Inspection on 23/05/06 for Moorlands Residential Care Home

This inspection was carried out on 23rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Moorlands Residential Care Home 24/08/07

Moorlands Residential Care Home 31/01/07

Moorlands Residential Care Home 19/01/06

Moorlands Residential Care Home 13/07/05

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 Moorlands 57/61 Stanhope Road Darlington Durham DL3 7AP Lead Inspector Rachel Dean Unannounced Inspection 09:15 23 , 24 May & 7th June 2006 rd th 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 Residential Care Home DS0000000811.V292842.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 Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moorlands Residential Care Home Address Moorlands 57/61 Stanhope Road Darlington Durham DL3 7AP 01325 487413 01325 487413 moorlands911@aol.com 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) Mr David Hodgson Smith Mrs Michelle Smith Mrs Michelle Smith Care Home 19 Category(ies) of Learning disability (1), Mental disorder, registration, with number excluding learning disability or dementia (1), Old of places age, not falling within any other category (17) Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Rooms 18 & 19 Are to be occupied at all times by independently mobile service users 19th January 2006 Date of last inspection 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 residents. The home is made up of a converted terrace of town houses and is pleasantly situated, overlooking a park and within walking distance of Darlington town centre. The home’s bedrooms and communal spaces are arranged over four floors, with a passenger lift providing access to three floors. Bedrooms are located throughout the building. Two of the bedrooms are only accessible by stairs and a condition of registration has been made requiring that these rooms are occupied only by people who are independently mobile. Communal space in the home includes two lounges, a dining room and a patio and garden area to the rear of the property. Communal toilets, two bathrooms and a shower room are located throughout the home. At the time of this inspection it cost £355 per week to live at Moorlands. Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection. It included site visits to the home on 23rd and 24th May and a feedback meeting with the home’s owners on 7th June. During the inspection the inspector talked with service users and their relatives about their experiences of living in and visiting the home. A selection of staff who work at the home were spoken to, including the home’s owners, deputy manager and a selection of care staff. Surveys about the home were also completed and returned by service users and their relatives. In addition to this consultation the inspector looked around the home and inspected a selection of records. What the service does well: What has improved since the last inspection? What they could do better: Some serious things were found to be wrong with the maintenance of the home, including a bathroom that had been out of order for two months, a badly damaged sink in a service user’s bedroom and a sink that had fallen off the wall in the remaining working bathroom. An immediate requirement notice Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 6 was issued during the inspection to make sure that these things were put right quickly. Although some parts of the home have been redecorated and refurbished, other areas are looking tired and worn, with old furniture and marked carpets. Other maintenance work, like the renewal of the homes electrical installation certificate is overdue. Comments made about the home included ‘the maintenance of the home needs to be ongoing, we’ve got used to it, but it needs work, needs bringing up to scratch’ and ‘its scruffy in parts’. Some concerns were identified around staffing levels in the home. At the time of this inspection the home had only six hours of domestic support each week, because the main member of domestic staff had left. In addition to this, care staff levels were not always being maintained at the levels they should be and care staff were having to cover additional domestic tasks, as well as the usual laundry and preparation of the tea time meal. An immediate requirement notice was issued during the inspection to make sure that staffing levels were maintained at appropriate levels. Comments from people living in, working in and visiting the home included ‘a little bit light on the staffing’, ‘at the moment there are lots of shifts to cover’, ‘we’re weary’, ‘it can be very hectic, particularly tea time’ and ‘they don’t have a lot of time to sit and talk to you because they are busy, but they are always there for you’. 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 DS0000000811.V292842.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 Residential Care Home DS0000000811.V292842.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 The overall quality rating for this outcome area is judged to be good. This judgement was made following this key inspection of then home, which included a site visit. Residents are admitted to Moorlands after their needs have been assessed and information has been collected from relevant professionals. This helps to make sure that Moorlands can meet residents’ needs before they are admitted. Moorlands Residential Care Home does not provide intermediate care. EVIDENCE: During this inspection the records of two people who had recently been admitted to the home were inspected. Basic assessments of need had been completed before admission and assessment information from the commissioning local authority was available in their records. Moorlands did not provide intermediate care at the time of this inspection. Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 & 10 The overall quality rating for this outcome area is judged to be adequate. This judgement was made following this key inspection of then home, which included a site visit. A new care planning and recording system is in the process of being introduced at Moorlands. However, this needs to be completed and developed to ensure that staff have access to detailed and up to date information about the care and support people need. People living in the home felt that their health needs were met and that the advice and support of other professionals was sought when needed. However care planning needs to be developed to make sure that a proactive approach is taken to identifying and meeting health care needs. Medication recording and administration need to be improved to ensure that service users medication is being handled and administered safely. The people living in and visiting the home felt that the owners and staff cared about the residents and did their best to treat them well and meet their needs. EVIDENCE: Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 10 Since the last inspection a new care planning and recording system has been developed at the home. The care plans that had been completed contained detailed and personal information about the preferences and care needs of the individual, and had involved the resident or their representative. However, at the time of this inspection all of the new care plans had not been fully completed. It is important that the care plans are completed as soon as possible, so that staff have access to all of the information about service users needs and so that they can be kept up to date as working documents. The home also needs to review how it carries out individual risk assessments for residents and make sure that care plans are in place for all areas that are relevant for each resident (for example, care plans for psychological and mental health where appropriate). Some quality issues were also identified. For example, not all records had been signed and dated by the author and lined paper was being used for care plans, rather than a form designed for that purpose. The people who were spoken to felt that medical assistance was always sought promptly when it was needed. People also felt that the advice of other professionals was sought when this was appropriate. However, some important parts of the care planning records, like skin integrity risk assessments (waterlow), were not all completed. This is important so that risks to people’s health can be identified and a proactive approach taken to maintain their health and wellbeing. The staff who are responsible for administering medication have undertaken in-house training and a ‘safe handling of medication’ course through a local college. During this inspection a selection of medication records and the homes storage arrangements for medication were checked. Since the last inspection a new medication trolley and medications fridge have been installed in the home. This has improved the medication storage arrangements in the home. However, a number of recording errors were found. For example, the recording of medication administration did not always tally with the medication stock that was left. A member of senior staff has been given lead responsibility for medication in the home and is introducing a regular audit system to identify errors and put them right. The people living in and visiting the home spoke highly of the owners of Moorlands and the staff working there. Comments included ‘the staff are all good, naturally you have your favourites, but they’ll all do anything for you, and David and Michelle (the owners), you couldn’t ask for two nicer people’, ‘they don’t have a lot of time to sit and talk to you because they are busy, but they are always there for you’ and ‘I do feel genuinely that David and Michelle (the owners) care very deeply about residents and their families’. The residents spoken to thought that staff did their best to treat people well and cater for their individual needs. Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 & 15 The overall quality rating for this outcome area is judged to be adequate. This judgement was made following this key inspection of then home, which included a site visit. The home provides a regular programme of activities. However, residents expressed mixed levels of satisfaction with the activities provided in the home, with some wanting more outings and craft, while others were satisfied with what was on offer. The home has an open visiting policy, with people being able to visit the home at times convenient to them and their relative or friend. Service user’s had mixed views about choice, with more choice felt to be available in some areas than others and depending on how able you were to ask for things. The home provides a traditional and balanced diet for its service users. However, some residents and staff felt that the teatime meal and suppers could be improved. EVIDENCE: Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 12 The home does not employ a specific, designated activities coordinator, but one of the care staff helps to coordinate activities in the home. Regular activities include bingo, film afternoons and evenings, a weekly visit from a manicurist, exercise classes and visits from entertainers. The home has access to a mini bus for outings, but staff confirmed