Inspection on 11/04/08 for Moorlands Care Home

This inspection was carried out on 11th April 2008.

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

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

Other inspections for this house

Moorlands Care Home 02/09/09

Moorlands Care Home 16/09/08

Moorlands Care Home 24/10/07

Moorlands Care Home 11/08/06

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Moorlands Care Home 104 Church Lane Brinsley Nottinghamshire NG16 5AB Lead Inspector Mary O`Loughlin Unannounced Inspection 11th April 2008 09:00 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 Moorlands Care Home DS0000065350.V362383.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. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moorlands Care Home Address 104 Church Lane Brinsley Nottinghamshire NG16 5AB 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) 01773 781381 managermoorlands@regalcarehomes.com www.regalhomes.com Regal Care Homes Ltd Position Vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (40) of places Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Regal Care Homes Limited is registered to provide personal care with nursing for service users of both sexes at Moorlands Care Home whose primary needs fall within the following categories :Old Age, not falling in any other category (OP) 40 2. 3. Dementia, over 65 years DE(E) 10 No one under the age of 65 years may be admitted to Moorlands Care Home The maximum number of service users to be accommodated at Moorlands Care Home is 40 24th October 2007 Date of last inspection Brief Description of the Service: Moorlands is a care home providing personal and nursing care for 40 older people and 4 beds are available to care for people with a terminal illness. The home is run by a company called Regal Care who are based in Kent, who purchased the home in August 2005. The home is located in the village of Brinsley close to shops, pubs, the post office and other amenities. The home was opened in 1986 and consists of an extended domestic dwelling. 32 of the home’s bedrooms are single, and all of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors and there is a passenger and stair lift. The home has a large well-laid garden that is well maintained and easily accessible. There is car parking available for 20 cars Fees: £290 - £561 dependent on the individual’s needs assessment and funding arrangements. A copy of the most recent inspection report is made available with the homes statement of purpose. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One regulation inspector conducted the unannounced visit over 2 days. A pharmacy inspector also carried out an inspection, which took 7.5 hrs. A review of all the information we have received about the home was considered in planning this visit and this helped decide what areas were looked at. The main method of inspection used was called ‘case tracking’ which involved selecting the care plans of 4 people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The registered provider, members of staff, people who use the service and their relatives were spoken with as part of this visit. A partial tour was undertaken by the regulation inspector, which included looking at people bedrooms and communal areas of the home. The last Annual Quality Assurance Assessment, referred to in this report as (AQAA), gave us information that is used to inform our inspection process. The quality rating for this service is 0 star this means that people who use the service experience poor quality outcomes. What the service does well: Staff at the home ensure that each person wanting to move into the home has their needs assessed and information is obtained from social workers and other professionals involved in the persons care, before they agree to provide a place for them. There are some positive aspects to the environment, for example: people can access gardens to sit in which are safe and they can bathe in baths and Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 6 showers that are suitable for their personal needs. There is signage in place that helps people to orientate themselves around the home. Staff have had some training which helps them to look after people and on most occasions they are aware of the need to refer to specialist community staff if necessary. What has improved since the last inspection? What they could do better: The appointment of a manager who is fit and able to manage the service is a priority. The manager needs to have an insight into how the home is operating and then to start improving the service delivered to ensure that people living in the home are well cared for and safe. Staff must carry out their work in a safe way by following policies and procedures, in particular in relation to infection control and health and safety. People must only be admitted to the home if their needs can be met, they must all have a care plan which is kept under review and up to date so that staff know how to look after them. People who use the service and their relatives must be involved in the development of the care plan and have some choice about how care is delivered. If any risks for people are identified they must be recorded and actions must be taken to reduce the risks, for example if someone is at risk of choking this should be recorded and staff should know what to do to ensure that person does not choke. There must be enough staff on duty at all times to be able to look after everyone, the staff must be able to care for people in the same way as they have learnt at their training. There must be consideration for peak times of activity to ensure needs are met within a reasonable timescale that ensures the well being of service users. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 7 This inspection found serious concerns in the way medicines are managed. Medication must be managed safely, people must be confident that they will receive their prescribed medicines on time and that the staff understand the importance of ordering, storing, administering and disposing of medication. People must have access to their preferred social or recreational activities whenever possible in an environment which is suitable for them. Mealtimes must be at a time that is the choice of people using the service. A system to make sure that people using the service are listened to and their comments acted upon needs to be implemented. 