Inspection on 27/05/08 for Morecambe Bay Care Home

This inspection was carried out on 27th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Morecambe Bay Care Home 22/03/10

Morecambe Bay Care Home 06/01/10

Morecambe Bay Care Home 03/11/09

Morecambe Bay Care Home 12/11/08

Morecambe Bay Care Home 29/11/07

Morecambe Bay Care Home 07/11/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Morecambe Bay Care Home Gleneagles Drive Off St Andrews Grove Morecambe Lancashire LA4 5BN Lead Inspector Mrs Marie Cordingley Unannounced Inspection 27th May 2008 09:30 X10029.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 Morecambe Bay Care Home DS0000068322.V366495.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 and Care Homes for Adults 18 – 65*. 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. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morecambe Bay Care Home Address Gleneagles Drive Off St Andrews Grove Morecambe Lancashire LA4 5BN 01524 400255 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) Four Seasons (No 7) Limited Manager post vacant Care Home 87 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (30), Physical disability (17) of places Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 87 service users to include up to 40 service users in the category of DE (Dementia) up to 30 service users in the category of OP (Older person) up to 17 service users in the category of PD (Physical Disability) 29th November 2007 Date of last inspection Brief Description of the Service: Morecambe Bay Care Home is owned and managed by Four Seasons, a company that operates a number of care services at various locations throughout the United Kingdom. Morecambe Bay Care Home is a Care Home with Nursing; it consists of 4 selfcontained units. Torrisholme House and Bare House each offer care for 20 older people with Dementia. All bedrooms are single and located around a landscaped courtyard. Grange House offers 30 ensuite bedrooms to older people who require nursing care. Cartmel House is registered to care for up to 17 adults with a physical disability. Each of the 4 units are staffed separately, with a qualified nurse in charge of each unit The homes manager post is currently vacant. Morecambe Bay Care Home is situated relatively close to the Promenade in Morecambe. Each of the units/houses within the centre have their own lounge and dining room and other facilities, for example, bathrooms and toilets. Each unit is on the ground floor offering easy access to all the facilities. Only the central part of the home has a first floor where the Managers office is located and the administration office for the home. The staff room is also located on the first floor. The current fees range from £497 to £809.81 per week according to the individual’s assessed needs. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of this service is 0 star. This means that people using this service experience poor quality outcomes. The inspection of this home included a site visit which was carried out over one day. This visit was unannounced meaning that the manager, staff and residents did not know it would be taking place until the inspectors arrived. During the visit we spent time talking with and observing residents, staff, the acting manager and a senior manager from Four Seasons. In addition, we viewed a selection of paperwork including a sample of residents’ care plans and staff training records. We also carried out a tour of the home viewing residents’ bedrooms and communal areas. A specialist pharmacy inspector carried out a full medication inspection which included examination of the home’s procedures, stock of medicines and all records relating to residents’ medication. As part of the inspection we carried out a case tracking exercise, which involved us looking closely at the care provided to selected residents from the point that they moved into the home. Prior to our visit, we wrote to the acting manager and asked her to fill in a very detailed self assessment questionnaire. This questionnaire provided us with a lot of information about the home and its management, and was returned to us within agreed timescales. We also wrote to a selection of residents, their relatives and staff members and asked them to take part in a written survey. As part of the survey, people were asked to share their opinions about various aspects of the service provided. A number of completed surveys were returned to us. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 6 What the service does well: We received a very good response to our survey and 33 completed questionnaires were returned to us by residents, relatives and staff members. Some of the people who responded made some very positive comments about the home. These included; • • • • • • ‘Staff are helpful, polite and courteous.’ ‘If I need any information the staff are very helpful.’ ‘They have looked after my relative for several years and I have always been happy with his care.’ ‘Exceptional care not just for my relative but to all the other clients.’ ‘I consider them to be excellent in looking after people.’ ‘The company is excellent at ensuring privacy, respect and dignity are provided at all times.’ We also received some positive comments from people we talked to during our visit. One resident told us ‘’I am happy here, I get on with the staff they are all very nice to me’’ and a visitor to the home said ‘’I have been coming here for a few years now and I think standards are very good. They have some very committed staff here.’’ The majority of residents that we consulted told us that they were able to have visitors at any reasonable time and also confirmed that they received support to maintain contact with their friends and families. During our visit we noticed that one resident was being supported to make a telephone call to a relative. One relative who responded to our written survey said ‘we are always made to feel welcome when we visit and the staff always offer us a cup of tea.’ All accommodation at the home is provided on a single room basis so no residents have to share rooms. In addition, most residents’ bedrooms have ensuite facilities. We viewed a number of bedrooms and found that these were nicely personalised with possessions such as pictures and ornaments to help residents feel at home. We viewed the personnel files of several staff members and found that in general, robust procedures are followed to ensure that only suitable people are employed at the home. All potential staff members are asked to provide a full employment history and references from previous employers, wherever possible. Prior to commencing employment all candidates must undergo a police check and are also checked against the Protection of Vulnerable Adults register. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? Following the last inspection of the home a number of requirements and recommendations were made. We found during this inspection that the majority of requirements had been addressed and that work was ongoing to address those still outstanding. Since the last inspection some training has been provided to staff in care planning. We viewed a number of residents’ care plans and found that they were more comprehensive in terms of people’s daily care needs and had been reviewed on a regular basis. We did however make some recommendations about how care plans could be improved further to enable staff to plan and provide care in a more person centred way. The acting manager has considered ways in which residents and where appropriate, their relatives can have more involvement with the development of their care plans. Some meetings have been held with residents and their relatives for this purpose. Work continues in this area to ensure that all the people who live at the home are included. Staffing levels have been increased in all of the four units in the home. This was commented on by a number of people we spoke with during our visit. One staff member said ‘’Things feel so much better and as we are not so short staffed, morale is better and there is not as much sick leave.’’ However, whilst we recognise an improvement in this area, we received some comments that confirmed staffing levels are still not sufficient to allow carers time to organise activities with residents on a regular basis. This issue is addressed later in this report. Following the last inspection a requirement was made that the home must be kept safe from intruders at all times. This was in relation to concerns identified about access to the home. We were able to confirm during this inspection that the requirement had been addressed. The system for dealing with complaints has been improved and the acting manager ensures that any concerns are properly recorded and dealt with in line with the home’s complaints procedure. Records are kept within the home to show action taken in response to complaints and subsequent outcomes. The manager ensures that all new staff members are provided with induction training at the start of their employment. In addition, ongoing training is now monitored and all staff have personal development plans to ensure that they are provided with training in the key areas. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 8 A number of environmental improvements have been made since the last inspection including the replacement of the kitchen area. In addition, some of the outdoor spaces have been updated to provide a more pleasant environment for residents. We were able to confirm during this inspection that the regular use of the tannoy system, which some residents found distressing, has stopped. The tannoy is now only used in an emergency. What they could do better: Whilst we found that the home had made some improvements in assessment and care planning processes, some people’s care plans still lacked information about their social care needs and their views and wishes in relation to areas such as activities and maintaining relationships. When assessing residents’ needs and planning their care, it is important to plan in a holistic and person centred manner. Gathering social history information about residents will assist staff in recognising and responding to people’s individuality. We identified a number of serious concerns in relation to the way that residents’ medicines are managed. We found evidence that medicines had not always been given to residents as prescribed and as a result their health and wellbeing had been compromised. Records of medicines received into the home, administered to residents and disposed of were not always accurate. We also found that a medicine prescribed for one resident had been administered to other residents. This practice is against the law and increases the chances of mistakes. Our findings were discussed with the acting manager and we made a number of requirements in relation to these matters. Not all the people who live at the home benefit from the opportunity to take part in activities or trips out on a regular basis. The majority of people we talked with and those who responded to our written survey told us that there were not enough activities planned for residents. Comments we received included; ‘It’s too quiet and boring, there aren’t enough activities going on in the home.’ ‘More activities should be done, it always seems they do the same things with certain residents.’ ‘The service could be improved by employing more staff so that there can be more activities done with residents.’ Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 9 The majority of people we consulted told us that they felt the quality of meals had improved over recent months. However, some people still raised concerns about the nutritional value of the meals currently provided. In addition, people felt that there was not enough variety offered. This was discussed with the manager who is currently in the process of reviewing menus. We recommended that advice be sought from relevant professionals during this process to ensure that residents are being provided with a well balanced diet. We found all areas of the home to be clean during our visit but a high number of people who took part in our written survey felt that at times the cleanliness of the home was not of an acceptable standard. One person wrote ‘Cleaners haven’t got enough time to be thorough especially at the weekend.’ This feedback was discussed with the manager during our visit. We were advised by some staff members that there is a shortage of specialist equipment in the home, in particular equipment used to assist residents with limited mobility. We advised the acting manager to carry out an audit of the equipment available on each unit to ensure that staff had access to the appropriate equipment to meet residents’ needs. We were able to determine that staffing levels at the home have increased since the last inspection. A number of people we talked with during our visit commented on the increase in staffing levels stating that residents’ care and the morale of staff had improved. However, people told us that they still didn’t have enough time in a working day to spend time with residents or organise activities. We were advised by the acting manager that she is currently in the process of recruiting additional staff to address this issue. At the present time there are less than 50 of carers employed at the home who hold National Vocational Qualifications in care. This means that the home are falling short of the national standard. This was discussed with the acting manager who has recently reviewed all the training provided to staff and has introduced individual development plans for each staff member. It was confirmed that all carers will be supported to obtain National Vocational Qualifications in the near future. 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. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1 & 3 OP (older people) and 1 & 2 YA (Younger Adults) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An assessment is carried out for each person before they move into the home. However, they need to be more person centred so that carers have more insight and a greater understanding of each resident. EVIDENCE: A Service User Guide is provided to people at the point that they express an interest in moving to the home. This document includes various information Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 12 such as the facilities and services provided and information about staffing and daily routines such as meal times and activities. We were advised by the acting manager that the Service User Guide can be made available in a number of formats such as large print and Braille so that everyone has equal access to the information. The acting manager also confirmed that people are encouraged to visit the home, have a look around and meet staff and residents. However, a significant number of people that responded to our survey told us that they did not feel they had received enough information about the home to help them make a decision about moving there. We talked to the acting manager about this and advised her to explore this area further so as to identify if improvements can be made. Unless someone needs to move into the home very quickly because of an emergency situation, there are processes in place to ensure that pre admission assessments are carried out with people before they move into the home. This means that the manager can ensure that a person’s needs will be met and that the home is right for them before they move in. It also means that staff have a good understanding of the care needs of new residents and can provide the right level of care straight away. We viewed a number of residents’ pre-admission assessments and found that in general, these were well detailed in terms of medical and personal care needs. However, some assessments lacked detail about the social aspects of people’s lives such as relationships, hobbies and preferred daily routines. These are very important areas which must be explored so that people’s care can be planned in a person centred way. Person centred planning means recognising and valuing people’s uniqueness and tailoring their care to meet their individual needs. We discussed our findings with the acting manager who advised us that a new format for assessing and planning people’s care needs is currently being tried. The manager explained that the new format will help people carrying out assessments to think in a more person centred way. In addition we were advised that training in person centred planning is soon to be provided for all staff. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 OP and Standards 6,9,16, 18,19 and 20 YA Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Poor practice when administering and recording medicines is placing the health and wellbeing of residents at unnecessary risk. EVIDENCE: Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 14 A number of people who responded to our survey told us that they were satisfied with the way their personal and health care needs were managed. In addition, several staff members who took part said that overall, the home was particularly good at providing personal and health care. We viewed a selection of residents’ care plans as part of our case tracking exercise. We found that in general, care plans were well detailed in relation to personal and health care needs but some examples lacked detail about the social aspects of people’s lives and their preferences in relation to areas such as activities. One care plan we viewed had no information about how the resident communicated and made her needs and wishes known, despite the fact that some useful information around this had been passed on to the home during the residents’ pre-admission assessment. We discussed the area of