Inspection on 14/12/07 for Moorlands Residential Home

This inspection was carried out on 14th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Moorlands Residential Home 18/03/09

Moorlands Residential Home 23/09/08

Moorlands Residential Home 18/07/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Moorlands Residential Home Moorlands Road Merriott Crewkerne Somerset TA16 5NF Lead Inspector Gail Richardson Unannounced Inspection 14th December 2007 09:45 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 Home DS0000067237.V354807.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 Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moorlands Residential Home Address Moorlands Road Merriott Crewkerne Somerset TA16 5NF 01460 74425 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) Darbyshire Care Ltd Mrs Jayne Marie Dadzitis Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Moorlands is a residential care home for up to 16 older people. The provider is Darbyshire Care Ltd. The manager with day to day responsibility for the home is Mrs Jayne Dadzitis. She leads a small team of staff. The home is situated in the village of Merriott. Local facilities including post office, church and pubs are available in the village. The home has pleasant and comfortably furnished communal areas. Bedrooms are arranged on the ground and first floor of the home. First floor accommodation is accessed by stairs and there are stair and passenger lifts. En-suite WC facilities are provided in all bedrooms. A small number of rooms have en-suite bathing facilities. The home has a pleasant patio area. The attractive garden is accessed by steps. The current fee range average is £400.00 per week. This does not include, toiletries, hair dressing and cost arising at some outings. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over 1 day (5 hours) on the 14th December 2007. A tour of the home took place and a selection of bedrooms and all communal areas were seen. There were 13 people using the service currently residing at the home. The inspectors spoke to 5 residents, and 4 members of staff, the Registered Manager was on leave and the care Supervisor was available throughout the inspection. All people using the service spoken to, and who were able, spoke of the staffs kindness and how much they enjoyed living at the home. The inspectors spent time talking to people using the service and staff and observed that on the day of inspection, residents appeared relaxed and comfortable in all areas of the home and the atmosphere was happy and calm. Records relating to care including 3 care plans, staff files, finances and health and safety records were examined. As part of this inspection the inspectors surveyed the opinions of a random selection of residents and their representatives, GP’s, District Nurses and Care Workers, a moderate response was received and their comments will be included in this report. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: The home is a large older building which has an ongoing maintenance programme to maintain the fabric and décor of the home. The home is clean and had no malodour, the décor and furniture was of a good standard. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 6 Pre admission assessment are made prior to all admissions and were detailed to ensure that the home can meet all the identified needs. Care plans were seen to identify each persons needs in an individual and personalised manner and staff use the care plans as a working tool to support and constantly re assess the person’s care needs. The care needs of people using the service appear well managed with the supporting involvement of visiting healthcare professionals. Activities provided are both individual and group activities and are appropriate to people using the service’s choices and preferences. The recording of activities was well documented to include how people had participated and how the activity could be developed to make it more person centred. All people using the service and staff were complementary about the choice, quantity and quality of food provided at the home. Nutritional intake is also monitored and appropriate action taken to support peoples choices and preferences. The manager had a positive leadership style, which reflects on the staff who feel supported by the management of the home. What has improved since the last inspection? Protection of Vulnerable Adults and Criminal Record Bureau Checks recruitment checks are now in place prior to all staff commencing employment to ensure that people using the service are protected from the risk of abuse. The fire alarm system is now tested on a weekly basis.A risk assessment is in place for the locked fire exit door and a key is available but not completely accessible to all staff. Some exposed pipe work relating to radiators have been covered with wooden protection to prevent the risk of injury to people using the service, however not all have been covered and an ongoing programme is in place to complete this task. Risk assessments are in place for some upper floor windows which do not have restrictors. Further review of risk must be undertaken and supporting actions to be taken as a result of this ongoing review. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 7 People using the service now have lockable storage in their bedrooms. The registered provider advised that the utility room floor has been measured for a replacement flooring and is due to be replaced. What they could do better: Medication systems are mostly complete but require review of hand transcribed medications to ensure that they are signed by 2 staff and dated on commencement to ensure that there is a clear audit trail of when medication was commenced and to reduce the risk of incorrect transcribing. Some creams were not signed and dated when commenced and one controlled medication quantity had not been updated in the Controlled Drug Book record and subsequently the total recorded was incorrect. This must be undertaken to ensure that a clear audit of medication prescription and administration can be followed. It s recommended that the home provide a policy for the staff to follow relating to wills and bequests to avoid any misinterpretation by staff and people using the service. Recruitment employment histories are recommended to be updated to ensure they are complete. Any gaps should be explored and documented to ensure that people using the service are not placed at risk. 8 upper floor windows were noted to be unrestricted and the risk of injury discussed with the supervisor and by telephone with the provider, as some people using the service were observed to have a degree of confusion and physical instability. An Immediate Requirement was made that these windows be further risk assessed and restricted immediately. It is noted that immediate action to restrict the windows was commenced by the homes Maintenance Staff who was obtaining restrictors during inspection. 