CARE HOMES FOR OLDER PEOPLE
Moorlands Nursing Home Northgate Guisborough TS14 6JU Lead Inspector
Julia Connor Unannounced 07 July 2005 10:50 am 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 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 B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Moorlands Nursing Home Address Northgate Guisborough TS14 6JU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01287 630777 01287 630374 Mr George Dixon, Mr Michael Dixon, Mrs Angela C Allick, Mrs Susan O Ellis Ms Rachel M Dewdney Care home with nursing 29 Category(ies) of OP - Old age registration, with number of places Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th December 2004 Brief Description of the Service: Moorlands is a care home providing both nursing and personal care for older people. It is a two storey purpose built home providing both single and shared accommodation for 29 Residents. There are 21 single bedrooms and 4 double bedrooms. The single bedrooms are a minimum of 10 sq.m and the double bedrooms are a minimum of 16 sq.m. There is a passenger lift giving access to the upper floor. There is a large lounge, conservatory and a communal dining room on the ground floor. Moorlands is situated close to local shops and amenities. There is a car park at the rear of the home. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection commenced at 10.50 a.m. and concluded at 3.55 p.m. Five Residents, three visitors and two members of staff were spoken to during the inspection. What the service does well: What has improved since the last inspection?
The documentation to record Residents personal finances has been updated. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 6 What they could do better: 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 B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 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 standard(s) 2 and 3 Residents have a written contract with the Providers of their care. Residents have their needs assessed by professionals prior to their admission to the home; however, they are not involved in the assessment. EVIDENCE: The Inspector evidenced contracts between the Resident and the Providers of the home. Residents had been assessed by the appropriate professional prior to being admitted to the home. The Manager or her representative also carries out a pre admission assessment. However, there was no evidence in the three care files that were audited that the Resident or their representative had been involved in the assessment process. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 8 and 9 The Residents health and personal care needs are recorded appropriately, and their health needs are met. There is a policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. EVIDENCE: The assessments audited contained the required information. Care plans were written once a need had been identified within the assessment process. Risk assessments had been written once a risk had been identified in the assessment process or following an evaluation of a care plan. Care plans are reviewed as stipulated. There was no documentation in place to show that the Resident or their representative had been involved in the assessment, planning or review of their care. The care documentation is currently being updated and the new care files that the Inspector audited were more structured. Doctors, District Nurses, Chiropodists etc are requested to visit the Resident as and when necessary. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 10 There is a policy and procedure for the receipt, recording, storage, handling administration and disposal of medicines. The home has recently started using the Monitored Dosage System (MDS) and the staff stated that it was working well. The staff received training on this system before they began using it. The chemist that provides the medication has agreed with the Manager of the home to take unused medication away. The Inspector evidenced the container that the chemist had provided for the unused medication. The Manager is still waiting for written confirmation of the agreement. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12 and 15 Activities take place within the home on a regular basis and appear to be varied and can be on a one to one basis or as a group activity. The Residents receive a wholesome and well balanced diet. EVIDENCE: There is an activities team, which includes nurses and care assistants. There is a weekly list of activities and a yearly list of events. The weekly activities include music therapy, dominoes, bowls and baking. One Resident showed the Inspector the jumper she was knitting for a friend. One Resident told the Inspector that she enjoyed crocheting. Another Resident stated that she enjoyed reading and looked forward to the visiting library every three weeks. She stated that she had seen the list of day trips and if she felt well enough would put her name down for some. The dining room was a pleasant environment in which to eat. There where staff available to offer assistance to those Residents who required help. There was a notice board informing the Residents what the menu was for lunch and tea. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 12 One Resident stated that the food was all right but it could be better. One Resident stated that the food was varied but the menus were different from the last Owners. Another Resident stated that the food was lovely, it was what she classed as ‘proper food’ especially the homemade soups. This Resident also stated that she enjoyed the homemade cakes, which were served with the afternoon cup of tea. Another Resident stated that there was always an alternative if you did not like what was on offer. The two visitors who the Inspector asked about the food were very complimentary especially about the home made cakes and soups that where served. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 Residents and their representatives are confident that should they complain they would be listened to and action would be taken. EVIDENCE: There have been two complaints since the last inspection in December 2004. One complaint was sent to the home and the other to the Commission for Social Care Inspection (CSCI); neither of the complaints where upheld. There is a policy and procedure in place for the staff to follow should they receive a complaint. The Residents who spoke to the Inspector stated that they would complain if they were unhappy about anything and were confident that they would be listened too, taken seriously and something would be done. The daughter of the Resident who spoke to the Inspector stated that she had spoken to the Manager in the past about concerns and that they had been dealt with appropriately. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19, 20, 21, 24 and 26 The Residents live in a well-maintained environment with access to indoor and out door communal facilities. The Residents have their own possessions in their bedrooms. EVIDENCE: The home is well maintained. The Inspector evidenced a bedroom that was waiting to be decorated. The Residents who spoke to the Inspector were happy with the décor of the home. There is a large communal lounge and dining room. The conservatory leads onto the patio area and car park. Only those Residents and staff who smoke use the conservatory. There are communal toilets and bathrooms, which are situated close to bedrooms and communal areas. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 15 One of the double bedrooms is currently being used as a single bedroom. The Residents who share the other double bedrooms have agreed to share. One Resident who shares a bedroom told the Inspector that she likes to have company. The Residents bedrooms had been personalised by the Residents or their family members, e.g. one Resident had a fridge in her bedroom. On the day of the inspection the home was clean and tidy and odour free except for the smell of cigarette smoke in the conservatory. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 and 30 The Residents are not protected by the home’s recruitment procedure. Staff have received training to do their job. EVIDENCE: Four personnel files were audited, none contained all of the information as required in Schedule 2 of the Care Home Regulations 2001. For example none of the files had proof of identity and only one of the files had a photograph of the staff member. However, all four files did have a criminal records bureau check (CRB). The following training has taken place since the last inspection in December 2004; fire, basic life support, first aid, manual handling, food hygiene and the administration of medication via the monitored dosage system. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35 and 36 A person fit to be in charge manages the home. The home is run in the best interests of the Residents and their personal finances are safeguarded. Staff are appropriately supervised. EVIDENCE: The Manager has the required nursing qualification to ensure that the needs of the Residents are fully met. The Residents and staff spoke highly of the Manager. There is a quality assurance and quality monitoring system in place within the home, and covers all areas within the home. Residents, families, staff and visiting professionals are asked to complete questionnaires regarding their opinion of the home. These questionnaire are then analysed and a report written. This report is available for anyone to read.
Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 18 There is a policy and procedure in place for Residents finances. Individual records are kept of all the money a Resident receives and spends and receipts are obtained and kept in their individual wallet, The care staff received regular formal supervision. This was evidenced within the personnel files and confirmed by the staff that spoke to the Inspector. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 3 x x 3 x 2 STAFFING Standard No Score 27 x 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x 3 x 3 3 x x Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 20 NO Are there any outstanding requirements from the last inspection? 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 3&7 Regulation 15 Requirement Care plans, assessments and reviews must be drawn up with the involvement of the Resident, and/or their representative. The registered person must maintain records as required in Schedule 2 of Care Homes Regulations 2001 e.g. proof of the person’s identity, including a recent photograph. Timescale for action 31st October 2005 Immediate 2. 29 17 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 26 Good Practice Recommendations The ventilation in the conservatory should be improved to help reduce the smell of smoke. Moorlands Nursing Home B51-B01 S55586 Moorlands V236528 070705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Unit B, Advance St Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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