Inspection on 13/07/05 for Moorlands Residential Care Home

This inspection was carried out on 13th July 2005.

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 Residential Care Home 24/08/07

Moorlands Residential Care Home 31/01/07

Moorlands Residential Care Home 23/05/06

Moorlands Residential Care Home 19/01/06

Moorlands Residential Care Home 16/03/05

Moorlands Residential Care Home 18/06/04

Moorlands Residential Care Home 17/03/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Moorlands Residential Care Home 57/61 Stanhope Road Darlington Co Durham DL3 7AP Lead Inspector Rachel Dean Unannounced 13 July 2005 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 Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Moorlands Residential Care Home Address 57/61 Stanhope Road Darlington Co Durham DL3 7AP 01325 487413 01325 487413 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) Mr D Hodgson Smith Mrs M Smith Care Home 19 Category(ies) of LD- 1 registration, with number OP - 17 of places MD - 1 Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Rooms 18 & 19 are to be occupied at all times by independently mobile service users. Date of last inspection 16 March 2005 Brief Description of the Service: Moorlands Residential Care Home is registered as a care home for older people, providing care and accommodation for up to nineteen service users. The home’s premises are located on two main stories, with a lower ground floor dining room and kitchen. A passenger lift providing access to all floors. Bedrooms are located throughout the building. However, two of these bedrooms are only accessible by way of stairs and a condition of registration has been made requiring that these rooms are only used to accommodate service users who are independently mobile. Communal space includes two lounges, a dining room and there is a patio and garden area to the rear of the property. Communal toilet and bathroom facilities are located through out the home. The home is pleasantly situated, overlooking park land and within walking distance of Darlington town centre and its many amenities. Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Moorlands Residential Care Home took place on Wednesday 13th July 2005. During the inspection 5 service users and four members of care staff were spoken to about the care provided. Discussions were also held with the owners of the home, Mr and Mrs Smith. In addition to this a selection of records that the home keeps about the care it provides were inspected. This inspection focused on how people are admitted to Moorlands, the personal and health care provided by the home, how the home helps people manage their medication and how the home protects its service users from harm. Some areas of the homes maintenance and the standard of decoration were also looked at. What the service does well: What has improved since the last inspection? What they could do better: There are a number of areas where Moorlands could improve and in most cases these have been identified during previous inspections, but have not been addressed. These areas include the records that the home keeps of the care it provides and the needs of its residents (care planning), the way help with medication is provided, the maintenance and decoration of the building, and the way the home monitors its own performance, including meeting requirements and recommendations made during inspections in a more timely way. CSCI is now working with the providers to ensure that prompt action is taken to resolve these issues. Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 6 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 Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 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 Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 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) 1 & 3 An up to date Statement of Purpose and Service User’s Guide are not currently available to service users. This means that the information contained in these documents is not available to prospective service users when deciding if they want to move into Moorlands. All service users have an assessment of their needs before moving in to Moorlands. This helps to make sure that the home can meet the needs of the people who live in the home. EVIDENCE: A Statement of Purpose and Service User’s Guide have been developed following the guidance given during the last inspection. However, these documents have not yet been printed and made available to service users. These documents must be made available as required by the Regulations and Standards and used as working documents without any further delay. All new service users are admitted to the home following an assessment of need by a member of the home’s staff. This assessment includes information gathered from social services, health professionals and family members where Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 9 this is appropriate. Information about this process was available on the files inspected. Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 &11 All service users have a plan of care, but these must be improved to ensure that staff are fully aware of the health and care needs of individual service users and that these needs are fully met. The service users spoken to during this inspection felt that their health and personal care needs were being met, although improvements are needed in care planning and professional advice is needed in some areas to ensure that this is the case. Some improvements are needed in the way medication is managed to ensure that the home’s practice meets legal requirements and protects service users. Service users consulted during this inspection felt that their privacy and dignity was respected. EVIDENCE: During this inspection four care plans and care records were inspected and showed that all service users have a basic care plan and record of their care needs in place. These records showed that little progress had been made in the development of care planning at the home since the last inspection. Some aspects of this, such as monthly care reviews had actually worsened since the Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 11 last inspection, with some of the information contained in the care plans appearing out of date. As a result the same recommendations and requirements have been made in this inspection report as in the last report (see requirements and recommendations section, page 21). It is expected that care planning and care records development will now take place without further delay and a plan of action has been agreed with the providers. A recent complaint had been received by CSCI