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Inspection on 10/10/06 for Moorlands Nursing Home

Also see our care home review for Moorlands Nursing Home for more information

This inspection was carried out on 10th October 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a good standard of care in a homely environment. The staff team was welcoming and friendly and there was good interaction with the manager was observed. The manager showed the inspector the thank you cards and letters received by the home complementing them on their good standards of care. The home had plenty of activities on offer with a good variety and on the day of the site visit the organiser had just completed some Christmas present shopping for the service users.

What has improved since the last inspection?

All the requirements from the previous inspection had now been completed. The manager said that she was still working hard with her registered nurses on the individual care folders of the service users but the standard has improved.

What the care home could do better:

Three recommendations were made following this inspection and can be seen in more detail at the end of the report.The recommendations included the need for all hand written entries on the medication administration charts to contain two signatures and the results of all service user surveys are communicated to them and their relatives or representatives. It is also recommended that NVQ training be resumed for care staff.

CARE HOMES FOR OLDER PEOPLE Moorlands Nursing Home Macdonald Road Lightwater Surrey GU18 5US Lead Inspector Lesley Garrett Key Unannounced Inspection 10th October 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 Nursing Home DS0000061257.V315427.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 Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moorlands Nursing Home Address Macdonald Road Lightwater Surrey GU18 5US 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) 01206 828 290 01206 828 291 Moorlands (Lightwater) Ltd Ms Kathleen Henrietta Buckley Care Home 41 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (41), of places Physical disability (1) Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One named service user to be accommodated within category Physical Disability (PD) Eight service users to be accommodated within category DE(E) Date of last inspection 31st January 2006 Brief Description of the Service: Moorlands is an attractive house built in the early 1900s. The home is set in its own grounds, situated 1 mile from Lightwater village centre, 2 miles from Camberley town centre and within reach of the major towns in North West Surrey. The home provides nursing care and accommodation on two floors for 41 older people. Twenty-five of the bedrooms have en-suite facilities. The home has a lift and stair access to the upper floor. The home is tastefully decorated and furnished, with lounges and quiet areas overlooking well-kept gardens. The home is staffed by Registered Nurses and health care assistants, and is supported by the Primary Health Care Team and specialist’s nurses. The range of fees for the rooms are from £535 - £760. Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was held over six hours and commenced at 0930 and ending at 1545. Lesley Garrett lead inspector for the service carried out the site visit and the registered manager represented the establishment. The inspector carried out a tour of the premises and spoke with some service users and staff. Some policies and procedures, care plans and employment records for staff were sampled. A pre-inspection questionnaire will also assist the inspection process, which was provided by the manager. The inspector would like to thank the service users, staff and manager of the home for their hospitality during this site visit. What the service does well: What has improved since the last inspection? What they could do better: Three recommendations were made following this inspection and can be seen in more detail at the end of the report. Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 6 The recommendations included the need for all hand written entries on the medication administration charts to contain two signatures and the results of all service user surveys are communicated to them and their relatives or representatives. It is also recommended that NVQ training be resumed for care staff. 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 Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All service users that move into the home have their needs assessed by someone competent to do so and are then assured that their needs would be met. The home has no intermediate care beds. EVIDENCE: The manager told the inspector that she would carry out all pre-admission assessments prior to service users moving into the home. If she is unavailable another suitably competent registered nurse will go in her place. An assessment tool produced by Caring Homes is used which is comprehensive and the inspector sampled some of the assessments. Care plans are then generated from this assessment. The home does not provide intermediate care beds. Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 9 Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 10 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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users individual plans of care are comprehensive and demonstrate that their health and personal care needs are met. The home has policies and procedures in place for the safe handling of medications and no issues around privacy and dignity were raised. EVIDENCE: The manager told the inspector that since the last inspection in January 2006, when a requirement was made around care plans, she and the registered nurses had focused on those issues and had now completed this paper work. The inspector sampled some service user folders and found them to contain individualised care plans and risk assessments. There was also evidence that they had been regularly reviewed and service users were consulted. The home has a local general practitioner (G.P) who, the manager stated, visits the home every three weeks and in between if necessary. The G.P. will also do medication reviews every six months. The manager also told the Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 11 inspector that other health care professionals are also available through the G.P.’s surgery. The chiropodist visits regularly and also the opticians. The inspector sampled some medication administration records (MAR) and found that they contained no gaps. The home’s medication policy is kept in the MAR folder and all registered nurses have access and knowledge of the policy and procedure for the administration of medications. The inspector noted that blister packs are used for the administration of tablets and the home’s local pharmacist dispenses this. Fridge temperatures are taken daily and are recorded within the normal limits. It will be a recommendation at the end of the report that all hand written entries has the signature of two members of staff. The home has a privacy and dignity policy and this subject is also discussed with new members of staff at their induction. The inspector observed staff knocking on bedroom doors prior to entering and shared rooms have portable screens available. The laundress explained the systems in place that ensured that service users wore their own clothes at all times. All service users have access to a telephone. They either have their own private line or a portable phone can be connected in their room if requested to make a telephone call in private. Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Arrangements for meeting service users social needs were a good standard and based on individual needs and expectations. Service users were able to exercise choice and control over their lives as much as they are able. Visitors were made welcome by staff. The presentation of food and arrangements for provision of meals was to a good standard. EVIDENCE: The home employs a full time activities organiser and she told the inspector her role within the home. She stated that the activity programme is displayed every week and service users can choose the activity they participate in. Records are kept of those that have attended and can be accessed by staff members. The activities organiser said that she organises large group activities and one to ones visiting rooms and offering aromatherapy, hand massages and manicures. The inspector was told that an entertainer visits every month and three volunteers come to the home to play dominoes and cards with the service Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 13 users. A monthly church service is held and on the day of the site visit the priest visited the home to see a particular service user. Local schools also visit to sing and entertain service users. The home also has a PAT dog that visits and the activity organiser often brings in her dog and the inspector saw that a risk assessment was in place for this activity. Visitors are welcomed to the home and on the day of the site visit the inspector was able to speak with some relatives. The manager told the inspector that service users could have choice and control over their lives and staff assists them to do this. They choose where to eat their meals, and when to go to bed and get up in the morning. They have choice about what to wear in the morning and the staff enables service users to do this. If a service user requests an early breakfast this is documented and choice of menu is given every morning. The inspector met the chef who shares the kitchen duties with a cook. The chef stated she meets all new service users to determine their likes and dislikes and also speaks with them every day following lunch to receive feedback. An environmental health visit took place in August with no recommendations made. The chef explained to the inspector that she organises all breakfasts and therefore service users can always have a cooked breakfast if they wish. Fridge and freezer temperatures are taken and recordings were seen to be within the agreed limits. The service users that the inspector spoke with were complimentary about the quality of the food. Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 14 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that their complaints will be listened to and taken seriously. Service users are protected from abuse. EVIDENCE: The home has a complaints policy which the inspector sampled this is available to every service user and is also displayed in the reception. A complaints log is kept by the manager to show the nature of the complaint and the investigations that take place and the outcome of the complaint. The manager told the inspector that she had received five complaints this year which are now resolved. The inspector sampled the complaints received by the home and they had been investigated and resolved within the stated timescales. Service users at the home are protected from abuse. The inspector sampled the home’s safeguarding adult’s policy, which was in line with Surrey Multi Agency Procedures. The manager had a good knowledge of the procedures and told the inspector that she has had training on this subject and this is ongoing training for all staff. There have been no local authority referrals this year. Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 15 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a safe and well-maintained environment, which is clean with no offensive odours. EVIDENCE: The home has a full time maintenance person who the inspector met. He told the inspector that he was responsible for all routine maintenance in the home including the gardens. Rooms are decorated when vacated or whenever needed. Outside contractors visit to do the routine portable appliance testing and these were found to be up to date. The corridors and communal areas were in good decorative order and there were no offensive odours. During the tour of the building the inspector saw a large number of divan beds and the manager said that they do have some hi/lo beds. Caring Homes regulation manager in a letter to the Commission has stated that service users needs are being met with the beds currently provided. The regulation manger Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 16 for Caring Homes also stated that further beds would be purchased if clinical needs change. The home was clean and tidy and free from offensive odours. The inspector spoke with the laundress who told her that the home has three washing machines and three driers so there is adequate equipment. The laundry was clean and tidy and well decorated. The member of staff said that plenty of training is provided by the home including infection control and she demonstrated a good knowledge of dealing with all the different types of laundry. Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 17 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are met by the numbers and skill mix of staff ensuring they are in safe hands at all times although staff with the NVQ fall below 50 of the carers. The home has a good recruitment policy and practice to ensure service users are protected. There is regular training available for all grades of staff to ensure they are competent to do their jobs. EVIDENCE: The inspector saw the staff rotas on the day of inspection and found that the home had adequate staff on duty for the assessed needs of the service users. The manager said that staff could be increased if the dependency levels increase. Night staff at the home is awake and random checks are made to ensure that this happens. The manager told the inspector that 50 of the care staff does not have the national vocational qualification but that this is planned and a training company is coming to the home to provide this training. It will be a recommendation at the end of the report for the home to resume the NVQ training for their care staff. Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 18 The inspector sampled the employment folders of some of the staff and found that all documentation was in place, which protects the service users. The manager told the inspector that the company provides a lot of training for its employees. All mandatory training takes place for example manual handling, safeguarding adults and fire. Caring homes have recently purchased a training company who provides all of the training including the NVQ assessments. Evidence of this training was seen on the homes training plan and certificates seen in the staff folders. The manager also said that all the registered nurses also had the first aid qualification. Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 19 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home that is managed by an experienced person who discharges her responsibilities fully. There are good quality audits in place and the service users views are sought. Financial interests of service users are safeguarded and their health and safety is promoted and protected. EVIDENCE: The manager has been in her current position for six years and enjoys her role and responsibilities. During the site visit the inspector observed good communication with her staff team and service users. The manager undertakes regular training to keep her knowledge and skills competent whilst managing the home. Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 20 The manager told the inspector that regular quality audits take place and these also seek the views of the service users. The results of these surveys are not fed back to the service users and this will be a recommendation at the end of the report. The manager stated that the home hosts resident meetings every two to three months which is also a social occasion, and relatives and representatives are also invited. The homes policies and procedures are regularly updated and the inspector evidenced this. No service user manages their own finances. The pre-inspection questionnaire was used to check that all health and safety checks were being made. The inspector also spoke with the maintenance person who explained the system that was in place at the home for checking systems and recording for example the hot water checks and fire alarm checks. These checks are all recorded in his book and are accessible for the inspector to see. Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 21 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 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 Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 22 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 OP28 Regulation 18 Requirement The registered persons must supply a training plan to show when the NVQ training will take place to ensure that 50 of the care staff have access to this qualification Timescale for action 10/11/06 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. Refer to Standard OP9 OP28 OP33 Good Practice Recommendations It is strongly recommended that for all handwritten entries on the medication administration charts there are two signatures. It is strongly recommended that National Vocational Qualification training be resumed to ensure that at least 50 of the care staff achieves this qualification. It is strongly recommended that the results of service user surveys be fed back to them and their relatives and representatives. Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Moorlands Nursing Home DS0000061257.V315427.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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