CARE HOMES FOR OLDER PEOPLE
Moormead House Nursing Home 67 Moormead Road Wroughton Swindon Wiltshire, SN4 9BU Lead Inspector
Susie Stratton Unannounced 12th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Moormead House Nursing Home Version 1.40 D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Page 3 SERVICE INFORMATION
Name of service Moormead House Nursing Home Address 67 Moormead Road Wroughton Swindon Wiltshire SN4 9BU 01793 814259 01793 879243 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Steven Barry Sharp Mr Steven Barry Sharp Care Home with Nursing 21 Category(ies) of OP Old Age (21) registration, with number TI Terminally ill (1) of places Moormead House Nursing Home Version 1.40 D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Page 4 SERVICE INFORMATION
Conditions of registration: 1. No more than 21 service users in receipt of nursing care at any one time 2. No more than 1 service user in receipt of terminal care at any one time 3. Staffing levels as specified in the Notice of Proposal dated 14 November 2002. Date of last inspection 13th January 2005 Brief Description of the Service: Moormead House is registered to provide accommodation and care with nursing, for up to 21 people aged 65 and over. One place may also be offered to any adult who is terminally ill. Accommodation is provided on two floors with a passenger lift in between. There are nineteen single rooms, and one shared room. Five of the rooms have en-suite facilities. A communal lounge is located on the ground floor. This also incorporates a dining area. Some seating is provided outside the front of the house. At the rear, there is an enclosed garden area with a patio. The home is privately owned, by Mr Steven and Mrs Zandra Sharp. Mr Sharp is also the registered manager of the home. A registered nurse is on duty at all times. They are supported by at least three care assistants in the morning, two in the afternoon, and one at night. The home also employs catering, housekeeping and maintenance staff. The home is in Wroughton, a village approximately one mile from Swindon. It is situated close to the village centre. This offers local amenities, including shops, pubs, and a health centre. There is a bus stop close to the home and some parking on site as well as street parking close by. Moormead House Nursing Home Version 1.40 D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on Tuesday 12th July 2005 between 10.35am and 1.15pm, in the presence of Mr Steven Sharp, registered manager. During the inspection, the Inspector also met with two of the care assistants, the chef and a domestic. The Inspector met and spoke with five residents and observed care for three residents who were unable to communicate. The records of four residents were examined in detail. The Inspector toured the home, observed a lunchtime meal, reviewed records and the home’s polices and procedures. What the service does well: What has improved since the last inspection?
The owners have continued to improve the home environment, including improvements to the front patio and back garden. The home have further ensured the health and safety of residents and staff by rewiring the building, separating the laundry and sluice room and upgrading one bathroom. New chairs have been provided and low airloss chair cushions, to prevent pressure damage in residents with high risk of pressure damage, have been purchased. A system for monitoring care plans has been set in place, this means that all plans reviewed had been completed to the same standard and fully documented each resident’s individual nursing and care needs. The home documents where a resident has asked for non-standard equipment. Where residents have mental health care needs, these are now documented. Evidence is available to show when care plans have been discussed with a
Moormead House Nursing Home Version 1.40 D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Page 6 resident or their relative. Systems for monitoring of the quality of service provision have been further developed. Accidents such as skin tears and unexplained bruising are documented in the accident book. The one requirement from the last inspection had been met. Five of the recommendations had been addressed and one recommendation continues to be in progress. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Moormead House Nursing Home Version 1.40 D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 & 4. The home does not provide intermediate care. A full service users’ guide is available. Pre-admission assessments are completed by senior staff. The home works with residents and their relatives to ensure that they can meet residents’ needs. EVIDENCE: The home has a detailed service users’ guide, which is available to all interested parties. The guide informs persons of the services offered by the home and includes a copy of the most recent inspection report. The registered manager or a senior member of staff performs detailed pre-admission assessments on all prospective residents. After admission, further assessments are completed, to ensure that residents’ needs can be met. If these further assessments show that the home cannot meet the resident’s care needs, the home takes action to ensure that all relevant parties are aware of this, to ensure that the resident can have the supports that they need and other residents needs can be met. Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 10 Residents are protected by Moormead’s comprehensive assessment and care planning system, these were observed to be effective working documents. Staff ensure that residents’ privacy and dignity is upheld. EVIDENCE: All residents have full assessments and care plans drawn up. These plans detail residents’ individual needs. Plans are regularly reviewed, this is done with the resident or their representative where possible. Records show that the home regularly consult with the residents’ GP and that the advice of other healthcare professionals is sought where relevant. Residents manual handling care needs are assessed and staff were observed to comply with care plans when lifting and transferring residents. Observations showed that staff were competent with the range of different manual handling aids provided by the home. Residents are assessed for risk of pressure damage and relevant aids are provided according to degree of risk. The home documents the type of pressure relieving mattress used on a resident’s bed but does not document the type of pressure relieving equipment which is in use on their chair, although such equipment was seen to be in use, this should take place to provide evidence of how the home are meeting residents’ needs. One resident was assessed as being at risk of experiencing pain. Clear records of
Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 10 treatments and responses to treatment were in place and evidence of regular consultation with their GP about how their pain was to be prevented. Frail residents looked comfortable, with clean skin creases, brushed hair and fresh bed linen. Their care was monitored by the use of frequent care charts, which were all fully completed. One resident was exhibiting complex behaviours relating to a mental health need. The home are seeking to ensure that this resident’s need can be met. It was advised that to ensure that external professionals can be fully informed of a resident’s behaviour over the 24 hour period, that a behaviour chart is put in place to document any instance of complex behaviours and when they occurred. Staff were observed to knock on resident’s room doors, prior to entry. Staff all called residents by their own preferred names, as documented in their records. All personal care was provided behind closed doors. Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14 & 15 Residents are supported in maintaining links with friends, family and the local community. Choice and autonomy are encouraged. Mealtimes are a social occasion, with residents enjoying their meals. EVIDENCE: Residents said that visitors were welcomed into the home at any time. Residents can go out with their visitors when they wish, and one resident was away on holiday at the time of the inspection. Many of the residents come from the local area and they are supported in maintaining links with people in the local community. One member of staff said that during the recent local carnival, residents were able to sit outside and take part in the community atmosphere. Residents said they could choose how they spent their days, one said they liked to stay in their own room “I like my own company” and that this was respected. One resident said that they could choose when they got up and went to bed. Another said there were “no restrictions” on them in the home. Residents reported that they enjoyed the meals. One said the meals were “very nice”, another “these plenty of it” and another “there’s as much as you can eat”. One resident said they liked the breakfasts best, another the roasts and another the fish and chips on Fridays. Meals were presented attractively. All required aids to support residents in feeding themselves were provided.
Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 12 Where residents needed assistance, staff sat with them, supporting and encouraging them. On the hot summers day of the inspection, all residents had been left with access to a range of drinks and staff were observed to actively support residents in ensuring that they were drinking enough fluids. Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Moormead has an effective complaints procedure, which residents and staff feel work in practice. EVIDENCE: Moormead has a full complaints procedure, which is displayed and available in the service users’ guide. Residents spoken with said that they knew who to bring matters up with, if they were concerned. One resident said “You can talk to anyone here” and another that they felt able to tell staff if they were not happy with anything. Moormead is a small home and all the staff know each other, staff all work together as a team and can inform the manager, who is also part of the team if residents have any matters of concern that they wish to bring up. Mr Sharp reports that he also tries to maintain regular contact with residents families, to ensure that if they have any concerns, he can be made aware of them and take action to address any matters that they raise. Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24 & 26 The environment provided by Moormead has been progressively improved since the current owners purchased it. Residents’ rooms are comfortable and there is a choice of outside sitting areas as well as a large communal sitting/dining room. All of the home is clean and equipment is provided to meet residents’ needs EVIDENCE: When Mr & Mrs Sharp bought Moormead, some five years ago, the home had not been well maintained for an extended period of time. Mr & Mrs Sharp developed action plans to address the shortfall presented by the building and have progressively worked through this action plan and only a few areas remain to be addressed. Since the last inspection, the home has been fully rewired and the front drive area has been improved and re-paved, providing an area where residents can sit out if they wish. The garden has been improved, with raised flower beds and a water feature, the patio area has been moved to the rear of the building, to improve privacy for residents with rooms at the rear of the building on the ground floor. Both external areas are fully wheelchair accessible. The ground floor sluice and laundry have been separated and the
Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 15 sluice room is awaiting tiling and flooring. One bathroom has been re-tiled and is awaiting flooring. Some new chairs have been provided in the sitting room. Mr Sharp reported that their next plan is to improve bathing facilities to increase the number of disabled bathrooms and wcs. All residents’ rooms were clean, tidy and looked comfortable. Several residents had brought in some of their own items, this gave the rooms a personal atmosphere. The lounge was homely and residents were observed to be sitting in comfortable chairs, chatting to each other or listening to music. One resident described the outlook from the lounge as “lovely”. A range of equipment is provided to meet residents needs, this includes manual handling equipment and variable height beds. A wide range of pressure relieving equipment is provided, the home have recently purchased more low airloss chair cushions for residents who are at high risk pressure damage, to sit on when they are out of bed. Residents reported that staff responded promptly when they used their call bell, one said “they don’t keep you waiting” and another “You ring the bell and they’re there in seconds”. The laundry was clean and well organised. Linen is managed so as to prevent risks of cross infection. All waste is properly disposed of. The home does not have a copy of the most recent health protection agency guidelines and it is advised that they contact the agency to obtain a copy to give them access to the latest infection control guidance. Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 28 Moormead are staffing the home as required by the Commission. A stable team of staff are employed. NVQ training is supported by staff and the owners of the home. EVIDENCE: Moormead is required to staff the home in accordance with a Condition of Registration set out by the Commission. They were meeting the requirements of this Condition. The home does not use agency staff; the home’s own staff cover each other for annual leave or sudden sickness. Many of the staff have worked in the home for several years and know the residents and the home’s procedures well. The home also employs domestic and catering staff. Ancillary staff work with the nursing and care team and support residents who need assistance. The owners of the home are committed to supporting staff in training for NVQ qualifications. Most of the staff have NVQ 2 and several are working towards NVQ 3. Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 & 37 Moormead is managed by an experienced manager, who is also a registered nurse. The home actively seeks feedback from the users of their service. Staff are supported by comprehensive polices and procedures. EVIDENCE: Mr Sharp is an experienced nurse and manager, who up-dates his skills regularly, across a range of areas. The home have a regular system for auditing quality of care provision, across a range of areas. A questionnaire has recently been sent out to residents and their relatives, this is in the process of being analysed and the results will be published, along with other indicators. Mr Sharp meets regularly with relatives to gain their opinions on care provision. All required records are in place and properly stored. The home has policies and procedures to support service users and staff, to which staff have access when needed. The home has pictures of all staff and their roles displayed on a noticeboard, to inform visitors and staff.
Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 18 Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 2 3 x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x 3 x x x 3 x Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 8 8 21 26 Good Practice Recommendations The type of pressure relieving equipment provided to service users in their chairs should be documented in their records. Where a service users exhibits complex behaviours, each behviour observed and the time it occurred, should be documented. The homes action plan for up-grading of bathrooms should be completed within the timescales set. A copy of the most recent Health Protection Guidelines should be obtained. Moormead House Nursing Home D51_D01_S15931_Moormead_V190881_120705_Stage4.doc Version 1.40 Page 21 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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