that it can sometimes be difficult to organise outings, especially if staffing levels are low. Service users had mixed views about the activities provided in the home, with quite a few people feeling that they would like more trips out and more opportunities to do craft. Other service users were happy with the activities provided. Some of the staff and residents spoken to felt that activities had suffered a little recently due to the home’s current difficulties with staffing levels. For example, trips not happening as often as people would have liked and people who need assistance to go out having to wait until staffing levels allowed this. The home has an open visiting policy, with people being able to visit the home at times convenient to them and their relative or friend. Residents and visitors who were spoken to during this inspection confirmed that visitors could come and go as they want and that there were no unnecessary restrictions on visiting times. The relatives spoken to spoke highly of staff and owners at the home and of how welcome they were made to feel. Discussions with the home’s owners, residents, relatives and staff working at the home indicated that people working at the home are very caring in nature and that they try hard to provide person centred care. However, some residents had mixed views about the choice available to them at Moorlands. The home’s routines around getting up and going to bed were thought to be flexible, as were the arrangements for having visitors. Overall people felt that staff did their best to provide person centred care. However, a number of service users felt that the choices and availability around food and activities could be improved. Menu’s showed that a traditional range of meals was being provided at Moorlands, with a main meal and pudding at lunchtime and sandwiches or a cooked alternative in the early evening. The kitchen staff go home after lunch, so care staff are responsible for preparing and serving the tea time meal. No formal alternative is available at lunchtime, but residents confirmed that alternatives were available if you asked for them. Comments made about the food included ‘I’m a fussy eater. If there is something on the menu I don’t like they always find me something else’, ‘by and large pretty good’ and ‘a bit repetitive in a way’. The main concern expressed by residents and staff was about the teatime meal and supper. Some residents and staff did not feel that there was always enough provided, with no seconds available if people were hungry. This had been raised in residents meetings and comments made to the inspector included ‘teas are sometimes a bit embarrassing to give, because it’s not something you would eat and the portion sizes aren’t great’ and ‘the evening meal and supper, not enough’. Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 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 the following standard(s): 16 & 18 The overall quality rating for this outcome area is judged to be adequate. This judgement was made following this key inspection of then home, which included a site visit. A complaints policy and procedure is in place and records suggested that complaints were being handled appropriately by the home. Further amendments are needed to the home’s adult protection procedures, to ensure that all suspicions and allegations of possible abuse are reported appropriately. EVIDENCE: The home has in place a complaints policy and procedure and a complaints records was available and was inspected. There have been no recent complaints made directly to CSCI about Moorlands or made directly to the owners themselves. Previous complaints appeared to have been investigated appropriately. Policies and procedures for referring appropriate staff for inclusion on the Protection of Vulnerable Adults (POVA) list and for handling adult protection allegations are in place. However, although the adult protection procedure has been reviewed recently, it would still benefit from being clearer about how and when adult protection referrals should be made and the role of the local authority in the referral process. Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 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 the following standard(s): 19, 21, 25, 26 The overall quality rating for this outcome area is judged to be poor. This judgement was made following this key inspection of then home, which included a site visit. The home is not currently being well maintained. Serious concerns about the home’s maintenance were identified and need to be addressed. At the time of this inspection one of the home’s bathrooms had not been in working order for some time and the other bathroom was not in full working order. This meant that residents did not have sufficient washing and bathing facilities. There are currently inadequate arrangements for domestic tasks at the home. This needs to be addressed so that residents live in safe and clean surroundings. EVIDENCE: Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 15 Although some parts of the home have been redecorated and refurbished, other areas are looking tired and worn, with old furniture and marked carpets. For example, in bedroom 10 the wallpaper boarder was hanging badly off the wall and needed to be replaced. Comments made about the home included ‘the maintenance of the home needs to be ongoing, we’ve got used to it, but it needs work, needs bringing up to scratch’ and ‘its scruffy in parts’. On a positive note some people described the home as ‘homely’ and the bedrooms that were observed had been personalised with people’s