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. Moorlands Care Home DS0000065350.V362383.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 Moorlands Care Home DS0000065350.V362383.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): 3-4-6 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Prospective service users receive a full assessment of need before admission is agreed, however the service offered does not effectively meet the needs of the service users in a manner that ensures positive outcomes. Intermediate care is not provided. EVIDENCE: Written information is provided for people who are interested in moving into the home in a document called the Statement of Purpose. For a recently admitted person, staff had obtained an assessment from the social worker and then completed their own assessment of the persons needs. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 10 The relatives of the service user told us they were consulted at the point of admission and felt that they had been provided with enough information to make an informed choice about coming to the home. The Commission considered the recent concerns about the home and looked at the homes statement of purpose and the services available for people with Dementia. Throughout this report we describe our findings in areas that are of significant importance for those service users with Dementia to see if the services offered are based on current good practice, and reflect relevant specialist and clinical guidance. We looked at the homes statement of purpose that told us it offers prospective service users a safe and comfortable environment, to encourage people in their interests and activities, providing support and stimulation. It says this will be achieved through constant dialogue with service users, families and friends and through a programme of activities designed to encourage mental alertness and self-esteem. We found that staff receive training in how to care for people with Dementia, however within standards 27-30 we describe how the numbers of staff and deployment do not fully protect service users. The person centred care plan system in use is not up to date and is not used to its potential as described in standards 7-8. The process of consulting service users and their representatives about their care is insufficient as described in standards 7-8. There were serious concerns around the management of medicines and the current use of medicines to control behaviour as described in standard 9. We found limited opportunities for service users to maintain social skills and be involved in meaningful activities or any recognised therapeutic intervention or approach, as described in standards 12-15. We found the environment is not utilised or maintained to meet the needs of the service users, there was restricted space as the main lounge dining room is the main day space in use and the area is noisy and cluttered with furniture, which does not allow service users good access to safely move around unsupervised, and infection control practices are poor, as described in standards 19-26. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 11 Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 12 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): 7-8-9-10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of up to date care plans, monitoring of health care and the management of medication means that people do not always get their health care needs met and dignity isn’t always maintained. EVIDENCE: The home has a good person centred care planning document that is electronically produced, it includes risk assessments, social and personal history and information on medical interventions, however there was no evidence that people or their representatives have been involved in the development or review of their care plans, although some staff said that relatives are invited to be involved. We did see that a letter is within each plan inviting people to be involved in care planning, but these were not completed. Some relatives told us that they were contacted when any changes in the service users health had occurred but had not seen the care plans. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 13 When a persons condition changes the care plan isn’t always updated, for example; one person’s mobility had changed but the care plan did not reflect this, the care needed therefore wasn’t accurately recorded and the care plan of one person with epilepsy doesn’t detail what to do in the event of a seizure. Staff completed daily records, which were good, but the information wasn’t used to update any of the care plans. Some staff said that they do not read the care plans. One care plan made no reference to a persons wounds and how they should be cared for. All records of wounds are held separate to care plans, this process can make it difficult for staff to know how to care for people. Staff didn’t think people were assessed regularly regarding their risk to developing pressure sores, however specialist pressure relieving equipment is provided for those people that are assessed as needing it. Where restraint such as bedrails are used people have given their consent, however on one occasion five staff restrained a person who had been trying to leave the building, the records of this incident did not clarify if this action was in his best interests and the care plan wasn’t updated by identifying what staff should do if this happens again. One person had fallen 7 times in March 2008 and there had been no review of the care plan to identify how to minimise the risk of falling and no referral to any specialist service. The acting manager stated that ‘we do not presently have anyone who is presently a falls problem’. We observed one person having 3 drinks left on her table which were unsafe for her to drink as they were not of the correct consistency and could have made her choke. The person giving out the drinks said that the care staff have the responsibility to make the drinks to the correct consistency, however she walked away without telling the staff that she had left the drinks. There was a list on the kitchen wall stating which people needed the consistency of their drinks changing but this was partly obscured and the person working in the kitchen wasn’t aware of it. We observed staff treating service users with respect and maintaining their dignity when delivering personal care, however one relative said that staff do not clean peoples dentures and on one occasion dentures were not even put in. We were also told that a hearing aid was continually set on the wrong setting, which meant that hearing was impaired for this person. We saw catheter bags being held in waste paper bins instead of the correct holders, this is not respectful of dignity and also is not safe practice. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 14 Some people are referred to specialist services when needed, for example, one person had been referred to a specialist team for some advice, this was recorded in their care plan, another person had been referred to the dietician which had resulted in a prescription being obtained and others are seen by the District Nurse. Relatives told us that they were paying for chiropody services but nails were not being cut as needed. Continence advisors informed us that service users are not assisted to the toilet as their assessment advises. The inspection of the medication standard was undertaken by the Commission’s pharmacist inspector. The inspector found overall that the home does not manage medicines safely for people who use the service. We found that the morning medicine round was still underway at midday so some people were not given their medicines at times intended by prescribers. It was also evident that medicine administration practices were sometimes unsafe as some records were not being accurately completed at the time medicines were being given. Some medicines were being left with service users to take themselves with the risk they could be taken by others. Similarly, medicines prescribed for external application were not all stored securely in people’s rooms. There was evidence that at times medicines were not being promptly obtained and therefore were not available to give to service users ensuring their treatments were continuous. Overall, the standard of medication record-keeping was poor. Records did not include all medicines available for administration so it was unclear if such medicines were still prescribed. There were gaps in records and for many medicines there was no system in place to enable them to be accounted for. For other medicines, a significant number of discrepancies were identified so it was a concern that these medicines had not been given to service users as intended by prescribers. A high proportion of service users were prescribed medicines for the management of psychiatric illness. It was evident that frequently arrangements were not being made to ensure the use of these medicines was reviewed regularly by prescribers. When requests were made to prescribe them or increase doses there was a lack of supporting evidence of deterioration in resident’s mental state. Some of these medicines were prescribed for administration at the discretion of nursing staff. When used, it was of concern to find both that there was frequently a lack of recording to support the fact that their use was necessary and that some people were experiencing sedative side effects. There was little written guidance for staff on the use of these medicines for individual service users. We found no evidence that the competence of registered nurses authorised to handle and administer medicines at the home is being regularly assessed. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 15 A full written report on the findings of the pharmacy inspection has been sent separately to the provider and feedback was given by the inspector at the time of inspection. A notice was issued to the manager highlighting matters of an immediate nature requiring urgent action. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 16 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): 12-13-14-15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People do not have their recreational and social needs met and they do not have a choice as to what time they eat their meals. EVIDENCE: The Statement of Purpose tells us that one of the objectives is to provide stimulation and encouragement for people to maintain as many previous skills, interests and activities as possible, however there are limited opportunities for service users to be occupied with activities of their choice. Someone now works as an activities co-ordinator but has not yet received training in her job role and people told us that there has been little change since the post was filled. Relatives told us that there were minimal activities offered, no regular exercise for service users and an overcrowded lounge that left them struggling to seat themselves without getting in the way. On the first day of this inspection the newly appointed activities person was manicuring a service Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 17 users nails at her table in the lounge during breakfast. No other activities were seen taking place. The overcrowded lounge had a radio in one side with 2 speakers positioned opposite a service user, her care plan clearly recorded that she disliked noise and was very anxious. The radio was loud. There was seating provided for 8 people to dine at tables, other people were observed eating their meals in an armchair; the manager said that this is their choice. Staff were observed at lunchtime supporting people to eat, they showed patience and sensitivity when assisting them with meals and were heard to offer a choice to people at breakfast and lunchtime. The menus that were displayed contained pictures of meals for each day of the week that would be good practice for supporting those that may have difficulty understanding, however they did not correspond to the meals on offer and only serve to further confuse people. The manager explained that people get offered supper, however staff said that this is only the case if they ask for it, this disadvantages those that are unable to ask. The cook was concerned that staff never inform her of new peoples dietary needs and when she asks them they are not always sure. Two relatives said that on some occasions basic foods such as bread, cheese and butter were not available, the cook said that this was due to the relief cook not ordering correctly. There were sufficient fresh and dried foods observed during the inspection. Some people said that they enjoyed the food. Kitchen staff reported that breakfast takes until around 11.00 most days, this isn’t people’s choice but due to the fact that staff struggle to get people up and dressed in time. One resident came down to the main lounge and received breakfast at 11.00 as staff did not realise he/she was up. Some people were seen to have their breakfast at 11.00- 11.30 and then their lunch at 12.45. Leftover foods stored in the kitchen fridge were not labelled and in one case a defrosted cold meat had an expired sell by date label and no guidance to staff on how long this was to be kept safely. