Inspection on 23/09/08 for Moorlands Residential Home

This inspection was carried out on 23rd September 2008.

CSCI found this care home to be providing an Poor service.

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 Home 18/03/09

Moorlands Residential Home 14/12/07

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 20/03/2009.

CARE HOMES FOR OLDER PEOPLE Moorlands Residential Home Moorlands Road Merriott Crewkerne Somerset TA16 5NF Lead Inspector Gail Richardson Unannounced Inspection 23rd September 2008 10:00 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.V372336.R02.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.V372336.R02.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) jayne@moorlands-care.co.uk 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.V372336.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 2007 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 who has 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. Steps access the attractive garden. 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.V372336.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced inspection, which took place over 1 day (7 hours) on the 23rd September 2008 by Regulation Inspector Gail Richardson and CSCI Regional Pharmacist Mr Brian Brown. There were 15 people currently residing at the home receiving personal care. A tour of the home took place and all of the bedrooms and all communal areas were seen. The inspector spoke to 9 people using the service, 1 visitor and 5 members of staff, the Responsible Individual was available throughout the inspection. As part of this inspection the inspector surveyed the opinions of a random selection of people using the service and their representatives, the responses received are used within the body of this report. Records relating to care including 6 care plans, three staff files, finances and health and safety records were examined. 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 provides a statement of purpose and service user guide, which provides information for prospective people using the service. Before any new person resides at the home the manger ensures that an assessment of needs is in place and ensures that the person can visit the home and ‘test run’ the service before deciding if it is right for them. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 6 Meals served at the home are of a good quality. All people using the service and staff were complementary about the choice, quantity and quality of food provided at the home. Visitors are welcome at anytime. The homes environment is comfortable and personally decorated to each person’s tastes. Policies and procedures are in place to ensure clear guidelines of good practice for staff. What has improved since the last inspection? What they could do better: The Registered manager must ensure that people using the service are assessed and reviewed to ensure that specialist health needs can be met and that the category of registration of the home is maintained. Care plans for people with more complex needs must be reviewed to ensure that each person has a care plan and that each care plan is reflective of that persons assessed needs and supplies appropriate information for staff. Care plans should also ensure that people using the service or their representative are consulted about their plan of care. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 7 The Registered manager must ensure that the equipment needs identified within each person’s care plan are made available. Medication systems require further review to ensure that medications are in date, that arrangements are made to record the actual dose administered for those medicines prescribed to be administered with a variable dose. Immediate Requirement Made. Arrangements must also be made to ensure that all homely remedies in the home are only used in accordance with the policy at the home. This is to ensure that people are only administered medicines in accordance with the manufacturers instructions. Immediate Requirement Made. Arrangements must be made to ensure that there is clear guidance to staff on how to make decisions and administer medicines prescribed to be administered “when required”. This is to ensure that people’s response to medicines can be accurately recorded and fed back to the prescriber. Arrangements must be made to ensure that when entries are hand written onto the Medication Administration Record chart, a safe system is used. This is to ensure that the records of administration are accurate. Arrangements must be made to ensure that all medicines and dressings that have passed the expiry date specified by the manufacturer are correctly disposed of and not available for use. This is to ensure inappropriate stock is not used for people living here. Immediate Requirement Made. The registered manager must ensure that all complaints and concerns raised are investigated using the homes complaints procedures and the outcomes recorded to ensure the protection of people using the service and staff. The Registered manager is required to ensure that all radiators are risk assessed and those with a high risk identified, suitably guarded. The manager must also ensure that CSCI are supplied with the confirmation of completion of this work. This is required to prevent the risk of injury to people using the service. Immediate Requirement Made. The Registered Manager must ensure that all substances hazardous to health are stored securely in line with the COSHH guidance. Immediate Requirement made. The registered manager is required to inform CSCI by regulation 37 notifications any occurrences which are outlined in the scope of notification. This requirement was made at the previous inspection and has not been met Immediate Requirement Made A further nine good practice recommendations have been made. 