Inspection on 05/06/06 for The Moorings

This inspection was carried out on 5th June 2006.

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 29/08/07

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 Mark Sims Unannounced Inspection 5th June 2006 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 Moorings, The DS0000012512.V289777.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.V289777.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.V289777.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th October 2005 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 four 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. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection appraised the home’s performance against the National Minimum Standards for Older People over the months following the previous inspection, undertaken on the 11th October 2005. The inspection process considered various sources of information, which together were used to support the decision-making process and the quality rating for the home, including: pre-inspection information provided by the Registered Manager, information from previous inspection visits and reports, comments from professional services involved with the home, comment cards and a fieldwork (site) visit, when records were inspected and service users, relatives and staff interviewed. The fieldwork visit was conducted over two days, 5th and 6th June 2006 and the following report has been drafted using the information gathered during the visit and the sources of data identified. What the service does well: What has improved since the last inspection? During the last inspection, 11th October 2005, the home was required to address concerns identified with the recruitment and selection of staff: ‘Recruitment procedures used by the home must be thorough and include all of the checks required by regulation. New staff must not start employment in the home until sufficient information and checks are satisfactory and the safety of the residents is assured’. At this inspection the records of three new employees were inspected and found to contain all relevant and required information. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 6 What they could do better: Through the inspection process, (data collection and fieldwork visits) the inspector determined that the service is failing to achieve compliance with the National Minimum Standards within the following area: • The service users’ plans are not consistently maintained, with a variety of similar but not identical documents and/or tools used to record information, which on reading the files can be confusing and misleading. This observation or finding is in general supported by the comments of a care manager who remarked via a comment card: ‘Care plans and risk assessments are very minimal, not always updated and risk assessments not in place. Encouragement and guidance have been given over the last year but with no effect’. However, a practice nurse comments that: ‘All care plans and medication charts are fully kept up together and are always ready for me when I visit’. • The moving and handling assessments for clients are minimal and do not reflect the guidance and recommendations available within the Manual Handling Regulations 2002. The evidence to support this statement coming from a review of the home’s records during the fieldwork visit (care planning and training), observations of the clients, the tour of the premises and environmental concerns identified via professional comment cards: ‘The home staff are always attentive. My only issues are with the building itself, as rooms are small and tight, which sometimes results in knocks to residents’ legs and arms’. ‘Care plans and risk assessments are very minimal, not always updated and risk assessments not in place. Encouragement and guidance have been given over the last year but with no effect’. ‘The Moorings provides a very caring environment but I feel that the physical environment is often inappropriate, many of the rooms are very small, as are the toilets on the first floor and the bathroom. These restricted areas are often the cause of injuries to residents’ arms and legs due to the lack of space’. • It was stated during the fieldwork visit that the role of training coordinator had recently been established within the home and it is hoped that this role will ensure a more structured and consistent management DS0000012512.V289777.R01.S.doc Version 5.2 Page 7 Moorings, The of training records, identification of staff training needs and witness the creation of a training and development plan, as presently these systems are lacking direction and organisation. The evidence to support this statement comes from a review of the staff training records, which whilst being transferred from a generic record to individualised records, provided sufficient information to illustrate that gaps or lapses in staff training have occurred. The dataset, which is a tool used by the Commission prior to visiting establishments, also documents that within the last 12 months staff have completed. 1. 2. 3. 4. 5. 6. First aid Dementia Care Food Hygiene Fire safety Medications Infection Control However, no dates for when these courses occurred or indication of the numbers of staff that attended each course were provided with the dataset. The dataset also helps establish that staff have not recently accessed training around: 1. The protection of vulnerable adults from abuse. 