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 18 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): 16-18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service say that they do not always feel listened to by staff, and that their concerns are not taken seriously. People cannot be assured that they are safe and protected from abuse. EVIDENCE: The acting manager hadn’t addressed three complaints correctly and the Commission have received 3 complaints about the service since the last inspection. The Commission alerted the Local Authority through Safeguarding Adults procedures, of concerns about neglectful care practices. Social workers and care managers from the local authority are currently reviewing each service user at the home to ensure they are safe. From letters sent to the provider during April 2008 we saw that some relative’s feel that they have there concerns addressed properly, records showed that actions were taken to improve the service, for example when a complaint about cleanliness was made the cleaning staff were increased. Other people told us that when they discussed their concerns about how care is delivered Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 19 “nothing ever happens”, there was evidence that some complaints received hadn’t been recorded. Staff files show that they have received training in protecting vulnerable adults from abuse or they are recorded on the training matrix as due to attend in 2008 and the revised Safeguarding Adults Procedures were available, although staff demonstrated a lack of knowledge about ‘restraint’ and the ‘whistle blowing policy’ which means that they haven’t got a clear understanding of how to protect people. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 20 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): 19-26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The way the lounge and dining areas are used does not create a calm and peaceful place in which service users can move freely and comfortably. The management of the environmental risks is poor and will not adequately control the risk of cross infection. EVIDENCE: The Commission received information about the infection control practices in the home and as a result consulted with the Community Infection Control Team within the Primary Care Team for North Nottingham. The Infection Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 21 control Nurse conducted an audit of the home during this inspection and will produce a full report to the provider on issues that require addressing. Although there are 3 lounges it was seen that it is the lounge/dining area which are used during the day, people aren’t able to walk around freely and it is difficult for staff to access people with equipment such as hoists. There is good signage throughout that enables improved orientation and recognition for people with Dementia. A nurse from the home has attended a meeting relating to infection control and the manager has said that she is able to cascade information to the staff but we found serious shortfalls in practices relating to infection control. Staff are issued with some protective equipment such as aprons and provided with safe systems to manage infected waste and linen, however in practice we saw the homes own audit records indicating poor infection control practice, we also saw poor practice during our inspection. Toilets and commodes were left dirty, linen was not always transported safely, and there was a lack of aprons for staff to use when entering food preparation areas. One relative said that ‘commodes are rarely washed out properly and that excrement is often visible’, and ‘on one’ occasion the commode hadn’t been emptied for the whole day’. The Infection control audit undertaken by the Primary Care Infection Control Team Nurse found many examples of poor practice including dust on high and low surfaces, stained carpets, dirty sinks, soiled items not disposed of correctly, dirty and torn bed rail covers and unsafe storage of clean equipment within dirty areas. There were also insufficient cleaning products available to minimise the risk of infection, the manager did address this during the inspection. There is some infection control training for staff planned in June 2008. A relative explained that after reporting a blown light bulb in a person’s bedroom it remained unchanged for several days. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 22 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): 27-28-29-30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Person centred care cannot be delivered due to inadequate numbers of staff. Although staff receive some training they do not ‘have the time’ to deliver care in accordance with their training Shortfalls in the recruitment of volunteers do not protect service users from those that may be unsuitable to work with them. EVIDENCE: The deputy manager told us that the numbers of staff working are based on the level of occupancy and are set by the company. On the second day of this inspection we found that one person was ringing her call bell for fifteen minutes, she was distressed, we saw staff working with other service users and not responding to the bell. Three staff said that they had been trained in moving and handling but that they had to cut corners due to pressure and lack of time and therefore didn’t follow safe practice, one relative said that staff are not moving people correctly and that on occasions one person ‘moves’ people where two people should undertake this task. We saw one person leave the lounge having been incontinent as she walked, some fifteen minutes later she returned to her seat in wet clothes and continued with her lunch, staff were not aware of her condition. We also saw that medicine rounds went on for an Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 23 extensive length of time and could have a serious outcome for the service users as they may receive their treatment at times not prescribed, and at too frequent intervals. A relative said that staff are caring but that they do not have the time to do everything. There was evidence of a robust recruitment practice with records of Criminal Record checks and the Protection of Vulnerable Adults register checks along with application forms, training records, references and supervision for all permanent staff, although a volunteer working at the home started work without the correct checks being undertaken. There were no records of induction held, however the staff confirmed they did receive an induction, the manager said it was linked to ‘Skills for Care’. One staff member told me a senior carer had done her induction with her and signed her booklet. Information from the home confirmed that over 50 of the care staff have National Vocational Qualifications in Care. Staff training and development records were not available. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 24 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): 31-33-38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There home is not run in the best interests of the service users and the lack of systems to monitor care results in many poor practices. EVIDENCE: Currently the acting manager who has been in post since November 2007 is managing the service, there is no registered manager. The manager said that she has no administrative support within the home; this was evident as some of the files were rather unorganised. Staff said that the manager generally works in the office but does come out if the emergency bell is sounded. Some Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 25 staff said that the manager was approachable, although others found her to be unapproachable. A relative said that staff are doing their best but there is no direction ‘from the top’ and another said that staff are very caring but that there is a lack of stimulation. A temporary manager had identified a number of poor practices during the week she had been working at the home that support some of the things we have said in this report. Actions to improve the management of medicines had been identified by the provider in a monthly report, which is supplied to the commission, although there has, as yet been no improvement in this practice. People said that they do not get an opportunity to have meetings or group discussions with the manager to inform the service of any shortfalls that could be rectified in the delivery of the service. Relatives said that they used to have meetings with the previous home manager, which they found helpful, but these have now stopped. The management of health and safety had serious shortfalls in moving and handling people safely, food labelling and dating and infection control. Equipment maintenance is carried out and health and safety certificates were up to date. The main doors are keypad controlled and care plans did not reflect whether service users are assessed as to any limitations on their freedom both internally and externally. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 26 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 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X X X 1 STAFFING Standard No Score 27 1 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X X X 1 Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation CSA section 24 (98) Requirement The conditions of registration must be complied with to ensure that all people who are admitted to the home can have their needs met. Service users care plans and risk assessments must be reviewed regularly to ensure that the plans continue to be in accordance with people’s holistic needs. This requirement had a timescale of 31/12/07, which has not been fully met. 3. OP7 15 (1) (2)(a)(b) Each person must have a care 30/06/08 plan which identifies their health, personal and social care needs that is available to them and is kept under review so that staff can see how to care for them. Care plans must be followed to 30/05/08 ensure that each persons health, personal and social care needs must be met. Timescale for action 30/05/08 2. OP7 15 (2) b 15/05/08 4. OP8 12 (1) Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 28 5. OP9 13(2)(4) Medicines must be administered to residents at the prescribed and scheduled times – immediate requirement Medicines must not be left with residents unsecured and safe medicine administration practices must be adhered to at all times –immediate requirement Safe record-keeping practices must be adhered to at all times when medicines are administered to residents – immediate requirement Medicines prescribed for external application must be safely and securely stored The non-availability of medicines must be avoided so they can always be given to residents at prescribed and scheduled times. Medicines currently unavailable must be obtained –immediate requirement Psychotropic medicines prescribed for administration to residents at the discretion of nursing staff must only be given when clinically justified. This must be demonstrated by record-keeping practices Records must demonstrate that requests to prescribe or increase doses of psychotropic medicines only take place when there is a change in resident’s mental state 14/04/08 6. OP9 13(2)(4) 14/04/08 7. OP9 13(2)(4) 14/04/08 8. OP9 13(2)(4) 09/05/08 9. OP9 13(2)(4) 14/04/08 10. OP9 13(2)(4) 09/05/08 11. OP9 13(2)(4) 09/05/08 12. OP9 13(2)(4) Records of medicine 09/05/08 administration (or nonadministration) must be fully and DS0000065350.V362383.R01.S.doc Version 5.2 Page 29 Moorlands Care Home 13. OP9 13(2)(4) accurately completed at all times that medicines are offered for administration. This is part of safe medicine administration procedures There must be full and accurate medication chart medicine entries for all currently prescribed medicines and which all detail current prescribed dose instructions Medicines must be administered to residents in line with prescribed instructions. This must be demonstrated by record-keeping practices that enable all medicines to be accounted for Medicines must be administered to residents by nursing staff who have their competence regularly assessed and are deemed competent You must ensure that no service user is subject to physical restraint unless employed as a practical means of securing the welfare of that or any other service user and there are exceptional circumstances. On any occasion where physical restraint is used you must record the circumstances including the nature of the restraint. Recreational interests must be provided for people (after consultation with them) to ensure that their social needs, preferences and expectations can be met. The lounge and dining areas in use must be suitable for the provision of dining, social, cultural and religious activities. Meals and snacks must be DS0000065350.V362383.R01.S.doc 09/05/08 14. OP9 13(2)(4) 09/05/08 15. OP9 18(1) 18(2) 09/05/08 16. OP10 13(7) 30/05/08 17. OP12 16(n) 30/06/08 18. OP15 23(2)(h) 30/06/08 19. OP15 16(2)(i) 30/05/08 Page 30 Moorlands Care Home Version 5.2 20. OP16 22(3) 21. OP18 13(7) 22. OP26 13(3) 23(2)(d) 13(3) 23. OP26 24. OP27 18 (1)(a) 25. 