CARE HOMES FOR OLDER PEOPLE
Moors Park House Moors Park House Moors Park Bishopsteignton Teignmouth Devon TQ14 9RH Lead Inspector
Peter Wood Unannounced Inspection 4th June 2007 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 Moors Park House DS0000067197.V334779.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. Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Moors Park House Address Moors Park House Moors Park Bishopsteignton Teignmouth Devon TQ14 9RH 01626 775465 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) Moors Park (Bishopsteignton) Ltd Mrs Nicole Haywood-Lloyd Care Home 37 Category(ies) of Dementia - over 65 years of age (37), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (37), Old age, not falling within any other category (37), Physical disability over 65 years of age (37) Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31 May 2006 Brief Description of the Service: Moors Park House is registered as a Care Home providing Personal Care for thirty-seven elderly frail service users who may have additionally a degree of physical or mental disability, in the categories of OP, PDE, MDE and DE. Most service users have single rooms (the two double rooms generally only used as doubles at the specific request of service users), and most have en-suite facilities. Moors Park House has been a successful residential care home for about two decades, and can cater for the full range of elderly people including those with associated mental and physical disorders such as dementias. The home is a superior detached property set in its own grounds, is well kept and managed and is well adapted and equipped to meet the needs of its service users. Fees are within the range £372 - £470. Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection site visit was unannounced and took place over one weekday in June 2007. The focus of this inspection was to inspect all key standards and to seek the views of residents, staff, relatives and professional visitors to the home, the latter using comment cards and survey forms. At the time of writing three care workers’ survey forms were returned, together with three “Have Your Say about Moors Park House” survey forms from relatives of residents. Correspondence from several relatives was taken into account in the preparation of this report. This includes two relatives who forwarded correspondence between themselves and the home concerning the care of their relative. During the inspection visit time was spent with the registered manager examining documentation, particularly relating to staff recruitment, training and support, and residents’ assessment and care planning. A full tour of the building was undertaken. About fifteen residents were consulted throughout the day, as were several people who were visiting their relative residents on the day of the inspection. What the service does well:
Quality in six of the seven outcome areas is good. Quality in the Environment outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The systems for admission are thorough and comprehensive and allow residents and their relatives to be confident that their needs can be met. Residents’ health, personal and social care needs are properly assessed and met and residents are treated respectfully. The home’s practices relating to medication administration protect the residents from risk. Social activities provide daily interest for the residents. Contact is maintained with families, residents are encouraged to exercise choice and meals are nutritious and varied. Residents are listened to and issues resolved promptly. Complaints and suggestions from residents, relatives or other visitors to the home, are treated seriously. The residents live in a very pleasant, well-maintained home that is comfortable and which has been enlarged to enhance the facilities for residents to meet their needs. Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 6 Residents are cared for by staff in sufficient numbers to meet their needs. Staff are competent by experience and training. Recruitment processes protect vulnerable residents. Residents live in a well run home. The owner, manager and their staff team strive to provide a stimulating, safe environment that respects and protects residents’ rights. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems for admission are thorough and comprehensive and allow residents and their relatives to be confident that their needs can be met. EVIDENCE: The home produces a brochure, Statement of Purpose, Services Users’ Guide and other documentation which accurately describes the aims, objectives, values and facilities offered at Moors Park House. The registered manager undertakes a pre-assessment prior to a resident’s admission, followed by detailed assessments that generate comprehensive care plans. The home does not offer intermediate care. Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are properly assessed and met and residents are treated respectfully. The home’s practices relating to medication administration protect the residents from risk. EVIDENCE: Detailed Care Plans were seen which were generated from comprehensive assessments. The Registered Manager reviews each care plan regularly. Risk assessments were seen with respect to safe handling. Night care needs, continence aids, and diabetes care were documented. The home has sufficient numbers of competent staff, with the backup of specialist equipment, to care for very dependent residents. Residents can self-medicate subject to a satisfactory risk assessment. The home has good policies, procedures and practices for the proper administration of medication. Residents were observed
Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 10 to be, and reported that they were, treated with respect by staff. Residents consulted reported that staff were “good”, “caring” and “are always patient with me”. Relatives who returned the survey forms commented: “They build relationships with the residents and cheer them up if they are down. Doctor when needed is always called for the slightest concern. Food is exceptional and well balanced and varied. I cannot think of anything they do not do well but many things they do well above that required by legislation.” To the survey question: “How do you think the care home can improve?” a relative responded: “By expanding and giving more old people the chance of excellent care.” “I think it should be compulsory for other care homes to visit and see how the job is done.” “They really care about the residents. My relative is always clean (even though she changes regularly) and her hair attended to. Her room is spotless and she can have many accidents marking furniture etc and this is quickly dealt with.” “They all seem to do a very good job under the circumstances. Nursing, accommodation and food excellent.” Complimentary letters sent to the home include: ”We were made to feel really welcome.. the staff could not have been more helpful. The decision to move into a care home was not easy, but we are now much happier having seen the lovely buildings, gardens and most importantly how caring everyone appears to be”. “I wish to express my unqualified appreciation for your excellent care resulting in improvement to her wellbeing overall and more specifically to her mental faculties.” An unsolicited email was sent to CSCI HQ Customer Service Officer in January 2007 which is worth inclusion in this report: “I have read your report on the above premises which appears excellent compared to other homes I have read about. However, I would like to say that both by 94 year old parents were admitted for respite care over the Christmas period but sadly my father died on Jan 1st 2007. Although I did not expect this to happen it appears the district nurses did which is why they suggested they go in. This Care Home in my view is remarkable. It does everything in your report at least as good as you found but there appears to be no section where you can say what this Care Home does well above and beyond the call of duty. In five weeks, despite my Mother suffering the loss of her husband just short of their 70th wedding anniversary, she has come on in leaps and bounds and from sitting\laying slumped at home for 2 years at least is now taking an Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 11 active interest in everything that is around her including knitting for charity. The transformation has been remarkable. On the day of my father’s funeral, they insisted on sending two nurses to the funeral just in case my mother needed them. They arranged a magnificent buffet in their restaurant for afterwards. When my father was dying they still came in and made him comfortable throughout the night even though it could be deemed a futile gesture as he was unconscious. And I have had plenty of time to watch, sometimes unobserved at the kindness and care from all members of staff given to other patients in their care. I would urge you to find a space in your next report which would make the difference between it being an excellent care home to a truly superb care home.” Staff took pride in the work they do. “The teams we have work together really well”. However, some felt they would like to be able to spend more time with the residents. However, two relatives or former residents forwarded to CSCI correspondence between themselves and the home regarding concerns they have regarding the care of their relatives. At the time of writing, contact with all parties remains on-going. In the light of this correspondence, it is recommended that the home considers creating an inventory of valuable items (such as jewellery) retained by residents. The home already keeps records and receipts of possessions handed over for safe keeping, as per standard 35.6. The home already keeps a records of furniture brought by a service user into the room occupied by him as required by Regulation 17 (2) Schedule 4 (10). Also in the light of this correspondence, it is recommended that the home encourages staff to be more precise in the “daily recording”. Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. Social activities provide daily interest for the residents. Contact is maintained with families, residents are encouraged to exercise choice and meals are nutritious and varied. EVIDENCE: Residents are encouraged and enabled to do as much for themselves as possible. Residents have a range of activities, published in “Moors Park News”, the colourful newsletter, from which residents choose whether or not to partake. On the afternoon of the inspection several residents enjoyed watching a classic video, one of the popular regular activities. Resident’s rooms reflected their personality, often containing items of their own furniture as well as smaller personal items. Residents said that they were able to get up and go to bed at whatever time they wished. Those with relatives who lived locally enjoyed being visited and taken out by them. This home receives a great number of visitors; on the day of inspection many relatives and friends, some with children, visited the home bring a certain freshness into the house. The lunchtime meal sampled in the very pleasant dining room was attractive, with
Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 13 choice offered. Residents who required assistance with their meal were given such assistance as required in a discrete manner. Opportunity was taken to discuss menu planning, meal variety and nutrition with the qualified cook. He knows each resident’s needs, such as diabetic or gluten intolerance and preferences, and occasionally introduces more experimental or exotic menus such as some Italian dishes. Menu plans accompanied the Pre-Inspection Questionnaire. Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are listened to and issues resolved promptly. Complaints and suggestions from residents, relatives or other visitors to the home, are treated seriously. EVIDENCE: The home has a complaints procedure, and follows the good practice promoted in the National Minimum Standards that issues are resolved before they escalate to become complaints. The home received one complaint since the last inspection. This was responded to within 28 days. As referred to under the Health and Personal Care section, two relatives of former residents forwarded to CSCI correspondence between themselves and the home regarding concerns they have regarding the care of their relatives. The home has good procedures and a training programme in place to protect residents from any form of abuse. Staff consulted say they have good guidelines for whistle blowing and are confident that it would be dealt with appropriately. However, an issue arose shortly after the last inspection resulting in the convening of a case conference under the Adult Protection procedures. Information was given by telephone to a member of staff indicating the possibility of abuse to a client. The conversation was not recorded resulting in only part of the information being
Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 15 passed to the manager. The home has now reviewed its policies regarding abuse and has added a section which includes recording of telephone conversations with regards to clients’ care or wellbeing. Staff have always been encouraged to report any incidents of possible abuse or intimidation of any person in the workplace and know it will be dealt with appropriately and in strict confidence as stated in the whistle-blower’s policy. Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 16 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 excellent. This judgement has been made using available evidence including a visit to this service. The residents live in a very pleasant, well-maintained home that is comfortable and which has been enlarged to enhance the facilities for residents to meet their needs. EVIDENCE: Moors Park House is a superior property, enhanced about three years ago with a new extension, which meets or exceeds all standards. Moors Park House has been a care home for many years, adapted to meet increased residents dependency over those years. The home is well maintained, decorated and furnished on a planned basis, and is set in its own attractive grounds. The facilities provided by the extension are exceptionally good. The relatively new owner has plans to further enhance the facilities of the home. Planning
Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 17 permission has very recently been granted for a further large extension which will further enhance the facilities for residents. Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 18 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. Residents are cared for by staff in sufficient numbers to meet their needs. Staff are competent by experience and training. Recruitment processes protect vulnerable residents. EVIDENCE: Staff are carefully recruited, inducted and trained, as evidenced by the documentation in the individual staff folders kept at the home and by the portfolio of experience and training files kept by individual staff members. Numbers and competence of staff, by reason of experience and training, is good at this home. The home uses a proper application form with a declaration of no convictions, undertakes CRB (Criminal record Bureau) checks and undertakes proper references. Sometimes these references are verbally given to the manager, who writes down comments from the referee. The home provides training in health and safety topics as required, and enables and encourages staff to undertake NVQs (National Vocational Qualifications). At the present time, seven of the nineteen care staff have NVQ level 2 or above. This amounts to 37 trained staff, compared to the 50 target. However, seven staff are now working towards NVQ 2, which will bring the percentage of trained staff to 74 . Additionally, two staff are working towards NVQ level 3.
Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well run home. The owner, manager and their staff team strive to provide a stimulating, safe environment that respects and protects residents’ rights. EVIDENCE: The home changed hands just over a year ago. The new owner already owns several successful care homes in another part of the country. The exceptionally well-qualified and experienced registered manager has remained as manager through four owners, each with their different styles and degree of hands-on approach. The new owner and manager have taken the advice previously given
Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 20 to write down their respective roles and responsibilities to ensure that all management aspects are covered. Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 21 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 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 3 3 3 4 4 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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. 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. Refer to Standard OP35 Good Practice Recommendations It is recommended that the home considers creating a list of valuables retained by residents as it does with valuables handed in for safe keeping, and furniture brought in by the resident. Moors Park House DS0000067197.V334779.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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
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