care planning with the acting manager. There is recognition that care plans need to be more person centred and include more detail about people’s individual strengths, needs and preferences. We were advised that staff were in the process of making improvements to care plans. Some of the staff members who responded to our written survey told us that they felt there was a shortage of specialist moving and handling equipment such as hoists and slings which are used to transfer people. We discussed this with the acting manager and advised her to carry out checks on all the units to ensure that staff had the necessary equipment to support people in a safe manner. As part of the inspection a specialist pharmacist inspector looked at how medicines were handled. We looked at the medicines stock and records in three out of the four units. On arrival in the first unit we found that all but one resident had been given their morning medicines but none of their records had been signed. We confirmed this by checking the medicines stock and speaking with the nurse in charge. This practice is dangerous and can result in medicines being given to residents incorrectly or being missed all together. We tried to carry out checks on a sample of medicines but found this difficult for medicines contained in traditional packets and bottles because no clear system of ‘stock audit’ was in place. We gave some advice to the manager on how to improve this. We found some stock did not add up correctly which showed some of the medicines had been missed. We found that some medicines were being used incorrectly as stock, which meant that one resident’s medicine was being used for others, this is dangerous and illegal. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 15 We found some medicines to be out of stock, one resident had gone without their sleeping tablet for the previous fifteen nights and when they were spoken with, said they thought they were still taking it. Going without prescribed medicines can seriously affect the health and wellbeing of residents. We checked a sample of medicines records and found the records of receipt and disposal to be confused and some examples showed they were missed altogether. This made auditing and checking difficult. We looked at how medicines dose changes and handwritten records were made. We found two mistakes that resulted in residents receiving a higher dose than prescribed for a liquid antidepressant, this was due to staff working the dose out incorrectly. Receiving medicines at the wrong dose can seriously affect the health and wellbeing of residents. We looked at how a resident who was having some medicines crushed before taking them was being managed, the crusher was very dirty and had not been washed for some time. We checked their care plan and found no information about the crushing of their medicines, no reference could be found to GP involvement and issues relating to the Mental Capacity Act had not been considered. Crushing of tablets can affect the way medicines work so it is important that care plans are developed to ensure it is safe and appropriate to do so. We checked the stocks and records of controlled drugs (medicines that can be misused) and found they were stored securely. Records were correctly witnessed and the current stocks that we checked were correct. One resident had been prescribed a strong pain relief patch but staff had failed to replace it on time on several occasions because they had allowed it to run out of stock and on other occasions had forgotten to replace it. This resident said that he had suffered severe pain in the past but could not remember if the patches had worked or not. Going without prescribed painkillers can seriously affect the health of a resident. We looked at how care plans supported the safe use of medicines, we looked at one resident with diabetes and found their care plan contained detailed information about how their diabetes was to be managed and monitored. We saw paperwork that supported the use of medicines prescribed as ‘when required’ and found these had sufficient detail to ensure they were given correctly. We looked at a resident who suffered from seizures and found the care plan to be detailed with information about how these seizures were to be managed. Having detailed written care plans helps ensure residents receive their medicines correctly. We saw some evidence of regular weekly and monthly checks being carried out by the managers. However these checks looked at counting stock and did not identify the type of mistakes we had found. We gave some advice on how to Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 16 improve these. Checks on medicines handling are important because they help ensure medicines are administered as prescribed and help ensure staff are competent. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 OP And 12, 13, 15 and 17 YA Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Not all the residents who live at the home have the opportunity to take part in enjoyable activities or trips out on a regular basis. EVIDENCE: Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 18 A large number of residents, relatives and staff members who responded to our written survey told us that they did not feel there were enough activities for residents to take part in at the home. This was also the view of people we spoke to during our visit. One resident said ‘’There are sometimes things going on but it varies from week to week.’’ A staff member told us ‘’It’s the same residents all the time that go out and take part in activities and others never seem to get the chance.’’ During our visit we saw that there were notices on the wall listing activities to be held for the week. However further investigation confirmed that the notice was a week out of date and information displayed on the boards referred to the previous week. Some care plans we viewed lacked detail about the kind of activities and pastimes residents preferred. In addition, the daily care records we viewed provided no evidence that people were being supported to engage in activities on a regular basis. A number of people we consulted felt that the lack of activities was due to the staffing levels at the home. One staff member said ‘‘Staffing levels are better but we are still often too busy to spend time with residents.’’ We discussed this area with the acting manager who advised us that she had identified activities as an area for improvement and was currently examining ways in how the improvements could be achieved. The majority of residents that we consulted told us that they were able to have visitors at any reasonable time and also confirmed that they received support to maintain contact with their friends and families. During our visit we noticed that one resident was being supported to make a telephone call to a relative. One relative who responded to our written survey said ‘we are always made to feel welcome when we visit and the staff always offer us a cup of tea.’ We received a mixed response during our survey about the quality and variety of meals at the home. The majority of people who responded expressed satisfaction with the standard of meals provided but a number of people said that the menus were not varied enough. One person wrote ‘The menu lacks variety and there are not enough fruit and vegetables.’ One resident we talked to during our visit said ‘’It seems like the same things week after week.’’ We also noted that some residents had previously raised the fact that they would like more fruit and vegetables during a residents’ meeting, although we were unable to confirm that any action had been taken in response to this. We discussed the feedback with the acting manager who advised us that she was currently in the process of reviewing the menus and was holding Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 19 discussions with residents to gain their views about how they could be improved. We recommended that consideration be given to consulting relevant professionals about the nutritional value of the menu to ensure that people are being offered a well balanced diet. We were able to confirm that a number of options are available for each meal time and residents are shown written menus and told verbally what the options are. We asked the manager to consider additional ways in which people could be made aware of choices available to them, such as pictorial menus or other visual prompts. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 OP 22 and 23 YA Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The acting manager ensures that any concerns raised are taken seriously. Not all residents have equal access to the complaints procedure as it is only available in a standard written format. EVIDENCE: The home has a complaints procedure in place which is written in a clear and easy to understand way. However, the procedure is currently only available in a standard written format. The procedure must be made available in a variety of formats for example, large print and audio, so everyone has equal access to the information. The majority of people who responded to our written survey told us that they knew how to make a complaint. Since the last inspection a new format for recording any complaints received and subsequent action taken has been introduced. This process is to help Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 21 ensure that all concerns are properly recorded and dealt with quickly and effectively. We viewed the record of complaints held within the home and found that all issues raised since the last inspection, had been investigated and responded to appropriately. In addition, we found evidence that the manager of the home maintains contact with residents and their relatives after complaints have been dealt with to ensure their ongoing satisfaction. For example, monthly meetings were being held with one resident and his relatives. The acting manager and all the staff we consulted demonstrated a good understanding of safeguarding procedures. The majority of staff members we spoke to told us that they had been provided with training in this area and records confirmed that this training is part of the core training programme for all care staff. People we talked with were also aware of the home’s whistleblowing procedures and understood their responsibility to report any incidents of abuse or poor practice. Staff members also told us that felt confident that they would be supported by management in the event that they made such a report. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 OP 24 and 30 YA Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at this home are provided with comfortable accommodation. The ongoing improvement programme will help ensure that all areas are maintained to a good standard. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 23 EVIDENCE: Morecambe Bay Care Home is a large building which is arranged in four separate living units. All the accommodation at the home is provided on a single room basis and the majority of residents’ bedrooms have en suite facilities. All residents’ living accommodation and facilities are on the ground floor. We carried out a tour of the home and found that in general, all the areas we viewed were furnished and maintained to a satisfactory standard. However, some areas of the home would benefit from a general update. We were advised by the acting manager that Four Seasons have implemented a refurbishment plan that will eventually result in the whole home being updated. As part of the refurbishment plan the main kitchen in the home has recently been replaced. At the time of our visit there was only one television available for people to watch on the unit for younger adults and this is in a very small room. Should several residents wish to watch the television together the lounge would be