individual possessions. However, some serious things were found to be wrong with the maintenance of the home, including a bathroom that had been out of order for several months, a badly damaged sink in a service user’s bedroom and a sink that had fallen off the wall in the other bathroom. An immediate requirement notice was issued during the inspection to make sure that these things were put right quickly. It is also required that the owner’s develop a regular maintenance audit of the premises and a formal maintenance plan, to ensure that ongoing maintenance takes place in a timely way. At the time of this inspection the home had only six hours of domestic support each week. This was because the main housekeeper had left the home’s employment approximately six weeks earlier. Observations made during the inspection showed that some domestic tasks were not getting done as quickly or regularly as would be desirable. For example, some commodes were not very clean, some carpets were marked and in need of cleaning, some areas of the home needed hoovering and the downstairs bathroom (the only bathroom currently in working order) was being used to store a mattress and clean laundry that was waiting to be put into people’s rooms. Comments made about this included ‘they don’t have a domestic, the girls (care staff) are doing the laundry and the cleaning, but it’s not getting bottomed’ and ‘some things aren’t getting done straight away, like the toilet was left all marked and wasn’t cleaned until later in the night’. The home does not have a laundry assistant, with care staff being responsible for doing the laundry for both the home and the external laundry service. During resident meetings some people had raised concerns about the laundry service provided by the home. These concerns included things not always getting returned or being returned to the wrong people. One of the relative’s spoken to had started to take their laundry home, because they didn’t feel it was getting cleaned properly at the home. Comments made about the laundry during this inspection included ‘things don’t come back or the wrong persons, I’ve a draw full of odd socks’, ‘I don’t have any problem, just recently there was a back log of laundry and our stuff wasn’t back as quickly. When a big load of external laundry comes in it takes longer. Odd times something goes missing or ends up in other rooms, but I ask or give stray stuff back to staff’ and ‘it would benefit from someone responsible for the domestic and laundry, so there’s a clearer line of responsibility’. Arrangements need to be made to ensure that here is adequate domestic support in the home to meet the needs Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 16 of the residents and cover any additional work that is created by the external laundry service. Moorlands Residential Care Home DS0000000811.V292842.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 The overall quality rating for this outcome area is judged to be poor. This judgement was made following this key inspection of then home, which included a site visit. Staffing levels in the home were not being maintained at appropriate levels. They need to be maintained at appropriate levels to meet the needs of the residents and take into account any additional demands that are placed on care staff. A high number of staff who work in the home have achieved National Vocational Qualification (NVQ) in care. Suitable recruitment procedures are in place. This makes sure that the staff working in the home are suitable to work with vulnerable people. Staff are trained and competent to do their jobs. However, some specialist training would be beneficial to make sure that staff are fully aware of the needs of some residents. EVIDENCE: Some concerns were identified around staffing levels in the home. At the time of this inspection the home had only six hours of domestic support each week, because the main member of domestic staff had left. Discussions with residents, relatives and staff confirmed that care staff were doing their best to cover the domestic tasks as well as their usual care duties. However, care Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 18 staff at Moorlands are also responsible for carrying out the laundry (including the external laundry service) and for the preparation and serving of the tea time meal, because the kitchen staff finish work after lunch. In addition to the additional domestic tasks that care staff were having to do, inspection of the rotas showed that the numbers of care staff were not always being maintained at the levels they should be. For example, sometimes only two members of care staff were on duty in the home for considerable periods. A number of residents living at Moorlands need two members of staff to assist them with mobility and personal care. Comments from people living in, working in and visiting the home included ‘a little bit light on the staffing’, ‘at the moment there are lots of shifts to cover’, ‘we’re weary’, ‘it can be very hectic, particularly tea time’, ‘moral is low’ and ‘they don’t have a lot of time to sit and talk to you because they are busy, but they are always there for you’. Accident records showed that since the last inspection there had been three accidents involving unsupervised falls during the daytime. One of these included a resident entering and falling in the kitchen whilst unsupervised. An immediate requirement notice was issued during the inspection to make sure that staffing levels are maintained at appropriate levels and adequately reflected the needs of the residents and any additional