CARE HOMES FOR OLDER PEOPLE
Moorlands Care Home 104 Church Lane Brinsley Nottinghamshire NG16 5AB Lead Inspector
Stephen Benson Key Unannounced Inspection 11th August 2006 09:30 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 Moorlands Care Home DS0000065350.V307854.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.V307854.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 www.regalhomes.com Regal Care Homes Ltd Julie Ann Wilkinson Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Terminally ill (4) of places Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users shall be within categories OP (40) or TI (4) 1 named service user as detailed in application recd 19/4/06 may be admitted within category DE/E 23rd January 2006 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 The manager said on 10/08/06 that the fees for the service range from £318 £378 per week for residential care and £441 - £511 for nursing care, depending on dependency needs and room occupied. Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first visit to the home since 1st April 2006 by The Commission for Social Care Inspection. The inspection lasted for 7 hours and the main method of inspection used was called case tracking which involved selecting 3 residents and tracking the care they receive through the checking of their records and discussing this with them. Other residents were spoken with and additional records were seen. A discussion was had with staff on duty, visiting relatives and care practices were observed. The premises were not inspected in detail but various areas of the home were visited as part of the inspection. What the service does well: What has improved since the last inspection?
There is now a system in place to assess residents prior to admission to ensure that their needs can be met within the home. The evidence shows that the home establishes whether they can meet the needs of any new resident. Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 6 Details of residents needs are included within the care plan so that staff are aware of how residents needs should be met. The evidence shows that residents needs are listed in their care plans Medicine Administration Records are prepared by the pharmacist and are not altered by staff preventing the risk of residents being given the wrong medication. The evidence shows that safe practices are followed in the administration of medicines. The manager has prepared a record of all training undertaken by care staff and when they are due an update. The manager says that she intends to do the same for all staff. This will show that staff have received the training they require to care for the residents. The evidence shows that staff training needs can be identified. There is now a system to record all money being looked after on behalf of residents, which protects them from financial abuse. The evidence shows that residents’ money is looked after. Visitors are welcome to the home and are able to visit for as long as they wish. Visitors said that they are made welcome and able to socialise with other visitors. The evidence shows that residents are able to maintain relationships with relatives and friends. What they could do better:
Comments were made that sometimes the more personal touches, like the way someone’s hair is brushed, sometimes get overlooked. During the inspection one resident was seen with a colostomy bag showing which did not get covered up and someone was told to wait to go to the toilet. The evidence shows that residents’ privacy and dignity could at times be better promoted The home could provide more regular activities, which are in line with residents’ interests so they have the opportunity to spend time taking part in things they enjoy. Residents said that they do not have a lot to do. The evidence shows that residents lifestyle does not always match their expectations. When assisting residents with taking their meals staff should always talk with residents to make the meal more of a social occasion. The evidence shows that some residents are not communicated with whilst being assisted. All staff should be aware of how to protect residents from abuse and of the correct procedures to follow in the event of any allegation. The evidence shows that the correct procedures were not followed following an allegation. Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 7 It would be of benefit to residents if the home was able to increase the amount of storage space available as at present the hoists are stored in one of the lounges restricting the use of this room. The evidence shows that the home does not have sufficient storage. All new staff appointed to work in the home must have been through the required checks, including taking up references, to make sure that they are suitable to care for the residents. The evidence shows that the manager could not show the correct procedures had been followed. 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. Moorlands Care Home DS0000065350.V307854.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.V307854.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents are assessed prior to moving into the home to ensure that their needs can be met. The home does not offer an intermediate care service. EVIDENCE: There were pre admission assessments seen in residents’ files, which were dated prior to the residents’ admission to the home. Where residents are funded through community care arrangements there was also an extended community care assessment seen. The manager said that she goes out to assess anybody who is referred to the home for a placement and that they are able to come to visit the home. The manager said that relatives are shown a copy of the assessment and sign to confirm they are in agreement with it. The manager was preparing a care plan
Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 10 from the pre assessment for a resident due to be admitted to the home the following day. Staff said that they know when someone is moving into the home and are given some information at handover and can find out more through reading the care plan. A relative spoke of discussing a resident’s needs with the manager prior to admission. Residents spoken with who had recently moved to the home were not able to comment on their admission to the home. There is no arrangement made for the home to provide an intermediate care service. Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents health, personal and social care needs are set out in an individual plan of care but are not being used by staff. Residents’ health care needs are fully met. Residents are protected by the homes procedures for dealing with medicines. Residents are not always treated with respect. EVIDENCE: The Care plans have been changed from an electronic version to a paper file. Plans seen were tailored to each residents needs and were being reviewed. There were some areas, for example activities, which could include more detail. The manager said there are pre prepared plans for all activities of daily living on the computer which she can then tailor to suit each resident. Residents are
Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 12 not involved in preparing their plans at present but the manager said that she intends to do so and has discussed involving relatives at a recent meeting. There were letters seen on some files asking relatives if they wish to be involved in care plan reviews. Staff said the change over to the new care planning system had been a difficult time and they would have liked more input on how to use these, but they now find the plans useful and refer to them when needing to know something about a resident. A resident with restricted speech said he would like to have a copy of his care plan describing how he wishes to be cared for to show staff when they assist him. There is a form to record all personal care provided each day so residents’ well-being can be monitored. The manager said that she had arranged for an optician to visit recently and everyone had an eye test. Staff said that they tell the nurse on duty if someone is not well and they will arrange for a doctor if needed and that one resident had improved as a result of receiving physiotherapy. Staff were observed using appropriate moving and handling techniques and ensuring residents had pressure relieving cushions. Residents said that they think their health is well looked after in the home. Only qualified nurses give out medication and there are suitable arrangements for storing this. The morning medication round was observed and the correct procedures were being followed, including residents being observed taking their medication. The Medicine Administration Records included photographs of residents and were fully completed. Residents said staff tell them when to take their medicine so they don’t have to worry about it. There is a reference to maintaining residents privacy and dignity included within residents’ care plans and the manager said that she expects this to be maintained at all times. Staff said that there have been occasions when some of the smaller details were not always attended to, like the way someone likes their hair done or their teeth not having been cleaned when got up in the morning. A resident was seen sat in the lounge with a colostomy bag on view throughout the morning, which did not get covered. A resident was heard asking staff during lunch if they could go to the toilet and was asked to wait until after lunch had finished. The manger said that both these incidents were not Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 13 handled as she would expect. There were notices displayed warning staff that any breach of confidentiality would be disciplined. Residents said that they are generally respected by staff, although some staff are better than others at doing this. Relatives said that they always found staff very respectful. Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents find the lifestyle experienced in the home does not always match their expectations. Residents maintain contact with family and friends. Residents are helped to exercise control over their lives. Residents receive a wholesome and balanced diet. EVIDENCE: The manager said that she sees everything residents do from when they get up as some form of activity and that some new games have been bought. The manager said that the last entertainer to the home in June had been well received and she was considering booking him again also that she had considered getting an activities coordinator. There have not been any trips out of the home, as they have not got any transport arrangements made at present.
Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 15 There is an activities file where all activities residents take part in are recorded. The entries seen showed that limited activities are provided. A recent survey undertaken included comments about not enough activities being provided. Staff said they try to do things with residents in the afternoons but this is difficult as they have to still tend to residents needs which can stop them organising things. Staff said that there are some books in the front lounge but these are not always easy to get at, as the hoists are stored here. Residents said that there was not a lot happening for them to do in the home. They said they enjoy the bingo and keep fit sessions and that they had not had any trips out this summer, which they would have liked. Some residents were seen discussing books they were reading and a member of staff was playing a board game with one resident. Relatives said they thought that residents could do with a little more stimulation. Several visitors were seen and those spoken with said that they are able to visit the home when they want and always find the staff helpful and polite. They said that they have got to know each other and have been sitting outside together in the hot weather. Staff were seen talking to a resident about a visit she was having later in the day and residents said that they can have visits when they want. Staff were seen asking residents what they wanted to do and where they wanted to sit. Staff said that they try to give choices to residents when they can, but not so much as to confuse them. They said that they had looked at providing choices in the recent dementia training. A resident said he had asked for a gate to be put at his bedroom door to prevent anyone wandering in. The catering manager was spoken with who described a number of changes she has made since taking up post and intends to make further changes. This has included changing some suppliers to get better quality, starting an audit of what residents like and dislike and providing a hot meal at tea time rather than just sandwiches, which a resident said she was very pleased had happened. Residents were seen having breakfast, some of whom had chosen a cooked one. A menu is prepared each month and this provides a choice at each meal. In addition alternatives are available, such as jacket potato or a salad if preferred. The catering manager served lunch in the lounge/diner and was seen asking residents if they enjoyed the meal. Staff asked residents if they wanted any more. Staff were seen helping residents who needed assistance with feeding. It was noted that some staff talked to residents whilst doing this and others were feeding in silence. The manager said she would expect all staff to be talking to residents whilst giving them their meals.
Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 16 There was limited seating at dining tables and many residents had their meals in the lounge chairs. The manager said that new dining tables and chairs are being purchased which will allow more residents to sit together at the table during mealtimes. Residents said they thought the food had improved and one resident remembered having previously said she would like some kippers occasionally and these are now included on the menu. Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are confident that their complaints will be listened to. Measures are not in place to protect residents from abuse. EVIDENCE: The home has a complaints procedure and a file to record any complaints in. This included a number of complaints, which have been appropriately addressed. Staff recalled a recent complaint made by a relative about a resident not being properly shaved. This was not recorded in the complaints file, but the manager said that she had dealt with this although not yet recorded it. Residents said that they would raise any complaint with the manager and one resident said that he had made written complaints. One complaint seen included an allegation that another resident had assaulted a resident. This had not been reported through the Adult Protection Procedures and the procedures seen in the office were not up to date. The manager said that she had not undergone any training on adult protection. Staff said that they had some training a long time ago. With the exception of this allegation residents and relatives said that they had never seen anyone being mistreated. Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained environment. The home is clean, pleasant and hygienic. EVIDENCE: The home is an old building with considerable character having a number of small rooms and corridors. The building was well maintained and a handyman is employed to see to any repairs. Staff felt that there was a lack of storage and currently the hoists are stored in one of the lounges. Residents said that they liked the decoration in the lounge, which has recently been painted and the manager said that quotes are being obtained for new furniture. The home employs housekeeping staff who are responsible for cleaning the home. The hours allocated for housekeeping have been reduced which the manager said was due to lower occupancy. Staff said that as a result they do
Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 19 not get to clean residents’ rooms thoroughly as frequently as they used to, although they are still cleaned daily. Residents said that they were happy with the cleanliness of the building and residents said that their rooms were cleaned daily. Staff said that there have been occasions where they have run out of protective clothing and bags recently but the manager said that there had been supplies in the garage, which should have been used. Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ needs are not always met by the numbers and skill mix of staff. It cannot be demonstrated that residents are in safe hands at all times. It could not be fully demonstrated if residents are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. EVIDENCE: The rota shows that there are five staff on duty each day, however staff said there have been occasions where they have been working under these numbers due to sudden staff shortages. The manager said that this should not happen and arrangements can be made for other staff to cover if a shift is not fully staffed. Residents said that staff are kept busy and don’t get a lot of time to talk to them. Some staff spoke of completing National Vocational Qualifications and the manager said that staff are expected to undertake either level 2 or 3. Staff files showed that the correct recruitment procedures are followed in recruiting care staff, however no references could be located for one of the
Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 21 adaptation nurses employed. The manager was uncertain whether these were still at head office. Until recently the home employed a house trainer, however she has taken up a position elsewhere within the company, as a result the manager is making fresh arrangements for meeting staff training needs. Staff said they have had good training opportunities and the dementia course had been particularly helpful. Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a suitable manager employed to run the home. Residents have opportunities to express their views on how the home is run. Residents’ financial interests are safeguarded. The health, safety and welfare of residents are protected. EVIDENCE: The manager took up post in January 2006 and completed the registration process in April 2006. Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 23 There is a system in place to seek residents and relatives views on the home through a survey sent out bi monthly. The manager prepares a report of the findings, which is published within the home and sent to head office. The manager has held a relatives and residents meeting and intends to do this on a regular basis. Staff said they found staff meetings useful and would like these to be held more frequently. There is a system in the home to help residents manage their personal allowances. A record is made of all transactions and two people witness this. Receipts are kept for each transaction. The manager said that all required health and safety checks and tests are carried out but the documentation for these was not checked due to time constraints. The fire alarm went off during the inspection and staff assembled at the identified point and checked all was in order. Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 24 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 3 8 3 9 3 10 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 25 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 Standard OP10 Regulation 12 Requirement The registered person must ensure that care practices promote residents privacy and dignity The registered person must consult residents about their social interests, and make arrangements to enable them to engage in local, social and community activities The registered person must ensure that all staff are aware of how to protect residents from abuse and the correct procedures must be followed in the event of any allegation The registered person must ensure that the correct recruitment procedures are followed for all staff Timescale for action 01/09/06 2 OP12 16 01/11/06 3 OP18 13 01/10/06 4 OP29 19 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 26 No. Refer to Standard Good Practice Recommendations Moorlands Care Home DS0000065350.V307854.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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