2. Moving and Handling 3. Health and Safety • The management of service users’ monies, whilst reasonably well managed, was noted, none the less, to need reviewing and updating to ensure that all purchases made on behalf of the clients are receipted and all transactions or deductions from their personal allowance accounts double signed. Again whilst the general principles and management of the home’s medication system are reasonable, changes or improvements could be made. In this case consideration should be given to replacing or upgrading the controlled drugs cabinet, as its design and build is not compatible with the recommendations within the ‘Safe Custody’ Regulations. Within the last 18 months the Health & Safety Executive has issued guidelines around the need for all accident reports, etc. to be stored and maintained in accordance with requirements set out within the Data Protection Act. • • Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 8 However, the accident record presently in operation at The Moorings does not comply with this guidance and/or the requirements of the Data Protection Act and this issue should be addressed. • The home has no formalised programme or process of staff supervision, although the manager and proprietor discussed various informal supervision systems used to monitor staff performance. The evidence to support this judgement came via conversation with the manager and proprietor, the lack of records to support or indicate that supervision is being planned and delivered and confirmation of staff that they do not formally or regularly meet with the manager. • Attention is required to high areas of the home, corners of ceilings, lampshades, tops of door frames, etc. as high levels of dust and cobwebs were noted during the fieldwork visit. The evidence for this comment comes from the tour of the premises when dust and cobwebs were clearly visible to the inspector. • The guttering, down-pipes, wooden window surrounds and pillars around the veranda are in need of attention externally, either replacing or repairing in the case of the guttering and down-pipes and redecorating in the case of the window surrounds, wooden pillars. Internally the skirting boards and doorframes are in need of attention, as they have been knocked and chipped and are showing signs of wear and tear. Again the evidence for this statement comes from the tour of the premises and direct observations of the areas mentioned. • The cook confirmed during conversation that she is maintaining records of the upstairs fridge(s), etc. although the records indicate the fridge is running hot, which could be a thermostatic problem. She also stated that she does not keep a record of the fridge(s), etc. downstairs, although food items are stored in these facilities. As Commission inspectors are not Environmental Health experts, it has been suggested that the manager or cook contact the Environmental Health Officers directly and seek advice and guidance. • Comments from service users and visitors indicate that the management should review its activities programme: ‘Perhaps needs more stimulation (some sort of activity that can be done in a chair). Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 9 ‘More to do, I am unable to walk without assistance but would like to do more than sit watching television and listen to music’. 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. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 10 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.V289777.R01.S.doc Version 5.2 Page 11 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): St 3 & 6. Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. Service users have their needs assessed prior to admission. The home does not provide an intermediate care facility. EVIDENCE: Evidence from the last inspection report and comments from the link inspector (the service’s central contact with the Commission) indicate that service users receive an appropriate assessment prior to admission: ‘Records show that all prospective residents have an assessment of their care needs before moving into the home and the registered manager usually does this’. ‘The information for the assessment includes all relevant information from other people involved in the care of residents such as families and/or care managers’. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 12 During the fieldwork visit five service users were subject to case tracking, a process used by the Commission to audit the care delivered to clients and which includes a review of the care plans. It was established whilst reading through these files that each service user’s plan contained a copy of a pre-admission assessment, social history and where applicable a local authority Schedule 3 placement order and/or care management plan. Although, as identified within the summary, care managers have concerns with regards to the home’s care planning system: Care plans and risk assessments are very minimal, not always updated and risk assessments not in place’, which stems from the assessment process. Comments from service users, provided via the comment cards circulated by the Commission, indicate that people: ‘Received enough information about the home before moving in and could decide for themselves that the placement was right’. Relatives spoken with during the fieldwork visit supported these testimonies and confirmed that they had visited the home, on behalf of the next of kin, prior to making a decision about the placement and had been provided with reading materials. They also confirmed that their relative had been visited prior to admission, often by the manager, and details of their needs and abilities established during these visits. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 13 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): St 7, 8, 9 & 10. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. Care plans are poorly set out, disorganised and confusing to read. The health care needs of the service users are well managed. The home’s approach to the management of service users’ medication is fair, although the storage of controlled medications should be reviewed. The service users’ rights to privacy and dignity are promoted. EVIDENCE: As previously mentioned, five service users were subject to case tracking, which included a review of their care plans. Evidence from previous inspection reports had indicated that the service user plans ‘contained relevant information to guide staff on the care to be provided and all care given was recorded and reviewed regularly’. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 14 Comments from visiting health professionals supported this view: ‘All care plans and medication charts are fully kept up together and are always ready for me when I visit’. However, the view of a local authority reviewing officer (care manager) differed and reflected that: ‘Care plans and risk assessments are very minimal, not always updated and risk assessments not in place. Encouragement and guidance have been given over the last year but with no effect’. During the fieldwork visit the inspector found the care plans to be disorganised, with numerous different sheets or documents used to record similar information on different plans. The failure to implement and maintain a consistent and comprehensive system of care planning and record keeping could account for the care manager’s comments, as the inspector found the experience confusing and misleading. In conversation with the manager and proprietor this issue was discussed and the manager acknowledged that there was a need to standardise the home’s approach to record keeping, especially since they now contracted and/or purchased records from a management company. In conversation with residents and/or their families it was established that whilst they appreciate that care records are maintained, etc. the impression generally is that: ‘these are for the staff’, a single comment which summarised peoples’ general perceptions. One specific record that was noted to require immediate attention was the moving and handling assessment, as the current document failed to comply with the requirements and/or guidance set out within the Manual Handling Regulations 2002 and failed to provide sufficient guidance to staff on how to safely move clients. This coupled with comments from community nursing staff, the views of the care manager - with regards to risk assessments; ‘The home staff are always attentive. My only issues are with the building itself, as rooms are small and tight, which sometimes results in knocks to residents’ legs and arms’. ‘Care plans and risk assessments are very minimal, not always updated and risk assessments not in place. Encouragement and guidance have been given over the last year but with no effect’. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 15 ‘The Moorings provides a very caring environment but I feel that the physical environment is often inappropriate, many of the rooms are very small, as are the toilets on the first floor and the bathroom. These restricted areas are often the cause of injuries to residents’ arms and legs due to the lack of space’ and direct observations of people’s mobility and environmental restrictions (one area of the assessment process not considered currently) and the picture created is of a service where peoples’ health and welfare is not being adequately promoted. However, this is one small part of the home’s overall approach to the promotion and management of service users’ wellbeing, with other records, those relating to visits by general practitioners, etc., indicating that peoples’ health care needs are well catered for and that access to medical advice, etc. is always forthcoming. Further evidence of the home’s good practice in supporting people in accessing appropriate health and social care services comes from the professional themselves, with 11 comment cards returned prior to the inspection and reflecting: That 11 out of the 11 people completing the cards are satisfied with the overall care provided by the service. That 10 out the 11 people completing the comment cards felt staff demonstrated an understand of the care needs of the service users. That 10 out the 11 people completing the comment cards felt staff communicated well with them and worked in partnership. People also added additional comments: ‘I was recently very impressed with the care they provided for one of their clients who was terminally ill, they involved the family and district nurses to provide a very caring and sympathetic approach’ ‘The Moorings provides a very caring environment’. Service users also confirmed via comment cards that: That they receive both the support they need and access to medical support if needed. In conversations with relatives it was established that they are kept informed of changes in their next of kin’s condition, health, etc. and that the ‘manager and her staff are very attentive and supportive’. