place over 5 hours and was undertaken by two inspectors. Both inspectors were new to Moorhaven and therefore a considerable length of time was taken talking and getting to know both the residents and staff. A complete tour of the premises was also carried out and an inspection visit of the 3 new bedrooms recently completed. The previous inspection was carried out on 28 July 2005 when most of the national minimum standards were inspected, together with a large selection of others. Both of these reports should therefore be used in conjunction with each to give a full picture of Moorhaven. What the service does well: What has improved since the last inspection? What they could do better: Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 Page 6 Staff files do not contain all the information required in the national minimum standard. This issue was highlighted in the last inspection, been carried forward from this inspection and the home must now resolve it in order to protect residents who live at Moorhaven. Staffing levels need to be continually monitored and reviewed taking into account resident numbers and dependency levels. These levels must be kept at the level agreed with the CSCI. 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. Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 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 the following standard(s): 1,2,3,4 and 5 not assessed as fully met the standard at the last inspection 6 does not apply to the home EVIDENCE: Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 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 the following standard(s): 7,8,10 not assessed as fully met the standard at the last inspection 9 partially met the standard at the last inspection and was reassessed The systems for the administration of medication are good with clear and comprehensive arrangements in place to ensure residents’ medication needs are met. EVIDENCE: The receipt, recording, administration, storage and disposal of medication were looked at. These were found to be very well monitored, with records well maintained. Residents who self medicate have a risk assessment and disclaimer completed. Boots regularly visit the home and training is carried out on a yearly update basis. Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 12,13,14,15 not assessed as fully met the standard at the last inspection EVIDENCE: The cook has recently left the home and an employee on a temporary basis has filled this position. Some residents told the inspector that the food was not as good as it used to be and this was discussed on the day. Menus are currently in the process of being redesigned and will provide varied and well balanced meal, which have been overseen by a suitably qualified professional. Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 16,17,18 not assessed as fully met the standard at the last inspection EVIDENCE: Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 19,20,21,22,23,24,25,26 not assessed as fully met the standard at the last inspection EVIDENCE: The home was clean on the day of inspection, with one slight odour noticeable in one of the small units. Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,30 not assessed as fully met the standard at the last inspection 28 exceeded the standard at the last inspection 29 partially met the standard at the last inspection and was reassessed Since the last inspection the staff recruitment procedure has improved, but not all appropriate checks are still being carried out which potentially leaves residents at risk The home must continually monitor the dependency levels of all residents and staff the home accordingly EVIDENCE: Five staff files were looked at. These generally contained all the information required to be held for employees. However, one file contained one written reference and one verbal telephone reference. One file did not contain any information regarding interview details. The home’s atmosphere was relaxed and welcoming on the day of inspection and many employees told the inspector they enjoyed working at the home. A common answer given by residents to the inspector was “they are all very nice here”. The home has a core staff that have worked at the home for many years. The home employs care support workers who have a dual role in providing care and performing domestic duties. The home was staffed as per the rota on the day of inspection with a clear line of organisational structure. However, during the inspection one resident complained that staffing levels had been very low on a couple of occasions and Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 Page 14 gave two examples. This was discussed with a staff member who confirmed that this might have occurred. This was then followed up with the manager and deputy manager. Both said they were unaware of any drop in staffing levels and stated that there was no reason why the home should ever be short of staff and that they were both contactable in any event to organise cover. Also during the inspection, one of the inspectors had to inform staff of three events when resident’s required help with personal care. The home has the use of the Somerset Care Bank Staff Scheme for use when needed. Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 not assessed as fully met the standard at the last Inspection 34 The home maintains good finance and accounting procedures EVIDENCE: A customer property and finance letter goes to all new staff as part of their induction pack which details staff involvement with wills, bequests, legal documents and gifts/presents. This is then held on staff files. Financial records were looked at and were satisfactory, with the appropriate paperwork, signatures and receipts maintained. Four resident’s monies were checked and these correlated with records kept. Senior staff only have access to these. The home has the correct insurance liability on display. Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 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. 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 X X X X Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 Page 17 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 OP29 Regulation 19 (2) Sch 2 1-7 Requirement The home must hold all the information required on each staff file, including two written references and records of interview details completed. The home must ensure that it is adequately staffed at all times and that the staffing levels reflect the dependency of individual residents. Timescale for action 03/02/06 2 OP27 18 (1) a 03/01/06 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 Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Moorhaven DS0000016063.V258272.R01.S.doc Version 5.0 Page 19 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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