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.V372336.R02.S.doc Version 5.2 Page 8 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.V372336.R02.S.doc Version 5.2 Page 9 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): 3 4 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A Statement of Purpose and Service User Guide is available to provide details for any prospective person using the service. People are supported to visit the home prior to admission. The home is not registered with the Commission for the provision of dementia care and must review its assessment criteria to ensure that the care needs identified in this area can be met. EVIDENCE: There have been no changes to the Statement of Purpose and Service User Guide since the last inspection. 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. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 10 One care plan seen documented that the people using the service had visited and spent time at the home prior to admission. 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. In one record seen, the person had a pre admission diagnosis of Alzheimer’s and had specific care needs relating to this. A second person admitted to the home also has identified specific mental health care needs and had been identified as needing a home which provided an understanding of memory problems and metal health. Staff at the home have recently undertaken dementia training however, the home is not registered with CSCI to admit people who have a primary diagnosis requiring dementia care and /or mental health care. The management of these two people was further case tracked during inspection and it was found that no increased staffing or specific care planning is in place to support these people and this may place them at risk. One survey told us that the person “ feels as the home is catering more for people with mental health problems. Staff need appropriate training e.g. Dementia care and should be updated every year.” Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 11 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 poor. This judgement has been made using available evidence including a visit to this service. Appropriate care plans are in place for people with minimal care needs. For people with complex care needs not all care plans seen reflected the needs of the person and action is not always taken in response to changes noted. Care records were not available for all people and record keeping is not consistent. People using the service are not involved in the care plan process or review. The system for management of medicines in the home does not protect people receiving medicines from risk of harm. EVIDENCE: Care plans were examined in detail for five people using the service and further care plans were examined looking at specific issues identified. Each of the five records examined in detail had a pre admission assessment and three people had a plan of care. One of the people without a plan of care had been admitted the day previously and we were advised that the manager Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 12 had not had time to write this care plan yet. The manager who completes the plans of care was away from the home for the next six days and so a care plan would not be available to staff for that period. This person has specific care needs, which may place them at risk of harm. There was an identified risk of absconding. The person had been admitted to an upstairs bedroom adjacent to a fire door, which was not alarmed. No missing person details had been planned and no photo was available. The responsible individual was organising photographs on the day of inspection. The pre admission details received from health professionals outside of the home stated that the person needed hourly checks and therapeutic activities on a daily basis. No system of checking was recorded or information to support staff with this identified need. No plan of activities was available or organised. This person had identified challenging behaviour needs that may have an impact on staff and other people using the service. No care plan was available to support this need. Staff had limited information to assist them and no plan of care to follow to ensure that this person’s needs and safety were maintained. The person appeared unsettled and records stated that overnight they had been upset. No care plan was available to staff to help them meet this persons needs during this admission period. Another person using the service had identified needs relating to pressure area care, which required a pressure-relieving mattress. This mattress was not in place and there was no documentation to state why not. No care plan was available to support staff to prevent the risk of pressure damage. This person also had specific care needs relating to management of continence, no care plan was available. There was evidence that this person had complex care needs. Risk assessments were in place but no care plan was available to support any other aspect of this persons care. There was no evidence of the person being involved in their care plan. A care plan for a person with a pre admission diagnosis of Alzheimer’s was examined. The daily record stated that the person had left the home unescorted and unbeknown to the staff on five occasions in the last six months. A risk assessment was in place for this person absconding, which stated that the person must be accompanied when off the premises as there was a risk of them becoming lost. This assessment was dated November 2007 and no further review had been undertaken. The monthly review records within the care plan make no mention of the person leaving the home unescorted. There was no clear plan in place to ensure the supervision of this person and no plan available to support them in accessing the community safely. Monthly weight records identified that this person had lost 7 lbs in one month. No action was recorded to investigate this loss. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 13 The daily records maintained within the care plans are not recorded on a daily basis and gaps of several days were seen in all care plans examined. In one instance a person had two daily records running for the same period of time. People using the service told the inspector that the staff were kind and they felt cared for. One person said to the inspector that “ the staff are all very pleasant” and another said “ Its OK here they look after you well “Two comments received were that some staff appeared to be very task orientated and things had to be done to suit the routine and not always the person’s choice. One staff survey told us that “Staff write in a communication book which is read every shift, sometimes things are overlooked and are written several times before being addressed”. Another said that the home “Considers the individuals needs”. People were noted to have access to health professionals as and when required. One person told us that “ The staff are very kind and if you need any help they know how to get it for you”. One survey told us that the home “Provides a homely environment for the residents. Another advantage is only having 15 residents so get better care and ensure residents are given choices and not forced to do anything they don’t want to”. We found that when medicines were received into the home for one person that a record was made on their Medicines Administration Record (MAR) chart. The person making the entry had not signed or dated it and had not got a second person to check the entry. Also there was no record of the quantity received. The carer in charge of medicines informed us at the time of the inspection that she had discovered a problem with this medicine in that it was not labelled for the person concerned. This means that the person may not have received their medicines as prescribed. For other people in the home we found several hand-written amendments to the MAR charts. We could not find information in these people’s care plans to indicate how these amendments were to be followed, meaning that it was not possible to determine if these medicines were being used as prescribed. We found that for people prescribed medicines to be administered with a variable dose that an entry was being made on the MAR chart to indicate that an administration had been made. However no record could be found of the quantity of medicine they had actually received. This means that it is not possible to feedback to the prescriber how effective the medicine had been. We also could find no reference to indicate how the decision to administer any particular dose was to be made. An Immediate Requirement was left to address this issue. We also found that when people were prescribed medicines to be administered “when required” that it was not possible to find any information to indicate how the decision to administer was to be made or any records of when these decisions had been made. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 14 We found one person had a medicine prescribed that needs to be administered every three months. Whilst we could find records of administration for 04/06/07, 27/08/07, 19/11/07 and 15/05/08 . We could find no record to indicate why the other administrations had not occurred nor when the next administration was planned. We looked at the medicine storage area and found that whilst the home did not have any person currently prescribed Controlled Drugs, the home did not have storage for them that complying with current regulations as amended in 2007. We also found that for some of the eye drops currently in use it was not possible to determine the expiry dates. For one person their drops had been dispensed on 24/07/08 but no date of opening was recorded. The manufacturer had specified that the drops only had a life of 28 days after opening. This places the person at risk of having unsafe medicines administered to them. An Immediate Requirement was left to address this issue. We then looked at the “Homely Remedies Box” and found that there was a policy in place, signed and dated by the manager on 04/03/08, stating “Any home Remedy used will be purchased from a local pharmacy ensuring clear instructions are on the label”. However the box contained one box of Gaviscon tablets and many loose strips of Paracetamol tablets, which had no directions with them. This means that people may not receive these medicines safely. An Immediate Requirement was left to address this issue. We also found that the First Aid box contained a sheet to indicate that the dressings had been checked each month from November 2007 to September 2008. However we found some dressings in the box to have date expired, which may place people at risk if they were to be used. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 15 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some activities are provided at the home either in group or one to one sessions. Recording of activities is not detailed or consistent. The meals in the home are of a good quality and a range of choice is available. EVIDENCE: Since the last inspection there has been a change of activity staff. The current activity coordinator has not been in the position long and is working four days per week. Due to unforeseen circumstances she was not available on the day of inspection. People using the service told us that there are activities but further activities and social interaction would be an improvement. One person told us that “ There is not a lot of things to do” and another said that that “There is not really much activity”. One person told us that “The staff help me a bit to go outside” and another told us that “We can walk in our own gardens and talk to people in the community”. People confirmed that they have access to the local shops and newspapers are delivered to the home. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 16 Activities noted on the board included one to one sessions, bingo, quizzes and games. They told us that several hairdressers visit the home and that the chiropodist also makes regular visits. Nobody attends the local church but a visiting clergy does administer Communion at the home, one person told us they would like to attend Sunday mass. One survey told us that the home “Need activities at the weekend as not so many staff to entertain the residents. They get bored and wander”. People confirmed that they could get up and return to bed when they wanted to if staff were available and as commented in Standard 8, two comments received were that some staff appeared to be very task orientated and things had to be done to suit the routine and not always the person’s choice. One person said “We can get up and go to bed anytime within reason”. They confirmed that visitors to the home are welcome at any time and are always made welcome. Visitors were seen at the home with their dogs, which appeared to be enjoyed by most people. 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. People who we asked were not aware of the choices available for lunch. People were seen to eat both in the dining room and in their bedrooms depending on their preference. The mid day meal looked pleasant and appetising and people using the service confirmed that they had enjoyed it. The lunch comprised of chicken and tomato casserole with fresh vegetables or fish cakes followed by steamed jam pudding custard or fresh raspberry trifle. The kitchen can cater for diabetic deserts and two choices of diabetic desert were also available. Nutritional intake is not recorded or monitored. People are weighed monthly but there is no evidence that this information is reviewed or prompts further action. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 17 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 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home does not follow the complaints procedure. Policies, procedures and training are available to staff on induction to ensure they have the knowledge to prevent people using the service from the risk of abuse Further training in abuse awareness is required EVIDENCE: The home has a complaints policy available to people using the service and staff. This policy outlines how people can make a complaint and the procedure that will be followed with given timescales. This policy is available to support people using the service and staff to be confident that any concerns will be addressed appropriately. One staff survey said that “We have always been told that if there is a problem to discuss it with the manager or the owner”. The management of the home has not followed the complaints procedure when concerns have been raised. Records indicate that serious concerns have been raised and no formal investigation, documentation or outcome has been recorded. This is poor practice. The Commission takes all complaints seriously and we are very concerned that the management of the home has not followed the homes complaints procedure. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 18 The Responsible individual told us that no complaints had been received and that there was not a complaints book available. The home has policies available to staff relating to whistle blowing, violence to staff and staff involvement in Wills and Bequests. The staff have not received any abuse awareness training other than at induction and the manager is recommended to ensure that all staff undertake this training. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 19 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 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: All bedrooms and 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 3 lounge areas and a large dining room. All bedrooms seen were of a good size and were pleasant and airy. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 20 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. The garden area was pleasant and accessible to people using the service. Bedrooms were personalised with service users photographs and some small personal belongings and pieces of furniture were evident. TV’s and call bells were available in each room. All rooms have en-suite facilities, 2 en suite bathrooms had brown debris around the base of the taps and tiled splash backs of sinks in some rooms need re-sealing. There are suitable and sufficient toilet and bathing facilities. Two bedrooms had bedside lights, for which the covers were missing, and one room did not have a safety lock in place and the person did not have a key to lock their room. Two bedroom windows were observed to be cracked and taped and in need of permanent repair and one window restrictor was noted to be broken. These issues were discussed with the responsible individual who will ensure their repair. It was raised a the last inspection that 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 people’s bedrooms were noted in the relevant persons care plan. An audit undertaken by home stated an expected completion of radiator cover fitting by August 2007. At this inspection there remains some radiators which are unguarded in bedrooms and communal areas. Risk assessments indicate that covers should be fitted ASAP and were last reviewed in November 2007. An Immediate Requirement was made that the management of the home are required to supply CSCI with an action plan with timescales for the completion of this work within 48 hours. This has been received. It was noted at the previous inspection that some bedrooms did not have access to sufficiently hot water and the water appeared tepid. The home has had thermostatic valve controllers fitted in all rooms. There continues to be some unresolved issues in some rooms where the water pressure is very low and the water temperature is tepid. It was noted that whilst bath temperatures were available for bathrooms these temperatures were not correct wit the temperature checked on the day. The general standard of cleanliness was very good however two bedrooms had a significant malodour, which needs to be addressed. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home must be reviewed to ensure that they are adequate to meet the assessed needs of people using the service with specific care needs. Staff training must be promoted to support all people using the service. 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 not available but the responsible individual was at the home for most of the day. Also on duty were 1 cleaner, 1 cook and 1 maintenance staff. Rota’s examined evidenced a consistent level of staff and discussions with staff confirmed this. Two people using the service told the inspector that sometimes they had to wait for assistance and that more staff would be helpful. Previously the registered manager had confirmed that the 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 Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 22 worker. Records of this induction were not available in the staff members files and are required to be forwarded to CSCI. 7 out of the 20 staff employed have successfully completed NVQ training and this does not meet the 50 of staff recommended by the National Minimum Standards. One person using the service told us that new staff appeared to need more training and that there appeared to be a lack of ongoing supervision of standards of care. Staff training has been completed in Fire, Food Hygiene, First Aid and Medication. No training has been recorded for manual handling, the manager is currently attending a manual handling trainers course and we require that she inform CSCI when all staff are trained and updated in Moving and Handling. Two Recruitment files were examined and were reflective of the evidence found at the previous key inspection. 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 declaration used within the application form to establish that all previous convictions, which may otherwise be considered as spent, must be declared, does not make this clear and is recommended to be reviewed to contain the correct detail. One person had a verbal reference, which was not followed up, by a written reference and another person only had one reference. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 23 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 34 36 37 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home does not currently support the staff and does not consistently support the health and welfare of people using the service. People using the service monies are managed in a safe and auditable manner. Staff are not supervised regularly and the manager does not supply CSCI with information required by Regulation 37 of the Care Homes Regulations. EVIDENCE: The registered manager of the home is Jayne Dadzitis who has managed the home for over 6 years. One person told us that a week could pass before they saw the manager. A similar comment was also raised at the previous inspection and the manager is Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 24 recommended to review contact with people using the service as part of the homes ongoing quality review. Personal money systems used within the home ensure a clear audit trail and were 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 at the previous key inspection that some areas, which fall under the scope of notification under Regulation 37 of the Care Homes Regulations 2001, had not been forwarded to CSCI. The timescale for the requirement made has been exceeded and the manager has not informed CSCI of several incidents, which included accidents, incidents. and equipment failures. An immediate Requirement was made that all notifications be forwarded to CSCI. The registered manager is required to ensure that all areas, which fall under the scope of notification, are forwarded to CSCI within 48 hours of the event occurring. An extended timescale was agreed as the manager was not available at the home. 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. It was observed that protective clothing was not available in all rooms for staff to use instead of hand wash and paper towels. There were also no foot-operated bins for the staff to dispose of these items after use. The systems in place must be addressed and be consistent in approach to ensure that there is no risk of cross infection to staff and people using the service. The storage of substances hazardous to health was observed to not be in line with the COSHH guidelines. Substances hazardous to health were observed in the laundry, staff toilet and unsupervised for periods of time in the homes cleaning basket. These solutions included bleach, toilet gel and anti bacterial spray. On all of these occasions there was unrestricted access by people using the service, some of whom have specialist dementia care needs. There is a risk of accidental ingestion of these solutions. An Immediate Requirement was made that these solutions be secured and we have received confirmation form the Responsible Individual; that this has now been undertaken. The Responsible Individual has confirmed that cleaning solutions have been secured. Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 25 Health and safety documentation was examined and were found to contain up to date service details for: Hardwiring Call bells Parker baths Loler Stair lifts Passenger lifts Emergency lighting Fire systems PAT Gas Environmental health visits Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 26 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 1 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X 3 X 2 3 1 Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP4 Regulation 14(2) 12 Requirement The Registered manager must ensure that people using the service are assessed and reviewed to ensure that specialist health needs can be identified and met prior to admission. The Registered Manager must ensure that the category of registration of the home is maintained. The Registered manager must ensure that; • • Each person has a care plan. That each care plan is reflective of that persons assessed needs and supplies appropriate information for staff. That people using the service or their representative are consulted about their plan of care. Version 5.2 Page 28 Timescale for action 30/11/08 2. OP4 14(2) 12 30/11/08 3. OP7 12 15 30/11/08 • Moorlands Residential Home DS0000067237.V372336.R02.S.doc 4. OP8 12 The Registered manager must 30/11/08 ensure that the equipment needs identified within each persons care plan are made available. A replacement supply of eye drops must be ordered and obtained within 24 hours to ensure that medicines are administered safely. Immediate Requirement Made. Arrangements must be made to record the actual dose administered for those medicines prescribed to be administered with a variable dose. This is to ensure that people’s response to medicines can be effectively monitored and fed back to the prescriber, also preventing the risk of either under or over dosing. Immediate Requirement Made. Arrangements must be made to ensure that all homely remedies in the home are only used in accordance with the policy at the home. This is to ensure that people are only administered medicines in accordance with the manufacturers instructions. Immediate Requirement Made. Arrangements must be made to ensure that there is clear guidance to staff on how to make decisions and administer medicines prescribed to be administered “when required”. This is to ensure that peoples response to medicines can be accurately recorded and fed back to the prescriber. DS0000067237.V372336.R02.S.doc 5. OP9 13(2) 24/09/08 6. OP9 13(2) 23/09/08 7. OP9 13(2) 24/09/08 8. OP9 13(2) 24/11/08 Moorlands Residential Home Version 5.2 Page 29 9. OP9 13(2) Arrangements must be made to ensure that when entries are hand written onto the Medication Administration Record chart, a safe system is used. This is to ensure that the records of administration are accurate. Arrangements must be made to ensure that all medicines and dressings that have passed the expiry date specified by the manufacturer are correctly disposed of and not available for use. This is to ensure inappropriate stock is not used for people living here. The registered manager must ensure that all complaints and concerns raised are investigated using the homes complaints procedures and the outcomes recorded. The Registered manager is required to ensure that all radiators are risk assessed and those with a high risk identified, suitably guarded. The manager must also ensure that CSCI are supplied with the confirmation of completion of this work. Recommendation made at previous key inspection Immediate Requirement Made. 24/10/08 10. OP9 13(2) 02/11/08 11. OP16 22(3) 30/11/08 12. OP24 12 30/11/08 13. OP38 12 The Registered Manager must ensure that all substances hazardous to health are stored securely in line with the COSHH guidance. Immediate Requirement made. 30/11/08 Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 30 14. OP38 37 The registered manager is 23/09/08 required to inform CSCI by regulation 37 notifications any occurrences which are outlined in the scope of notification. This standard has not been met .Previous timescale 01/01/08 Immediate Requirement Made 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 OP12 Good Practice Recommendations The registered manager is recommended to access activity training for the activity coordinator and training in the recording of activities undertaken. The manager is recommended to access a copy of the Safeguarding Vulnerable Adults Protocol for Somerset. (May 2007) The Registered Manager is recommended to ensure that all staff receives abuse awareness training. The manager is recommended to undertake repairs to the home • • • • 5. OP29 The repair of cracked windows The repair of debris around tops The evident malodour in two rooms Covers to two over bed lights 2. OP18 3. 4. OP18 OP24 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 DS0000067237.V372336.R02.S.doc Version 5.2 Page 31 Moorlands Residential Home ensure that people using the service are not placed at risk. 6. OP29 Recommendation made at previous key inspection . The manager is recommended to ensure that the Declaration of the Rehabilitation of Offenders Act contained within the application form contains sufficient information. The registered manager is recommended to ensure that verbal references are followed up with written confirmation and that all staff have received two references prior to commencing employment. The registered manager is recommended to ensure that all people using the service have regular contact with her. The Registered manager is recommended to ensure that all staff receives supervision no less than six times per year in line with the National Minimum Standards. 7. OP29 8. 9. OP31 OP36 Moorlands Residential Home DS0000067237.V372336.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West 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.V372336.R02.S.doc Version 5.2 Page 33 - 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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