about the management of continence at Moorlands. The complainant was concerned that incontinence pads were not being used where service users had been assessed as needing them. The provider has recently reviewed the way that continence is managed at Moorlands, with the aim of maintaining continence through regular toileting programmes rather that the use of pads. This approach has advantages in maintaining independence, dignity and continence where it is implemented appropriately. However, there was some concern expressed by staff and some service users that indicated that in some cases this approach may be having a detrimental effect on dignity and wellbeing of some service users. One service user gave the following example of how they were effected; ‘I don’t like sitting downstairs, you can’t sit on the chairs, because they wet the chairs……you don’t realise when you’re sitting down, then you get up and your skirt is damp’. Staff also expressed some concern that in some circumstances the approach was having a detrimental effect, such as people having ‘accidents’ despite frequent toileting because of lack of bladder control or awareness. In addition to these concerns there were some shortfalls noticed in the toileting chart documentation and care plans, for example these documents didn’t always state clearly how often each individual should be toileted and the actual times of toileting fluctuated and didn’t always match to toileting frequency where this were specified. Discussions with the provider indicated that the approach was being implemented with the best interests of service users in mind, but it is recommended that the advice of the local continence adviser is sought to ensure that the approach is implemented appropriately for all service users, according to their individual needs. A selection of records relating to the storage and administration of medication were inspected. Staff who administer medication had been suitably trained and one demonstrated to the inspector how medication was safely administered at Moorlands. Photographs of service users have now been added to the medication administration charts, as recommended during the previous inspection. However, staff responsible for the administration of medication were unclear if a controlled drugs register had been implemented since the last inspection. No controlled drugs were currently being used in the home, but systems must be in place and staff must be aware of legal requirements in case they are used again in the future. There were also some parts of the medication audit trail that were unclear, particularly around medication that was not prescribed in the monitored dosage system or where medication was prescribed in variable doses (for example, one or two tablets as needed). This needs to be reviewed to ensure that there is a clear and Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 12 auditable record of all medication entering the home, being administered and leaving the home. The service users spoken to during this inspection were complimentary about the attitude of staff and the way that care was provided at Moorlands. One service user described how staff always ‘knocked or shouted are you alright’ before entering their room and everyone spoken to commented about the willingness of staff and management to help. The people spoken to indicated that they felt that their needs were being met and that help from the doctor or other professionals was accessed when needed. Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 13 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) These standards were not assessed during this inspection. EVIDENCE: Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 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 standard(s) 18 The home’s policies and procedures covering adult protection and the referral of staff to the POVA list need to be developed to ensure that service users are adequately protected from the risk of abuse. EVIDENCE: There remain two outstanding requirements from the previous inspection that need to be addressed as soon as possible. The home’s adult protection policy and procedures need to be developed to reflect the local multi-disciplinary procedure for the protection of vulnerable adults and ‘no secrets’ guidance. In addition to this procedures for the referral of appropriate staff for inclusion on the POVA list also need to be developed. Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 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 standard(s) 19 Improvements are needed in the homes maintenance and décor to ensure that service users continue to have a comfortable and pleasant place to live. EVIDENCE: A full inspection of the homes premises was not carried out during this inspection. However, a number of concerns were raised during the inspection that need to be addressed. These include the state of the dining room (which had been stripped of wall paper four or five weeks previous to the inspection and was still not decorated), gutters that had large plants growing out of them and needed clearing out, badly marked carpets in the reception areas and badly marked wall paper in the downstairs lounge. Some staff indicated that they now felt that the place was looking ‘scruffy’ and that it could be embarrassing when people came to look round Moorlands. Discussion with the home’s owners indicated that they have plans to decorate the dining room and downstairs lounge during August 2005, including fitting new carpets and new furniture. They have also purchased a new industrial carpet cleaner to help maintain the carpets. However, given the other concerns identified it is recommended that a maintenance audit and plan be completed to identify what tasks need doing and how and when these will be completed. Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 16 During the inspection a number of doors in the home were propped open using wooden chocks or furniture. It is required that advice is sought from the Fire Authority about safely propping open doors and that self closing door guards are provided where this is considered necessary to protect service users in the event of a fire. A copy of the locally agreed fire protocol was provided during the inspection for guidance. In addition to the above the home’s policies and procedure covering infection control still needs to be further developed to reflect the home’s practice. Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 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 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) These standards were not assessed during this inspection. However, staff would still benefit from training in the area of Learning Disabilities, due to the needs of some residents living at Moorlands. EVIDENCE: Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 18 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) 33 Improvements in the home’s own quality assurance systems are needed, to ensure that prompt action is taken to address shortfalls in the service provided and to ensure that ongoing improvements are made. EVIDENCE: Improvements are needed in the home’s quality assurance systems. It is concerning that very little progress has been made since the last inspection and that a large number of requirements and recommendations have not been addressed. The Commission for Social Care Inspection has agreed to work closely with the owners of Moorlands to ensure that the required improvements are now made within appropriate timescales. Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 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 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x 1 x x x x x Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 20 Yes 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 1 Regulation 4&5 Requirement The Statement of Purpose and Service Users Guide must be made available to all service users in accordance with the Regulations and Standards. Risk assessments must be developed in more detail and linked to the care plans that relate to each area of risk (for example, a moving and handling or falls risk assessment should be located with the resulting care plan for mobility or manual handling and the care plan should include any action identified as necessary by the risk assessments).· This was a recommendation in the last inspection report, but has not been addressed by the providers. Care plans must be developed to include more detailed information about the care needs of each individual. This was a recommendation in the last inspection report, but has not been addressed by the providers. Care plans must be reviewed monthly or more often if Timescale for action 31st August 2005 2. 7 13(4) 31st October 2005 3. 7 15(1) 31st October 2005 4. 7 15(2) 31st October Page 21 Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 5. 8 12(1) & 13(4) 6. 8 12(1) & 15(1) 7. 8 12(1) & 15(1) 8. 9 13(2) required by the changing needs of each service user, to ensure that each plan of care is kept up to date. This was a recommendation in the last inspection report, but has not been addressed by the providers. It is required that the home implements a risk assessment tool for the maintenance of skin integrity (for example, the waterlow score). This was a recommendation in the last inspection report, but has not been addressed by the providers. Care plans must be developed to include more detailed information about the health care needs of each individual (for example, care plans for maintaining continence should include the type of pads a service user needs, details of any toileting programme and the input of other professionals, such as continence adviser or catheter care by district nurses). This was a recommendation in the last inspection report, but has not been addressed by the providers. Weight must be monitored on a monthly basis and more often if required by the needs of the service user. The provider has recently purchased ‘sit on’ scales so that all service users can be weighed accurately and at appropriate intervals. This was a recommendation in the last inspection report, but has not been addressed by the providers. Medication records need to be reviewed to ensure that there is a clear and auditable record of 2005 31st October 2005 31st October 2005 31st October 2005 31st August 2005 Page 22 Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 9. 18 13(2) 10. 18 13(6) 11. 12. 19 19 16 (1)(c) & 22(3)(b) 13(4) 13. 33 24 all medication entering the home, being administered and leaving the home. This includes medication not prescribed in the monitored dosage system. Some amendments are still required to the homes adult protection procedures. This requirement is outstanding from two previous inspections. Procedures for the referal of appropriate individuals for inclusion on the POVA list still need to be developed and integrated into the homes formal policies and procedures. This requirement is outstanding from the previous inspection. The dining room and downstairs lounge must be re-decorated and recarpeted. It is required that advice is sought from the Fire Authority about safely propping open doors and that self closing door guards are provided where this is considered necessary. Effective quality assurance and quality monitoring systems must be put in place and should include consultation with service users and their representatives. This Requirement remains outstanding from previous inspections. 31st August 2005 31st August 2005 30th September 2005 31st October 2005 31st January 2005 14. 15. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 23 Moorlands Residential Care Home 1. 8 2. 7 3. 4. 9 9 5. 19 6. 26 7. 8. 9. 10. 11. 12. 13. 30 Care plans must be structured in an easier and more user friendly way (for example, using an index and subject dividers). This recommendation is outstanding from the previous inspection. A printed daily record sheet must be developed and routinely used, instead of loose A4 paper. This recommendation is outstanding from the previous inspection. It is recommended that the input of a continence adviser is sought to advise on the homes use of incontinence pads and toileting programmes. Given that the home has to store insulin and other medication that requires refrigeration for a number of service users, it is recommended that a small medications fridge is provided. This recommendation is outstanding from the previsou inspection. It is recommended that a maintenance audit of the premises is carried out to identify maintenance tasks that need to be done (for example, clearing out the guttering, identifying areas that need redecoration) and a maintenance plan drawn up covering how and when these tasks will be completed. The current vista point policy and procedure for the Control of Infection in the care home should be individualised to reflect the homes circumstances and practices. This recommendation is outstanding from previous inspections. Training in the area of Learning Disabilities is recommended. This recommendation is outstanding from previous inspections. Moorlands Residential Care Home B54 S0811 Moorlands V228407 130705 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection No.1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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. 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