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 16 The home’s approach to supporting service users with their medication, also, appears to be well supervised and in conversation with the manager it was established that training, albeit in house training and therefore not accredited, is regularly provided. A testimony supported by information taken from the dataset, returned prior to the inspection, which indicates that medication training has been provided within the last twelve months for all staff, although details of who attended and when this training occurred is not included in the dataset. During the fieldwork visit the manager was in the process of uplifting, from a generic document to individualised records, details of the training courses completed by staff. The indication from the records available at the time was that medication training had last been undertaken in 1999 and 2000, however, at the last inspection the inspector recorded that ‘the manager ensures that staff that dispense and administer medication have received the appropriate training’. The manager should focus on completing the transfer of information from one training record to another and ensuring that accurate and updated information is available at all times. The practical elements associated to the safekeeping, handling and administration of medicines to residents were explained and demonstrated to the inspector during the fieldwork visit. The structure and organisation witnessed was reassuring, with most elements or aspects of the home’s medication system ensuring or reducing the likelihood of errors. All records inspected were accurately and appropriately maintained and those staff observed dispensing medications were noted to be thorough and competent. Comments cards from general practitioners indicate that: ‘Service users’ medications are appropriately managed by the home’ The general practitioners, health care staff and care managers also confirm via the comment cards that: ‘Service users are able to see them in private’ A testimony supported by observations of a student nurse’s visit to the home during the fieldwork visit, when staff were quickly on hand to assist a service user to her bedroom for her treatment. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 17 In conversation with relatives it was explained that whilst the home had no separate quiet lounge it was normally possible to find a secluded location either within the dining room or one of the home’s two lounge areas, although the first floor lounge is a little tight for space. People also discussed being able to use their bedrooms for visits and one lady visited during the inspection spoke at length about enjoying people coming to see her in her bedroom and preferring to entertain than to come out of her room. The inspector also observed several visits occurring during the fieldwork visit and noted that people do often locate quiet areas, normally the dining room, for the purposes of visiting. The inspector was also impressed by the attentiveness of staff at The Moorings, with one staff member coming in on her day off to visit a service user she has become friendly with. Her approach and that of other staff observed during the visit was very respectful and polite and demonstrated a good level of understanding and appreciation for the needs of the service users. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 18 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): St 12, 13, 14 & 15. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The home’s activities programme does not provide sufficient stimulation for service users and should be reviewed. Relatives and visitors are actively involved in the home. Independence and choice are promoted within the home. Menus highlight that meals are varied and offer choice, some concerns over records to be retained should be discussed with the Environmental Health Officer. EVIDENCE: Evidence from the inspection undertaken on the 4th May 2005 records that the manager and staff offer a range of social and leisure activities for service users. However, comments from both a relative and service user dispute this and raise concerns over the lack of stimulation provided by the home: Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 19 ‘Perhaps needs more stimulation (some sort of activity that can be done in a chair). ‘More to do, I am unable to walk without assistance but would like to do more than sit watching television and listen to music’. During the fieldwork visit service users were observed to be involved in a variety of activities; watching television, listening to music in the lounge, sat in the garden, reading newspapers and socialising. However, on reflection no-one was involved in any planned or organised activity and everything going on during the visits was self-directed, which relies on the person being able to arrange or implement their own entertain. The dataset information returned by the proprietor does include a list of available activities: • • • • • • • Bingo Games Scrabble Quiz Exercise Hand and leg care Happy hour These activities, however, are all internal or in house programmes, which provides further evidence of the lack of variety and stimulation provided by the home, although the happy hour was established as a firm favourite between service users. In discussion with service users it was established that some access services outside of the home, whilst others are supported by their families when getting out and about. In conversation with the proprietor it was stated that the home used to provide access to a minibus but due to liability considerations this service is no longer available. Several groups or individual service users were observed whilst visiting the home during the fieldwork visits, the inspector having the opportunity to meet with most people to discuss their impressions of the service and how it was meeting the needs of their next of kin, etc. Through these conversations it was established that visiting arrangements are fairly relaxed and open and that this generally suits people, especially when working shifts themselves. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 20 A relative’s comment card does confirm that people are always made welcome, however, it also states ‘not after 8 pm unless notified before’. This statement it is assumed reflects the fact that the management would appreciate notification of visits, as part of their safety and security process. An observation supported by the home’s statement of purpose documentation, which records: ‘Visitors will be welcome at all times, and are asked to let the person in charge know of their arrival and departure from the home. For security and fire safety reasons visitors must sing the visitors book on each occasion. With respect to our residents we request that visiting at meal times is avoided’. One person spoken with confirmed: ‘I am always made to feel welcome during my visits and offered a drink should I require one’. Another visitor also testified to the friendly welcome of the staff and confirmed: ‘the home is very good and I have eaten with mum on occasions, the food is fine’. Visiting professionals also commented via the comment cards that: ‘The Moorings staff are always very helpful and patients treated with respect’. ‘A senior member of staff is always available to confer with’. Mealtimes within the home were observed to be fairly social occasions with almost all of the service users opting to dine in the dining room, however, a couple of service users (confirmed during discussions) prefer to dine alone in their bedrooms, as they enjoy their own company, etc. Comment cards returned indicate that the food is considered to be good generally and the meals being served during the fieldwork visits appeared nicely served and individually portioned. As reported earlier a relative has on occasions eaten with their next of kin and found the food served to be fine, service users also stated the meals were satisfactory and generally met their needs. In conversation with the cook it was established that a cook is available between 07.00 hours and 13.00 hours and 14.00 hours to 17.00 hours, ensuring a member of the catering team is available to prepare breakfast, dinner and tea. Records of the meals served are maintained by the cooks and generally reflect the dish advertised on the menu, however, the cook felt the menu should be seen as a guide and not an absolute, allowing flexibility if required. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 21 The cook is also responsible for maintaining records of the core temperature of the meals served and the running temperatures of the fridge(s) and freezer(s), on reading through these records it was noticed that the main fridge was running hot, which could be the result of a faulty thermometer, the cook also advised that she does not maintain a check on the downstairs or ground floor fridge, as this is only used for dairy or fresh fruit, etc. As the Commission inspectors are not Environmental Health Officers, it has been suggested that the cook and/or manager seek advice from the experts at the Environmental Health Offices. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 22 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): St 16 & 18. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. Service users are confident that complaints or concerns are handled appropriately. Measures taken to ensure service users are protected from abuse are inadequate. EVIDENCE: Files retained by the Commission, which were reviewed prior to undertaking the fieldwork visits, indicate that no formal complaints have been made against the service since the last inspection. The last inspection report, 11th October 2005 also records that the home has a complaints procedure and residents’ complaints are taken seriously. In discussion with the manager and proprietor it was established that no major complaints have been received and that the expectation is that any minor issues been addressed immediately. The previous inspector also commented on the residents’ meetings which occur and that minutes of those meetings highlight that service users’ concerns are noted and dealt with appropriately by the manager. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 23 Information contained within comment cards returned prior to the fieldwork visits also support the fact that the home manages peoples’ complaints appropriately and provides people with sufficient information to raise a complaint should they wish, people confirming that: ‘They are aware of the home’s complaints process but have had no cause to use it’. The care manager also confirms via her comment card that she had not dealt with any complaints about the home’. This coupled with peoples’ statements of being satisfied with the care provided suggests that complaints, etc. are well handled by the management and staff. It would appear from the educational information provided, as part of the dataset, that the home is failing to provide staff with access to adult protection training. The training records, which we have established are in a transitional phase, also suggest training around adult protection is not being made available to staff, although management of aggression training was provided in 2005. The dataset does establish that policies and procedures around adult protection are made available and it was observed during the fieldwork visit that these files are accessible within the manager’s office, although the information contained within the in house guidance is significantly out of date (1999) and therefore in need of updating. The in house communication book or ongoing training instruction book does direct staff to read the in house policy and sign to confirm once they have read this, however, the last entry that coincides with adult protection was in 2004, when staff were asked to read the aggression and restraint policy. As already mentioned within the body of the report, relatives feel the home is meeting the needs of their next of kin and no concerns regards their safety or wellbeing were identified. Observations also demonstrate or support the belief that people feel happy and safe within the home, service users and staff interacting well throughout the fieldwork visits. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 24 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): St 19 & 26. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The premises is adequately maintained, although in need of some external and internal redecoration and hygiene levels could be improved. EVIDENCE: On the first day of the fieldwork visit the inspector undertook a brief guided tour of the premises to familiarise himself with the layout, as this was his first visit to the home. During that tour it was noted that areas around the ceiling, in corners, on light shades and/or any high aperture, etc. were covered with dust and cobwebs and therefore this was rechecked during the second fieldwork visit day, when again it was evident that high dusting was causing a problem within the home. However, the general impressions of service users and their relatives was that the home was clean and tidy: Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 25 ‘the home being described as always fresh and clean’. In truth, apart from the high dusting concern the home is relatively clean and no malodorous smells, etc. were detected at either visit. The inspector also noticed that a domestic staff member was available across both days, although on reviewing the dataset the proprietor has clearly documented that only one domestic is employed at the home, which could explain why the high dusting, etc. is not being appropriately addressed. The combined tours of the premises (day one and two), shows that the home is in need of inward investment, although given the comments of the proprietor and evidence of the last inspection report this has begun to occur. The last inspection report indicating that: ‘The home has a lot of refurbishment since the last inspection and this has greatly improved the general environment and facilities for service users’. However, it was noticeable internally that paintwork is badly chipped and marked around the home, and some areas of the décor perhaps looking a little tired. Externally, whilst it is appreciated that new replacement windows, etc. have been installed, some wooden window frames remain and are in need of repainting, as are all areas of exposed wood outside of the home, as described in the summary. Concerns over the appropriateness of the environment, given the needs of some of the clients were also raised via the professional comment cards, people stating: ‘The home staff are always attentive. My only issues are with the building itself, as rooms are small and tight, which sometimes results in knocks to residents’ legs and arms’. ‘The Moorings provides a very caring environment but I feel that the physical environment is often inappropriate, many of the rooms are very small, as are the toilets on the first floor and bathroom. These restricted areas are often the cause of injuries to residents’ arms and legs due to the lack of space’. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 26 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): St 27, 28, 29 & 30. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. Staffing levels are sufficient to meet the needs of the service users. The management team is committed to maintaining the target of 50 of the care staff trained to National Vocational Qualification (NVQ) level 2 or above. The recruitment and selection practices of the home have been improved and are ensuring service users’ wellbeing and safety are promoted. In-house training and development opportunities for staff are poor. EVIDENCE: Copies of the staffing rosters, supplied prior to the fieldwork visits, indicate that the home is well staffed and that sufficient care staff are available, across the twenty-four hour period, to meet the needs of the service users. Observations, on both fieldwork visits days, provided further evidence of the fact that adequate care staff are available to meet peoples’ care needs, this being particularly evident during the afternoons when a few of the service users were helped outside to enjoy the sunshine and staff were noted going backwards and forwards monitoring their needs. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 27 It was also evident during mealtimes, when staff were noted to be positioned in the dining room as well as available to support people within the lounge and/or their own bedrooms if required. Service users’ families also commented on the availability of the staff stating that: ‘there are always sufficient numbers of staff on duty’, testimonies supported by the professional comment cards, which also support the fact that sufficient and appropriate staff are available during the day with all comment cards returned indicating that: ‘there is always a senior member of staff to confer with’ and personal comments: ‘the staff are always very helpful and caring’. The staff too seemed happy with the staffing levels within the home and described how generally they were a supportive and united staff group. Training for staff, as already highlighted, is a concern given the transient condition of the training records, the small number of courses completed within the last twelve months, as highlighted by the dataset and the reliance on in house training programmes, which should be provided by credible and reliable training organisations. In discussions with staff they felt training and development was being adequately managed in house and pointed to the appointment of a training coordinator as evidence of the management’s commitment to training and development. The manager and proprietor also discussed how having a permanent training co-ordinator and in house assessor would improve the management and organisation of training events, although these statements cannot be tested out as only time can tell if the appointment has been a success. In conversation with the manager it was established that 9 out 15 care staff have completed an National Vocational Qualification at level 2 or above, which equates to 60 of the care staff and is above the recommendation of 50 within the National Minimum Standards. The files of three care staff employed since the previous inspection were reviewed during the fieldwork visit. These files were noted to contain a completed application form, work history, interview notes, health declaration, two written references, photo, contract and copies of certificates from previous employment, etc. The files also contained evidence of Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, disclosure numbers maintained on the staff files. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 28 The manager described the induction process for new staff, which includes the covering of all mandatory training requirements; confirmation of completion of the induction was seen on the new staff files and it is intended that this process will link into the employees’ training review. In conversation with service users and relatives it was established that staff are considered to be caring, considerate and friendly. Professional sources also confirm that staff are knowledgeable about the service users and feel the care delivered is good. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 29 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): St 31, 33, 35, 36 & 38. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The manager possesses a relevant care and managerial qualification. The home’s quality audit system does adequately take into consideration the views of the service users. The arrangements for handling service users’ monies are inadequate and not guaranteed to safeguard peoples’ financial interests. The staff do not receive adequate supervision, although their practice is supervised. The health, safety and welfare of service users and staff is being appropriately managed and promoted, although moving and handling risk assessments are required. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 30 EVIDENCE: Information contained within the last inspection report reflects that: ‘the registered manager has many years of experience in care and has the necessary qualification in care and management, as well as being an accredited National Vocational Qualification Assessor’. Copies of the certificates for all of these courses were seen during the fieldwork visits, as they are displayed within the home’s entrance hall. The dataset, provided prior to the fieldwork visit, whilst not listing the manager’s qualifications, documents that the manager has been employed at The Moorings since 1992, establishing that she has 14 year’s worth of experience, as a minimum, within this sector. Additional information, gathered from previous inspection reports, indicates that the manager likes to have a hands-on approach to care, which in discussion with the manager and her staff would appear to remain the case. Whilst this is her preferred style of working, which is understood to help keep her in touch with the needs of the residents and working practices of staff, it can cause problems, as experienced during the fieldwork visit when the unannounced inspection meant the manager had to arrange, hurriedly, additional staff cover, as evidenced on the inspector quality audit form, where the manager has asked: ‘to be given a phone call as the inspector leaves to visit, giving me 10 minutes grace to re-arrange my day-to-day running of the home, as I am a hands-on manager’ (this request does not seem unreasonable given the manager’s style of management). However, the lack of flexibility this type of management approach brings has also been identified by other visiting professionals, with the care manager commenting: ‘the manager is often busy in the kitchen, etc. and not always free to spend time speaking with professionals’. However, the service users do all know the manager well and describe her as ‘supportive’, ‘caring’ and ‘approachable’. Visitors and/or relatives also seem happy with arrangements commenting that they are: ‘happy with the way the home operates and is run’. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 31 A useful tool for the manager, which enables her to ensure the home continues to run and operate effectively are the meetings and specifically the residents’ meetings, as recorded in the previous inspection report: ‘there is a residents’ meeting held every three months and records show that feedback from residents at these meetings is listened to and taken seriously by the manager who takes action to address any problems’. The quality assurance programme does not yet appear to have to been rolled out to monitoring records, although this is not intended to suggest that care records, etc. are not being appropriately reviewed and updated as the evidence from reading these documents indicate they are. This comment is aimed more towards the haphazard nature of the recording tools used and to the fact that training records are being poorly maintained and in house guidance documents, like the aggression and restraint guide, not updated since 1999. Another important facet of any quality assurance programme is the work undertaken with staff, which was discussed with the manager during the fieldwork visit and which established that presently the home does not possess a formalised supervision process, where the manager spends time on a one-toone basis with a carer exploring issues directly affecting or influencing their performance at work, training and development needs, etc. The manager stated that she does work with staff, as she is hands-on and through working with them is able to monitor their performance, although records of these practice supervisory sessions are not made. The manager and proprietor have also introduced a programme of regular team meetings, which are fully minuted but are poorly attended, as evidenced by the minutes of the meetings, although all staff are required to read the minutes of the meeting and sign to confirm they have read them. Service users admitted to the home have a variety of options available to them with regards to how they manage their personal allowances: • • • Self management Family and or advocate In house personal allowance account. Information from the dataset indicates that 16 out the home’s 19 residents have agreed to use the home’s in house personal allowance accounting system, which is overseen by the manager. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 32 The accounts of three of the five service users, the subject of case tracking during the inspection, were reviewed and were found to have accurate balances between the funds available to them and the account records. All monies were being safely and securely held and each resident had a separate account and fund available to them. However, the records were found not to be being double signed when transactions were conducted, which was a recommendation of the Office of Fair Trading in 1999 and receipts for some items purchased on peoples’ behalf were not available. In conversation with a relative it was established that he was happy for his mother to participate in the scheme operated at the home and that he had no worries with regards to how his mother’s monies were being used, stating that: ‘the manager asks me for a top up when mother has spent her allowance and I’ll provide £50 or so, which is used on her behalf’. No immediate health and safety concerns were identified, with regards to the fabric of the premises and full health and safety policies, etc. are made available to staff according to the dataset. However, as highlighted earlier within the report the care planning process is lacking a moving and handling assessment, which should be addressed as soon as possible. This issue is directly linked to health and safety, as the 2002 manual handling regulations are produced by the health and safety executive (HSE) and are one of a number of regulator instruments devised by the HSE that directly impact on this area. The views of the care manager should also be considered, at this point, as more generalised, individual risk assessments should be available to direct staff, the care manager commenting: Care plans and risk assessments are very minimal, not always updated and risk assessments not in place. Encouragement and guidance have been given over the last year but with no effect’. However, other elements associated with health and safety would appear to be being handled much more effectively with the previous inspection report reflecting that: ‘health and safety assessments for all areas of the home are available’. Access to paper towels and liquid soaps in bathrooms/toilets, etc. and access to aprons and gloves also indicates that attention to infection control is being Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 33 given, with the dataset providing additional evidence, as it indicates that specific policies around this area are made available to staff. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 34 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 2 X 3 Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 35 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. 1 2 Standard OP7 OP8 Regulation Requirement Timescale for action 30/07/06 30/07/06 3 OP12 4 OP19 Regulation The manager must attempt to 15 standardise the care planning documents and process. Regulation The manager must ensure staff 13 have access to updated and appropriate moving and handling assessments. Regulation The manager must ensure the 12 activities programme for service users is reviewed and includes external and internal entertainers and entertainments. Regulation The proprietor must provide to 23 the Commission a timescale, not exceeding six months, for the repair and redecoration or replacement of all guttering and down-pipes The proprietor must provide to the Commission a timescale, not exceeding 6 months, for the repainting of all external wood (window frames, pillars, doorways, etc.). The proprietor must provide to the Commission a timescale, not exceeding 3months, for the 30/07/06 30/07/06 Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 36 6 OP30 repainting of all skirting boards and doorframes. Regulation The manager must ensure all 19 staff training records are updated and then produce a staffing matrix for monitoring training completed and training required. The manager must also produce a training plan and/or schedule for both mandatory courses and additional training specific to the needs of the service users. Regulation The manager must seek to 19 introduce a programme of formal supervision for staff. 30/07/06 7 OP36 30/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP9 OP37 OP26 OP15 Good Practice Recommendations The proprietor should consider replacing and updating the home’s controlled drugs cabinet. The accident records should be stored in accordance with health and safety guidelines and data protection requirements. Attention should be given to high dusting and consideration to increasing the available domestic staffing hours. The home should liaise with the Environmental Health Department over the operating temperature of its fridge and the need to maintain records of fridges used to store dairy produce, etc. Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 Moorings, The DS0000012512.V289777.R01.S.doc Version 5.2 Page 38 - 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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