2 wardrobes were seen to not be secured to the wall and may pose a risk of injury to people using the service. An Immediate Requirement was made that these be secured on the day of inspection. 2 Free standing radiators identified by the supervisor as a risk to people using the service as they were at high risk of falling over them where reassessed by the Supervisor and removed from the rooms during inspection. Further risk assessment is recommended by staff as an ongoing process, to prevent further risk of injury to people using the service. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 8 The locked fire exit door within the Coach House must be reviewed to ensure that all staff are able to access the key to unlock the door in the case of an emergency. The hot water delivery to some rooms is inadequate and the water was noted to be tepid. One en-suite had no hot water delivery and staff have to carry hot water from other areas to the rooms with insufficient supply. This is required to be reviewed to ensure that staff and people using the service are not at risk of scalds by carrying hot water. The storage of dental tablets is required to be risk assessed to avoid the risk of accidental ingestion. The registered manager is required to forward regulation 37 notifications to CSCI offices when any of the required notifications take place. An audit of falls is recommended to identify trends and incidences to attempt to reduce further accidents. 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. The summary of this inspection report can be made available in other formats on request. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 9 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 Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is able to provide prospective people using the service and relatives with sufficient information in the format of the Service User Guide and Statement of Purpose for them to make an informed decision about the home. All prospective residents receive a pre admission assessment by the registered manager to ensure the home can meet the assessed needs identified. EVIDENCE: 3 Residents surveys received stated that all felt they had received enough information prior to admission, about the home to make an informed decision. Comments received included; ‘Helpful and welcoming staff on our first visit. Warm friendly atmosphere came across straight away’ and ‘Obviously contended, smiling staff and residents.’ Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 11 Prospective residents and their families/representatives are able to visit the home and spend time there before they make a decision on residency. Short term respite care is available. 3 care files were examined, pre admission assessments had taken place to ensure that the home could meet the prospective persons social, health and care needs. One person using the service confirmed that their family had chosen the persons bedroom and all people using the service were happy with the room provided for them. Contracts were not examined at this inspection. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person using the service has a care plan, the assessed areas of need were reflected in this plan of care and the detail recorded ensures that staff can provide a good standard of care. Staff were observed to treat service users with dignity and respect at all times and residents fell well cared for. Medication systems were mostly correct and require the changes discussed to meet the standard. EVIDENCE: 3 care plans were examined and were of a good standard and provided staff with the details of identified risks and made a plan of care to meet these risks. These were written in a clear and concise manner and showed that a detailed assessment had taken place to ensure that each persons care plan was detailed and personal to their choices and preferences. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 13 Residents and relatives were consulted in the care planning process and the routine monthly reviews. Support was evident from visiting health professional where an need had been identified and records were maintained of GP and District Nurse visits. When asked do you receive the care and support you need, 3 surveys said always and 2 said usually and 4 felt they received the medical support they needed and 1 said usually. 7 staff surveys received, confirmed that these staff were involved in care planning for residents. Inspectors spent time observing the care being given and noted that staff treated people using the service with dignity and respect at all times. People using the service appeared relaxed in the company of the staff and the atmosphere was happy and calm. People using the service were observed to shows signs of well being and contentment. Medication systems were mostly correct and appeared to be mostly well managed, staff had undergone medication training the day before. It was noted that hand transcribed medications were not always signed and dated by 2 staff, some creams were not named and dated when opened and there was an error in the total of a controlled medication stored. These issues were discussed with the supervisor on duty and later with the manager and these areas must be addressed to ensure there is no risk of accidental mis administration of prescribed medications. People using the service have the opportunity to self medicate if requested with lockable storage available in each room and risk assessments in place. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are opportunities for social stimulation and people are supported to join in with organised activities or pursue their own interests. The choice of activity is led by the preferences of people using the service. The recording of activities promotes and supports development of activities being person centred. The meals in the home are of a good quality and a range of choice is available. EVIDENCE: Resident’s surveys asked are there activities arranged by the home that you can take part in, 1-always, 3-usually, 1-sometimes. Comments included ‘Brilliant outings and activities, lots to do. Peaceful times respected too-Thank you.’ And ‘Could do better with more activities and out for residents’. On the day of inspection the activity coordinator spent time during one to one sessions with people using the service who wished to remain in their rooms. Late morning a quiz took place which people were observed to enjoy and join in with. This quiz was managed in such a away to create discussion and social interaction between other people using the service and staff. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 15 Some people using the service were assisted to the shops and out with friends and relatives. The hairdresser was also at the home and the atmosphere was busy and cheerful. Each care plan has a social history and choices of activities. The recording of activities included peoples participation and enjoyment. The activity staff explained that this record is used to develop further activities to ensure people got the most out of the activities provided. The people using the service were able to tell the inspector about other activities provided and most felt that they had enough activities and social interaction provided at the home. The routines of the home are led by the choices of people using the service who confirmed that they could get up and return to bed when they wanted to. They confirmed that visitors to the home are welcome at any time and are always made welcome. The inspector discussed the meals with people using the service who all confirmed that the standard and choice of food is very good. The staff advise people using the service of the choice for the day which is then given to the cook Comments included; ‘They are given a wide choice of good food including different dietary needs’ and ‘Lovely food, varies depending on the cook’. People were seen to eat both in the dining room and in their bedrooms depending on their preference. The dining room was laid with nice linen and background music was playing, this created a pleasant dining atmosphere. The mid day meal looked pleasant and appetising and people using the service confirmed that they had enjoyed it. The lunch comprised of Mariners Pie with fresh vegetables or cutlets and chips followed by pear upside down cake and custard. The evening meal was bacon rolls with a choice of 4 desserts made freshly at the home. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 17 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff and residents are confident that the homes management team would appropriately deal with any complaints or concerns. Policies, procedures and training are available to staff to ensure they have the knowledge to prevent service users from the risk of abuse Further training in abuse awareness is planned. EVIDENCE: 3 people using the service surveys, confirmed that they knew how to make a complaint and surveys confirmed that people knew who to speak to if they were unhappy, 2 said they did not. On the day of inspection all people using the service who spoke with the inspector, felt able to speak to the staff about any concerns and would feel confident that the issues would be dealt with in an appropriate manner. One person commented ‘I have no problems but if I had any I would speak to the staff’. The home has no ongoing complaints and no concerns about the home have been raised with CSCI. The complaints policy was displayed within the home and contained the contact details for CSCI. The staff on duty who were asked were aware of the homes whistle blowing policy. The registered manager is recommended to include the contact details for CSCI on the whistle blowing Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 17 policy to enable an alterative means of contact to be available to staff and people using the service. The registered manager is recommended to provide a policy outlining the homes directives for staff regarding wills and bequests to support and protect both staff and people using the service. 8 staff surveys confirmed that they were aware of policies about protecting vulnerable adults and how you report any concerns about poor care practice or allegations of abuse. In house abuse awareness training has taken place provided by the manager and provider, further training is planned. All 8 staff surveys received confirmed that they had received a Criminal Record Bureau Check and examination of recruitment files confirms that these check were undertaken before staff commenced employment. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is a large older building, which appears to be well maintained, the home provides sufficient and suitable facilities but requires further attention to some environmental health and safety areas. The standard of hygiene is good. The gardens are attractively laid out and suitable for people using the service use. EVIDENCE: A selection of bedrooms and all communal areas were seen at this inspection. The home is pleasantly decorated with décor and furnishings of a good standard, the home was clean and appeared well maintained. The home provides 1 lounge area and a large dining room. All bedrooms seen were of a good size and were pleasant and airy. There is mostly level access around the home and people using the service have access to other floors via a passenger lift or stair lift. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 19 The garden area was pleasant and accessible to people using the service. There are suitable and sufficient toilet and bathing facilities. The upstairs Parker bath was noted to not have any overflow facility and staff must be aware of the risk of overflowing. Bedrooms were personalised with service users photographs and some small personal belongings and pieces of furniture and TV’s and call bells were available in each room. 2 wardrobes were noted to not be secured to the wall and may place people using the service at the risk of injury. An Immediate Requirement was made that this be rectified. One wardrobe was later noted to have been fixed. Some radiators remained uncovered and may place people using the service at the risk of burns should an accident take place. The maintenance staff on duty confirmed that an ongoing program of radiator covers being fitted is underway. Risk assessments for radiators uncovered in peoples bedrooms were noted. An audit undertaken by home states expected completion of radiator cover fitting is August 2007. During the inspection the supervisor on duty observed that 2 free standing radiators were being used in bedrooms, which due to the person mobility risks they felt that they were at a high risk of falling over them. The supervisor took the immediate action of removing this risk. It was noted that some bedrooms did not have access to sufficiently hot water and the water appeared tepid. One en-suite did not have any hot water available. When asked, staff confirmed that they had to carry hot water from other areas of the home for people to use for washing. The home is strongly recommended to review the supply of hot water to ensure that suitably warm water is available which does not exceed 43 degrees. The general standard of cleanliness was very good. Residents surveys confirmed that the home is always clean and fresh, 4- always and 1- usually. One comment received was; ‘I feel the residents rooms are always kept very tidy and clean’. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home are adequate to meet the assessed needs of people using the service and staff training is promoted to support these people. The induction process for staff is recommended to involve the Skills for Care, Common Induction Standards. The recruitment procedures within the home require further detail to protect the people using the service from risk. EVIDENCE: On the day of inspection there were 2 staff on duty, the registered manager was on leave and a supervisor was in charge. Also on duty were 1 cleaner, 1 cook, 1 activity staff, 1 maintenance staff and 1 hairdresser. Rota’s examined evidenced a consistent level of staff and discussions with staff confirmed that the home had an established staff team who have worked together for a period of time. Staff and people using the service felt there were adequate staff available. Staff feel they communicate well and comments included ‘We usually are told by senior staff and information is also available in the care plan. We have also note books where we put down changes.’ And ‘information is passed on by previous staff before you start a shift and notes left in book e.g. to read something new in the care plan.’ Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 21 7 staff returned comment cards to CSCI, all staff confirmed that they felt they had received adequate induction and supervision when they commenced their job. 7 staff confirmed that they were clear of what the service users needs were and also all staff were aware of the duties they must not undertake. One staff commented ‘I had a very good induction ‘. The registered manager confirmed that induction programme includes the Skills for Care Common Induction Standards, which aims to give all new staff a thorough understanding of the role of the care worker. This was not available at this inspection and will be reviewed at the next inspection. 11 staff have successfully completed NVQ training and this exceeds the 50 of staff recommended by the National Minimum Standards All staff training records were up to date and action had been taken to ensure that there was available on each shift a carer with a suitable first aid qualification. All statutory training is recorded as having been completed Recruitment procedures were examined and were mostly adequate to ensure that people using the service were not placed at risk. Some gaps were noted in employment history and the registered manager is recommended to ensure that all gaps are explored and documented prior to staff commencing employment. The manager is also recommended to ensure that references are received from the most recent employer to ensure that people using the service are not placed at risk. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 35 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is effectively managed and benefits from the positive and proactive management style of the registered manager. People using the service monies are managed in a safe and auditable manner. Some health and safety procedures need to be reviewed to ensure the safety of people using the service. EVIDENCE: The registered manager of the home is Jayne Dadzitis who has managed the home for over 6 years. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 23 Both staff and people using the service told the inspector that they had confidence in the management of the home and the leadership of the registered manager. People using the service stated they had confidence that any issues raised would be dealt with appropriately by the manager. One staff survey commented; ‘I am very happy with my manager’ and a person using the service said that ‘Jayne is available if you want her’. The provider of the home visits weekly and undertakes Regulation 26 inspections of the home. One survey commented; ‘I feel the home would benefit from the owner of the home being present more often.’ Minutes were examined of both staff and people using the service meetings which were observed to be an opportunity for open discussion about the lifestyle at the home. Throughout the inspection people using the service were being assisted with their personal monies and the systems used within the home to ensure a clear audit trail are robust and noted to be accurate. Regular audits of peoples personal monies stored at the home take place. Records stored at the home are stored securely and in line with the Data Protection Act. Staff are aware of the need for security of confidential documentation. It was noted that some areas which fall under the scope of notification under Regulation 37 had not been forwarded to CSCI. This include a person who had fallen and resulted in an visit to hospital. The registered manager is required to ensure that all areas which fall under the scope of notification are forwarded to CSCI. Accident records are available for falls noted in the daily record of people using the service. An audit of falls is undertaken within each persons care plan. The staff do not have access to hand wash and paper towels in each persons room to ensure there is no risk of cross infection when assisting with personal hygiene. Staff stated that they always use gloves and aprons and flip top bins were available. Maintenance records were well maintained and up to date these included ; * Fire Extinguishers Due 01/12/07 Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 24 * * * * * * * * * Weekly fire alarm tests and 6 weekly staff fire training. Call bells which are checked monthly Emergency lighting is checked monthly PAT Tests last tested June 2007 Gas service 22/01/07 Fire System service 26/06/07 Lift serviced June 2007 Stair lift serviced 06/11/07 Boiler service 22/01/07 Some areas of Health and safety require further immediate review. Some upper floor windows were identified as being restricted and may place people using the service at the risk of injury. Whilst these windows had been risk assessed it was not identified within that risk assessment that the person using the room has a degree of confusion. The windows must be further risk assessed to determine to actual risk considering all contributing factors and restriction undertaken immediately. An Immediate Requirement was made. A fire door which is kept locked did not have an accessible key to the member of staff on duty. The key is kept on a high ledge out of view which staff may struggle to access. This issue must be risk addressed and appropriate action taken. The storage of dental tablets is required to be reviewed under the COSHH guidelines as there is a risk of accidental ingestion. One tube was noted to be easily accessible in a bathroom when there was a previously identified risk of a person who may mistake them for medication. One bathroom was noted to have toiletries and a multi surface cleaner available on the bath side. This practice must be reviewed to prevent any risk of accidental ingestion. Recording of bath temperatures is recommended to be taken by thermometer as current records do not give a temperature reading and state ‘elbow’. The Electrical hardwiring certificate is to be forwarded to CSCI. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 25 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 3 X 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 1 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X 3 1 Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13(2) Requirement Prescription creams must be dated on opening. Previous unmet requirement. Dates for compliance were 25/07/06 and 31/03/07. The registered manager is required to ensure that all hand transcribed medications are dated and signed by 2 staff. The registered manager is further required to provide a regular audit of controlled medications stored at the home to ensure that the correct amount stored are recorded in the controlled drug book. 3. OP19 23(4) (b) The home must provide a suitable means of escape at one fire exit. Access to the key must be available to all staff. The risk assessment of unrestricted windows must take into account the person/s living or accessing the bedrooms and windows fitted immediately. DS0000067237.V354807.R01.S.doc Timescale for action 01/02/08 2. OP9 13(2) 01/02/09 01/01/08 4. OP38 13(4)(a)( b)(c) 01/01/08 Moorlands Residential Home Version 5.2 Page 27 Immediate Requirement issued 14/12/07 5. OP19 13(4)(a)( b)(C) All wardrobes and high units are required to be secured to ensure there is no risk of injury to people using the service. Immediate Requirement issued 14/12/07 The hot water system requires review to ensure that hot water not exceeding 43 degrees is made available to all people using the service rooms to avoid the practice of staff carrying hot water from other areas. The storage of dental tablets is required to be risk assessed to ensure the correct storage will prevent the risk of accidental ingestion. The storage of toiletries in bathrooms must be reviewed to avoid accidental ingestion. 01/01/08 6. OP25 13(4)(a)( B)(C) 01/01/08 7. OP38 13(4)(c) 01/01/08 8. OP38 37 The registered manager is 01/01/08 required to inform CSCI by regulation 37 notifications any occurrences which are outlined in the scope of notification. 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 OP18 Good Practice Recommendations The registered manager is recommended to provide a policy outlining the homes policy for staff regarding wills DS0000067237.V354807.R01.S.doc Version 5.2 Page 28 Moorlands Residential Home 2. OP29 3. 4. OP38 OP25 and bequests to support and protect both staff and people using the service. The whistle blowing policy is recommended to contain the contact details for CSCI. The registered manager is strongly recommended to ensure that all gaps in employment history of all prospective staff are explored and documented and that references are received from the most recent employer to ensure that people using the service are not placed at risk. The home is recommended to continue the program of covering all exposed radiators to ensure there is no risk of injury to people using the service. Records should be maintained of the temperatures of hot water output in bathrooms and showers at monthly intervals to ensure output is maintained at around 41oC. This temperature should be recorded by thermometer. Moorlands Residential Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Home DS0000067237.V354807.R01.S.doc Version 5.2 Page 30 - 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. 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