Inspection on 29/08/07 for The Moorings

This inspection was carried out on 29th August 2007.

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 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

The Moorings 18/08/09

The Moorings 05/06/06

The Moorings 11/10/05

The Moorings 04/05/05

The Moorings 24/11/04

The Moorings 20/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Moorings, The Egypt Hill Cowes Isle Of Wight PO31 8BP Lead Inspector Janet Ktomi Key Unannounced Inspection 29th August 2007 09:45 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 Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moorings, The Address Egypt Hill Cowes Isle Of Wight PO31 8BP 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) 01983 297129 01983 293386 Mrs Janet Holmes Miss Dawn Amanda Richards Care Home 25 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (3) Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th June 2006 Brief Description of the Service: The Moorings is an attractive period house set in its own grounds and close to Cowes sea front, with good views of the Solent from some of the first floor windows. The home is registered to admit up to 25 older people including 3 people with a physical disability and 2 people with dementia. The accommodation is arranged over three floors with the sitting and dining rooms on the first floor. There is a passenger lift between the floors and one part of the building that requires access via a short flight of steps; these five bedrooms would not be suitable for anyone who is not fully mobile. There is a large conservatory on the ground floor that provides an additional sitting room for residents to enjoy a view of the garden and Egypt Hill. The home is owned by Mrs Janet Holmes and managed by registered manager Miss Dawn Amanda Richards. Weekly fees range between £369.25 to £500.00 depending on assessed needs and room occupied. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 29th August 2007. All core standards and a number of additional standards were assessed. The inspector would like to thank the people who live at the home, the manager and staff for their full assistance and co-operation with the unannounced visit. The visit to the home was undertaken by one inspector and lasted approximately six hours commencing at 09.45 am and being completed at 4 p.m. The inspector was able to spend time with the registered manager and care staff on duty and was provided with free access to all areas of the home, documentation requested, visitors and people who live at the home. Prior to the visit the manager completed an annual quality assurance questionnaire, information from which is included in this report. Comment cards were returned from one GP and one district nurse. The inspector met with a visiting health professional during her visit to the home. Comment cards were sent to the home for distribution to people who live at the home and their relatives/visitors. Ten comment cards were received from people who live at the home and seven relative response were received. Information was also gained from the link inspector and the home’s file containing notifications of incidents in the home. During the visit to the home the inspector was able to meet with and talk to most of the people who live at the home and one visitor. What the service does well: The home has a very high number of care staff with an NVQ in care at level two and many with a level 3 qualification. Once the three staff who are currently completing this qualification have achieved it only one member of care staff (recently recruited) will not have an NVQ. Comment cards from relatives, professionals and people who live at the home were all positive about care staff. One relative commented ‘they treat everyone with care, respect and a great deal of patience. Nothing is too much trouble for them. Everyone is treated like a much loved member of a big family’. Another saying ‘a lot of patience and caring towards the residents’. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 6 Professional sources stated that staff are knowledgeable about the people who live at the home and felt that the care delivered is good. Many comment cards returned by people who live at the home or their relatives were positive about the manager who they stated was approachable and would resolve any concerns. During the inspection the manager demonstrated that she was open and aware of issues and how these should be addressed. What has improved since the last inspection? What they could do better: There were no requirements or recommendations made following this inspection. An issue in respect of medication was immediately addressed by the manager and the home had already identified the need to replace divan bed bases and parts of the kitchen. Moorings, The DS0000012512.V342826.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. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All people are assessed prior to moving into the home to determine that their individual needs can be fully met. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable, as the home does not provide intermediate care. EVIDENCE: The registered manager explained the homes admission procedure and three pre-admission assessments were viewed. The registered manager or her deputy undertake pre-admission assessments on all prospective people. The home has an assessment tool that covers all the relevant areas necessary for the home to decide if it is able to meet a prospective persons needs. The manager was clear about the level of care needs the home can accommodate and consideration would be given as to the available room when completing an Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 10 assessment as a few bedrooms can only be accessed via a short flight of stairs. The home has a high occupancy rate and the manager stated that there is no pressure to admit people whose needs they cannot meet. The inspector was able to speak with the most recent person admitted to the home who confirmed that her son had visited the home. The manager stated that ideally the person would visit the home prior to deciding to move in however when this was not practicable relatives or representatives are invited to visit the home and view the available room. Ten comment cards were received from people who live at the home. These all stated that they had received a contract and that they (or in many cases) their family had received enough information about the home before they moved in. Statements including ‘my daughter came in and dealt with it – but I’m very satisfied’, ‘my family and neighbour sorted it out’ and ‘I have been here before so I knew what it was like’. The service users guide was also viewed during the inspection visit, a copy being available in the entrance hall. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are set out in an individual plan of care. Medication is appropriately stored and records fully maintained. People are treated with respect. EVIDENCE: Following the previous inspection undertaken in June 2006 a requirement was made that the manager must attempt to standardise the care planning process. The inspector viewed three care plans for new and existing people. Care plans are individual and relevant to the needs of people. All care plans followed a similar format with forms being used from a care planning process purchased externally by the home. The home undertakes a weekly review of care provided and any other significant incidents (e.g. GP visits), these being seen in care plans. People living at the home confirmed that they were aware that the staff maintained written records however they were not that interested in viewing their care plans. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 12 The home was also required following the previous inspection to ensure that the staff have access to updated and appropriate moving and handling assessments. Within all care plans were comprehensive individual moving and handling assessments, which clearly indicated how people should be supported with moving and handling. These had seen to be reassessed in respect of a person who has increasing needs. Also in care plans were risk assessments in relation to falls, information about catering needs, a hazard analysis and specific risk assessments relating to individual risk. These individual risk assessments were well-completed and aimed and minimising and managing risks not restricting people. An example being one person with some age related memory loss that enjoyed going for walks along the nearby sea front. The risk being that she would forget the way home and this being managed by her having the name and phone number of the home on her person at all times. People identified at risk of falls from bed were also appropriately managed without necessarily using bed rails. Training records confirmed that staff have undertaken manual handling training. The inspector was able to meet many of the people living at the home. They all stated that they felt very well cared for; others whose level of disability made conversation difficult appeared comfortable, relaxed and well cared for. The inspector spoke with one visitor who stated that she was very happy with the level of care her relative received. Comment cards were received from seven relatives, all stated that medical and care needs were always met. No concerns about the level of care were raised in these comment cards. Comment cards were also received from ten of the people who live at the home, eight stated that they always receive the care and support they need, the remaining two stating that they usually receive the care and support they require. Comment cards from people living at the home stated that they always or usually received the medical care they required. Comment cards were received from one GP and a District nurse. These both stated that the home seeks advice and acts upon it to improve and manage people’s health care needs. They also stated that they felt the staff had the necessary skills to meet peoples needs one stating ‘generally the care provided appears to have improved over the last year or so to a good standard, despite having many dependant people’. The inspector spoke with a visiting health professional who was very complementary of the care provided to people living at he home and stated that she has recommended the home to people she supports in the community who may be considering residential care. Discussions with the manager during the inspection visit indicated that she knew how to contact external professionals and when this should be done. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 13 Records seen during the inspectors visit indicated that health professionals are appropriately consulted. The inspector undertook a tour of the home with the manager and was therefore able to meet people who had chosen to remain in their bedrooms. Care staff stated that they felt they had enough time to meet people’s health and personal care needs. Comment cards received from people confirmed that staff are available when required. Only senior staff who have undertaken additional training and been deemed competent administer medication in the home. All medication was seen to be appropriately stored in secure locked facilities. The home uses a pre-dispensed blister system where possible. It was noted that the home was using one bottle of liquid laxative for everyone prescribed that medication rather than opening a number of individual bottles. This was discussed with the manager as the practise, (whilst understandable) is not appropriate. Whilst the inspector was completing the remainder of the inspection the manager consulted with the local pharmacist and the home is now to be part of a pilot bulk-prescribing scheme in the Cowes area. Until this is organised the manager stated that she would ensure that individual bottles are used. A requirement is therefore not made as the manager has already taken the necessary steps. Comment cards received from people confirmed that staff listen and act on what they say. The home provides only single bedrooms. People and relatives the inspectors spoke with confirmed that staff treat them with respect and that their privacy is maintained during personal care. During the inspectors visit staff were observed to treat people with respect, this was also confirmed by professional comment cards received. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines for daily living and activities made available are flexible and varied to suit people’s individual needs. Family and friends are able to visit. People receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. EVIDENCE: The routines for daily living and activities made available are flexible and varied to suit people’s individual needs. People and relatives confirmed to the inspector that they are able to choose where in the home they spend their day, many were seen to spend time in the homes bright lounge with others remaining in their bedrooms. The home also has a pleasant conservatory, which is heated in the winter. The inspector spoke with people who had chosen to sit in the conservatory and they confirmed that it remained at a pleasant temperature throughout the year. People were observed being asked where they wanted to have their meals, most people choosing to eat in the dining room. People confirmed to the inspector that they are given choice over their meals with options being chosen on a daily basis. Bedrooms seen contained Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 15 personal items brought into the home. Care plans and assessments include information about leisure activities, catering and religious needs. People stated that they are able to get up and go to bed at times of their choosing. An activities list was noted on display in the dining room. This listed activities planned and provided by care staff and external groups. The home also organises weekly minibus trips out to places selected by the people who live at the home. Ten people completed comment cards and stated that the home provides activities adding comments such as ‘I always enjoy it – like the trips and lovely garden party and see everyone there, I think anyone who gets here is very lucky’. Another person stating ‘I have recently been on three minibus outings round the island and have joined in some indoor games, including dominoes and snakes and ladders, I enjoyed the recent garden party’. Trips and parties were also mentioned on other comment cards and are much appreciated by the people who live at the home. One external health professional comment card identified that the home provides social activities on a regular basis within the section requesting what the care service does well. The inspector was able to meet one visitor with comment cards from relatives stating that they are able to visit at any time and kept informed about issues affecting their relative. The home has a good-sized dining room where many people choose to have their meals. People stated that the food is always/usually good and choice provided. Relatives confirmed that they are able to have meals at the home if they wished and that their relatives appeared to enjoy their food. The inspector was present for the main lunchtime meal. The food appeared well presented and appetising. Drinks and snacks are also available throughout the day with people confirming this as well as the inspector observing people being given morning and afternoon hot drinks and biscuits. The need for special diets or supplements is recorded pre-admission with one person who is vegetarian confirming that she is provided with an appropriate meal. One person added on their comment ‘I have a good appetite these days and quite frequently have second helpings when offered. The cooking is of a good standard; cups of tea and coffee are offered during the day and Horlicks nearer to bedtime’. Another stated they were ‘satisfied and I used to be a cook’. The home has a good-sized kitchen, which the manger confirmed is due to be refurbished, as parts are looking worn due to age and use. Some staff have undertaken food hygiene courses, the manager stating that these staff may cook in the absence of the cook. The home has not recently been inspected by the environmental health department and therefore has not yet received a star rating for its food hygiene. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse. EVIDENCE: The homes complaints procedure is included in the service users guide provided to all prospective admissions or their relatives. Within the entrance hall is a notice providing further information as to what to do if a person or visitor has any concerns or complaints. Care staff stated that they would try to resolve any issues raised by people or relatives, if they were unable to do so they would inform the manager. The annual quality assurance assessment completed by the home prior to the inspection stated that no complaints had been received in the previous twelve months. People the inspector spoke with also stated that although they had no concerns or complaints they would feel able to raise any issues with staff or the manager. Comment cards received from people living at the home predominately named the manager as the person they would talk to if they had any concerns or complaints. Comment cards from relatives stated that they knew how to make a complaint and the home had responded appropriately if any issues had been raised. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 17 The homes policies and procedures in respect of recruitment and people’s personal finances should ensure that unsuitable people are not employed at the home and that people will not be financially abused. It was identified in the previous inspection report that staff had not received adult protection training. Care staff have now had safeguarding adults training. Care staff stated they would pass on concerns to the manager. Discussions with the manager indicated that she was aware of the actions, including involving social services and notifying the commission if there were any adult protection concerns. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a clean, safe, well-maintained environment that meets their individual and collective needs. EVIDENCE: The manager showed the inspector round the home (as she had not previously visited the home) and the inspector was then able to move independently around the home. The home has a part time maintenance person and gardener. Overall the home is clean and well maintained. The home is an adapted older listed building therefore it is restricted as to changes it can make to address issues previously identified re narrow corridors and some smaller bedrooms. The manager stated that she considers these issues when assessing and considering new people for the home and offers alternative rooms if these become available to existing people. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 19 The home has a shaft lift, dining room, conservatory, pleasant accessible gardens and a bright lounge with sea views. All bedrooms are used as single and have ensuite facilities. People stated they were happy with their bedrooms and communal facilities. Assisted bathing facilities are available and WC’s are located close by the lounge/dining room. Following the previous inspection requirements were made in respect of the repair, redecoration or replacement of the guttering and down pipes, repainting of the external wood (window frames, pillars, doorways etc) and internally the repainting of all skirting boards and door frames. These were all seen to have been completed. It was also recommended that attention be paid to high dusting and the increase of domestic staff hours. During this visit no issues re high dusting or cleanliness in general were noted. The manager identified to the inspector one bedroom where they are about to replace the carpet with a high quality washable floor covering. This has been discussed with the relatives of the person who occupies the bedroom. The ten comment cards from people living at the home all confirmed that the home is always fresh and clean. The manager maintains a list of new/replacement equipment in the home. This was seen by the inspector. Since the previous inspection the home has provided new headboards, bedside lamps and light shades and curtains to the majority of bedrooms. All bedrooms now have a lockable facility with keys provided to the room’s occupant. New bedding and two new fallout mattresses have also been provided. The inspector viewed many bedrooms and these all looked pleasant and well decorated and provide en-suite facilities. Bedroom sizes do vary and the manager was aware that some rooms are not suitable for people who may require moving and handling equipment or wheelchairs, and some rooms are only accessible via a short flight of stairs. The manager identified in the annual quality assurance assessment that the home is not suitable for people who self propel a wheelchair. The inspector noted that a number of the bed bases looked old and are in need of replacement. A requirement is not made as the manager stated that this was planned as part of the overall improvements to the bedrooms. In addition to the new items in the bedrooms the home has also purchased new kitchen and cleaning equipment and now provides a cooled water dispenser located near the lounge/dining room. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs appropriate numbers of care and ancillary staff that ensure that peoples needs are met. Staff receive the necessary training and a very high number of care staff have NVQ in Care. EVIDENCE: All comment cards, from people who live at the home, relatives and professionals were positive about care staff. One relative commented ‘they treat everyone with care, respect and a great deal of patience. Nothing is too much trouble for them. Everyone is treated like a much loved member of a big family’. Duty rotas were seen during the visit to the home. Duty rotas stated that four care staff, and a cook and cleaner, are provided in the morning; three care and a cook in the afternoon and three care in the evening between 3 and 8pm. Two care staff are provided at night. People and visitors stated that there are sufficient staff on duty. During the inspectors visit staff on duty corresponded to those on the duty rota. Care staff stated that they generally have sufficient time to meet people’s needs and throughout the inspection care staff appeared to have time to meet people’s needs. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 21 The manager provided training and qualification information during the inspection. The home has a very high number of care staff with an NVQ of at least level 2 with many having a level three qualification. Of the four staff who do not possess an NVQ three are currently undertaking this qualification so that once they have completed only one person who has been recently recruited will not have an NVQ. The manager has now organised a training matrix so that she can easierly identify who requires training or updates. This was required following the previous inspection. The training matrix indicated that staff have received the necessary training to meet peoples individual and collective needs. The matrix also indicates when training and updates are scheduled with who should attend. Health and safety and infection control are scheduled for September. The manager stated that she alters the times of training to ensure all staff, including those who only work nights or evening shifts can attend. In addition all staff have a training file, which contains the certificates issues to staff once training has been completed. The previous report identified that staff required supporting vulnerable adults training and records indicated that this had occurred in September 2006. Care staff confirmed that this training had occurred. In addition to mandatory training staff have also received in house training relevant to the specific needs of people living at the home such as death and bereavement, challenging behaviour and dementia. The recruitment records for the three newest staff were viewed. These contained all the required information and confirmed that all staff are fully checked including references, CRB and POVA checks prior to commencing employment at the home. The homes recruitment procedures should ensure that unsuitable people are not employed at the home. The manager explained the homes induction procedure and showed the inspector the induction booklet in use at the home for care staff. Discussions with the newest staff member confirmed that she had been appropriately recruited, that she had undergone an induction and had not been expected to do anything she did not have the necessary skills to undertake. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the necessary skills and experience to ensure that the home is appropriately managed and run in the best interests of the people who live there. People’s financial interests are safeguarded. Staff are appropriately supervised and annual appraisals have been completed. The health, safety and welfare of people and staff are promoted. EVIDENCE: The manager has been the registered manager of the home for approximately fourteen years and has the necessary qualifications in management and care as well as being an accredited National Vocational Qualification Assessor. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 23 Copies of certificates for these and other courses she has attended were seen on display in the homes entrance hall. Throughout the inspection visit the manager demonstrate knowledge of the people who live at the home and the mechanisms by which support can be obtained when necessary. Many of the comment cards returned by people living at the home and their relatives named the manager as the person they would approach if they had any concerns or problems. Within care plans the inspector saw satisfaction questionnaires, which had been completed by the people who live at the home. The manager stated that these are undertaken yearly. The home also undertakes regular residents meetings the minutes of which the inspector saw. The manager stated that at present quality assurance questionnaires are not routinely sent to relatives or other stakeholders such as visiting professionals, GP’s, District Nurses etc. However the inspector noted comment forms and envelopes in the entrance hall beside the visitors signing in/out book with a request for people to provide compliments and complaints. The home does not have a formal system for collating responses from questionnaires or comment slips and the manager stated that she will consider how she can formally seek the views of people in addition to those who live at the home, and how this information may be collated and presented formally. The home does not does not act as appointee for anyone. The home will hold small amounts of personal cash for people from whom the manager will pay for additional services such as the chiropodist, hairdresser and the homes shop. The records and storage of this money were viewed and found to be appropriate. Only the manager has access to the money with the homes petty cash being available if people need money at other times. Staff confirmed that they felt appropriately supervised. Following the previous inspection in June 2006 the home was required to ensure that care staff received formal supervision at least six times per year. All staff now receive an annual appraisal and have formal recorded supervision every two months. The inspector viewed records of these and the manager showed her the supervision matrix on which she records when supervisions have occurred such that she can clearly identify who has not received supervision. As previously stated the manager works some shifts each week with care staff so is also able to supervise their practical work and interactions with the people who live at the home. Care staff stated that they felt appropriately supported with an on call system in place when the manager is not at the home. Various records were viewed during the inspectors visit. All records were appropriately stored with access only available to people who should have access. Records were seen to be well maintained. During the inspectors visit there were no concerns in respect of health and safety identified. The home is well maintained and generally clean, with staff Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 24 having relevant training to meet people’s needs. On the day of the inspectors visit an external company were checking the homes fire detection system and emergency lighting. Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 25 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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Moorings, The DS0000012512.V342826.R01.S.doc Version 5.2 Page 28 - 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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