work that care staff undertake. The recruitment records for the three most recently employed staff were inspected. These records showed that new staff undergo the required checks before they start work, including obtaining two written references and a Criminal Records Bureau (CRB) Disclosure. Since the last inspection a form has been developed to help record any difficulties the home has in obtaining references and what action it takes to address this. Staff training records were inspected. Each staff member has a record of the training they have undertaken and the training that they plan to undertake in the next year. These records showed that staff training in areas like National Vocational Qualifications (NVQ’s), manual handling and first aid is being provided and that training plans are in place to provide the training that staff need over the coming year. Staff are undertaking training in dementia care and the staff spoken to were happy with the training provided. However, training in the needs of people with learning disabilities has still not been provided and would be beneficial due to the needs of some of the residents living at the home. Moorlands Residential Care Home DS0000000811.V292842.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, 36 & 38 The overall quality rating for this outcome area is judged to be poor. This judgement was made following this key inspection of then home, which included a site visit. The home has suitably qualified and experienced owners. However, there are concerns that the owners are not currently discharging their management responsibilities fully. Improvements in the home’s own quality assurance systems are still needed, to ensure that prompt action is taken to address shortfalls in the service provided and to ensure that ongoing improvements are made in a timely way. Safe systems are in place to help service users manage their personal monies, where this assistance is needed. Supervision systems are in place, although not all of these sessions covered all of the issues relevant to the individual staff member. Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 20 Although some health and safety checks and systems are in place, improvements are needed to ensure the ongoing safety of service users. EVIDENCE: Moorlands Residential Care Home is owned and managed by Mr and Mrs Smith, who have run a care home for many years. Mrs Smith is the registered manager of the home and has achieved the registered managers award (RMA) and appropriate care qualifications. Residents, staff and visitors to the home were very complimentary about the owners’ caring nature and approachability. However, the manager is also currently registered as the manager of a domiciliary care agency and there is concern that this additional role is impacting on the managers ability to effectively manage the care home. These concerns have been raised by the large number of outstanding requirements and recommendations identified during previous inspections and the serious issues identified during this inspection. As a result of this it is required that an alternative manager is registered for the domiciliary care agency, so that the registered manager of Moorlands can concentrate on fulfilling their management responsibilities for the care home. The home’s management must now make serious and sustained improvements in the areas identified in this report, to demonstrate to CSCI that they have the capacity to manage Moorlands appropriately. Since the last inspection Moorlands owners have developed a Quality Assurance statement and started to put together a Quality Assurance file. This includes a plan of audits and surveys that are to be completed during 2006/07. Although the formal Quality Assurance system has not yet been fully implemented, the home does have some elements of quality assurance that are already in place. These include resident meetings that are held approximately every three months and regular staff supervision. However, given the concerns raised during this inspection about the maintenance of the building and staffing levels, there are concerns about the provider’s ability to identify and address problems independently and within appropriate timescales. The home has in place safe systems for the storage of residents’ personal monies. All monies are stored individually in the home’s safe, with individual records and receipts kept of expenditures. A staff supervision system is in place at Moorlands. The records of three staff were inspected and these showed that staff received supervision approximately once every two months. However, where staff are on probation and possible problems have been highlighted during the recruitment process (for example, possible language difficulties), it is important that these issues are reviewed during supervision to ensure that they are appropriately managed. Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 21 Supervision sessions should be effective and meet the needs of staff and residents. The home’s health and safety policy and procedure has recently been reviewed by the local authority. The policy and procedure currently does not contain all of the information that it needs to and it is required that it is reviewed in line with the local authorities recommendations. The last Electrical installation certificate for the home was issued in June 2000 and was due for renewal in June 2005. Moorlands owner’s state that an electrical installation check of the premises has recently been completed by a qualified electrician, but at the time of this inspection the certificate was not available to verify this. Maintenance records confirmed that lifting equipment was being maintained in accordance with the Lifting Operations and Lifting Equipment Regulations 1998. Since the last inspection a number of self closing devices have been fitted to doors that need to be propped open. However, during the inspection a number of bedroom doors were propped open with door wedges. This needs to be reviewed, with the guidance of the Fire Authority, to ensure that residents are adequately protected in the event of a fire. The inappropriate storage of items around the building should also be reviewed to prevent avoidable fire risks (for example, the mattress in the downstairs bathroom, the doors stored in the laundry corridor and the upstairs cupboard that is filled with clothes and cardboard boxes). Since the last inspection the home has undertaken fire training and started to implement ongoing fire training for staff. However, the Environmental Health Officer’s recommendation that regular portable appliance testing (PAT) be arranged to ensure that the electrical appliances used in the home are safe has not been carried out. Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 22 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 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X 1 X X X 1 1 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 3 X 1 Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement Care plans must continue to be developed so that detailed information about the care needs of each individual is available. This is outstanding from previous inspections. Timescale for action 31/07/06 2. OP7 12 & 13(4) 3. OP9 13(2) 4. OP17 16(2)(i) Care plans must be reviewed monthly or more often if required by the changing needs of each service user, to ensure that each plan of care is kept up to date. This is outstanding from previous inspections. The way individual risk 31/08/06 assessments for residents are carried out and completed must be reviewed to ensure that staff are aware of how identified risks are managed. A regular audit of the medication 30/06/06 records, stock and storage must take place to ensure that medication is being managed safely. This requirement is outstanding from previous inspections. The home must provide an 31/07/06 adequate diet for its residents. DS0000000811.V292842.R01.S.doc Version 5.2 Page 24 Moorlands Residential Care Home 5. OP18 13(2) 6. OP19 & OP21 23(1), 23(2)(b) & (j) 7. OP19 & OP21 23(1), 23(2)(b) & (j) 8. OP26 & OP27 18(1)(a) & 23(2)(d) 9. OP27 18(1) 10. OP33 24 11. OP31 10(1) Provision of the teatime meal and supper in the home must be reviewed to ensure that a sufficient diet is provided. Some amendments are still required to the homes adult protection procedures. This requirement is outstanding from previous inspections. The damaged sinks and bathroom must be replaced/repaired as required in the immediate requirement notice issued during this inspection. It is required that a regular maintenance audit of the premises is carried out to identify maintenance tasks that need to be done. A maintenance plan must be produced covering how and when identified tasks will be completed. Arrangements must to be made to ensure that here is adequate domestic support in the home to meet the needs of the residents and cover any additional work that is created by the external laundry service. Staffing levels must be maintained at appropriate levels and adequately reflect the needs of the residents and any additional work that care staff undertake, as required in the immediate requirement notice issued during this inspection. 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. The manager must be able to discharge their management DS0000000811.V292842.R01.S.doc 31/07/06 13/06/06 31/07/06 30/06/06 23/05/06 31/08/06 31/10/06 Page 25 Moorlands Residential Care Home Version 5.2 12. OP38 23(4) 13. OP38 13(4) 14. OP38 13(4) responsibilities fully. The registration of an alternative manager for the domiciliary care agency must be seriously considered. The practice of wedging open doors must be reviewed, with the guidance of the Fire Authority, to ensure that residents are adequately protected in the event of a fire. The home’s Health and Safety policy and procedure must be reviewed, in line with the local authorities recommendations. It is required that the home’s electrical installation certificate is renewed (it was due in June 2005). This requirement is outstanding from previous inspections. 31/07/06 31/08/06 30/06/06 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. Refer to Standard OP30 OP38 Good Practice Recommendations Training in the area of Learning Disabilities is recommended. This recommendation is outstanding from previous inspections. The inappropriate storage of items around the building should also be reviewed to prevent avoidable fire risks (for example, the mattress in the downstairs bathroom, the doors stored in the laundry corridor and the upstairs cupboard that is filled with clothes and cardboard boxes). It is recommended, in line with the Environmental Health Officer’s recommendation, that regular portable appliance testing (PAT) is arranged to ensure that the electrical appliances used in the home are safe. 3. OP38 Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Darlington Area Office 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. Extracts may not be used or reproduced without the express permission of CSCI Moorlands Residential Care Home DS0000000811.V292842.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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