26. OP29 19)(1) (a) 18(1)(a) (c) OP30 27. OP33 24 (1)(a)(b) served at the time chosen by people to ensure that their nutritional needs are met and that they are given choice. All complaints received must be responded to in accordance with the policy and acted on. All complaints received must be recorded, this will assure people that they are being listened to and taken seriously. All staff must be aware of the procedure to follow when restraining people to protect service users. The environment and any equipment used must be clean to ensure the safety of people and prevent the spread of infection. Infection control policies and procedures must be adhered to by all staff to ensure the safety of people and prevent the spread of infection. You must assess the level of need of each service user and based on that assessment ensure that the numbers of staff are sufficient to meet those assessed needs. All volunteer staff must be safely recruited to work in the home to protect people. All staff must have a training and development profile including induction and foundation training which is recorded and available for inspection. You must establish an effective system for reviewing and improving the quality of care provided to people. Any review conducted by the registered person must be supplied to the Commission and a copy of the report must be made available to people who use the service. DS0000065350.V362383.R01.S.doc 30/05/08 30/05/08 30/04/08 30/05/08 30/05/08 30/05/08 30/06/08 30/06/08 Moorlands Care Home Version 5.2 Page 31 28. OP38 13(5) (4)(c) Safe Moving and Handling techniques must be carried out to protect staff and meet the needs of people. 30/05/08 29. OP38 16(2)(j) You must consult with environmental health officers on the safe storage of foods. 30/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations It is recommended that medicine refrigerator temperatures are monitored using a device to British Standard It is recommended that the order of MDS containers on medicine round racks is synchronised with medication chart medicine entries to assist in ensuring medicines are safely selected for administration It is recommended that medication chart medicine entries for medicines supplied in and administered from ‘original’ pharmacy containers are highlighted to assist in ensuring these medicines are safely selected for administration It is recommended that resident-identifying photographs are placed alongside medication charts for all residents to assist in ensuring medicines are safely administered It is recommended that where care plans are in place for the management of resident’s increased psychological agitation and where medicines are prescribed on a PRN basis, there is guidance included on the exact circumstances when such medicines can be considered for use. It is recommended that steps are taken to ensure regular medication reviews are undertaken for residents DS0000065350.V362383.R01.S.doc Version 5.2 Page 32 2 OP8 3 OP8 4 OP8 5 OP8 6 OP8 Moorlands Care Home prescribed medicines particularly those of a psychotropic nature and the outcomes of such reviews fully and accurately recorded at the home 7 OP8 It is recommended that the home conducts regular and frequent audits of medicines in such a way that medicines are accounted for It is recommended that two registered nurses are involved in the destruction of medicines at the home including the completion of records for their destruction It is recommended that medicine stock levels are regularly rationalised to ensure the home has improved medicine stock control It is recommended that the medicine policy document be reviewed to ensure it reflects the home’s established medicine management practices. The review should also take into account issues raised by this inspection to provide nursing staff with appropriate guidance on medicine management practices. The document should be made readily accessible by staff for reference. You should facilitate access to personal records for service users. It is recommended that there is a suitable system in place that will ensure service users do not miss their meals. It is recommended that there are systems in place to ensure that all service users are offered a supper meal and the practice is audited to ensure the service user receives supper. It is recommended that information provided to service users regarding the meal provision is accurate and up to date. The lounge and day areas should be utilised in a way that ensures service users can move around safely. It is recommended that there are arrangements for service users and their representatives to have regular meetings. Formal staff supervision sessions should be arranged for all staff a minimum of six times a year. It is recommended that staff label and date any foods once open and stored within the kitchen fridge. DS0000065350.V362383.R01.S.doc Version 5.2 Page 33 8 OP8 9 OP8 10 OP8 11 12 13 OP14 OP15 OP15 14 OP15 15 16 17 18 OP19 OP32 OP36 OP38 Moorlands Care Home The equipment used within the kitchen requires audit to inform new provision. 19 OP38 It is recommended that you involve the falls team specialist services within the Primary Health Care Team for those service users at an increased risk of falling. Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Moorlands Care Home DS0000065350.V362383.R01.S.doc Version 5.2 Page 35 - 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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