very cramped. As this unit accommodates 17 people, we advised the acting manager to review the situation and consider how a more spacious and comfortable facility could be provided. Since the last inspection of the home work has been carried out to improve the communal garden areas to make them more inviting for residents. A sensory garden has been created in one area. Part of the unit for younger adults backs on to secure outdoor space that is not accessible to people who use wheelchairs. There are a number of people who live on the unit who would benefit from being able to access this outdoor space independently. We have made a recommendation that consideration be given as to how this area can be made more accessible. During our visit we found all parts of the home we viewed to be clean and free from offensive odours. However, a number of people who responded to our survey told us that they did not think the home was fresh and clean at all times, some people commented that the cleanliness of the home depended on which domestic staff were on duty. This feedback was passed on to the acting manager and a recommendation made to closely monitor all areas of the home. The home has clear guidance in place in relation to infection control. Staff members we talked with were aware of the guidance and also confirmed that they had carried out training in this area. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 24 The acting manager was aware of the Department of Health guidance ‘Essential Steps.’ We advised her to review the home’s infection control procedures to ensure that they are in line with this guidance. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 OP 32, 34 and 35 YA Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People receive their care from staff who have been carefully recruited. Current staffing levels at the home do not enable carers to regularly provide support in areas such as social activities. EVIDENCE: We viewed the personnel files of several staff members and found that in general, robust procedures are followed to ensure that only suitable people are employed at the home. All potential staff members are asked to provide a full employment history and references from previous employers, wherever possible. Prior to commencing Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 26 employment all candidates must undergo a police check and are also checked against the Protection of Vulnerable Adults register. A number of staff members who responded to our written survey told us that their induction (the training given at the start of their employment) only partly covered the areas they needed to know. Some staff said that they had been expected to work straight away without receiving any induction. However, during our visit we were told by the acting manager that the processes for inducting new staff members had now been improved. This was confirmed by two new staff members we talked with during our visit who said that they had been given induction training over several days and found this helpful. Ongoing training for staff includes the mandatory training in areas such as moving and handling and first aid as well as additional training in areas such as safeguarding and caring for people with dementia. The acting manager advised us that she has recently carried out an audit of all staff training and has implemented individual development plans for every staff member so as to ensure that they complete training in all of the key areas. All staff members have been advised of the training they need to carry out and arrangements put in place to ensure any outstanding training is provided. Currently less than 50 of carers at the home hold National Vocational Qualifications in care at level 2 or above. This means that the home are falling short of the national minimum standard. This was discussed with the manager who advised us that plans were in place to address this shortfall. We viewed rotas which confirmed that staffing levels have increased since our last inspection and people told us that staff morale had improved as a result. However, a large number of people who responded to our written survey told us that they felt staffing levels at the home were not always adequate to meet people’s needs particularly in relation to activities. Some people told us that the units they worked on were, on occasion short staffed but that this was now rare and usually as a result of staff sickness. We talked with the acting manager about this who advised us that she was in the process of recruiting more staff to address these issues. When viewing rotas we noted that on occasion, carers work twelve hour shifts. One resident that we spoke to said that carers sometimes got a bit tired and ‘niggly’ when they worked these long hours. We discussed this with the acting manager and advised that staff members carrying out these working patterns should be monitored and supported through regular supervision. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33, 35 and 38 OP 37, 39 and 42 YA Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The acting manager has the necessary skills and experience to ensure that standards are improved across the home. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 28 EVIDENCE: At the time of our inspection the home was without a registered manager, however an acting manager has been appointed and is currently going through the process of registration. The acting manager is a registered nurse with extensive experience in managing care homes. In addition she holds the registered managers’ award. We were also able to confirm that the acting manager is supported by the area manager from Four Seasons who visits the home regularly and has been involved in developing and implementing an improvement plan put in place by Four Seasons following the home’s last inspection. Throughout this inspection we found evidence that improvements have been made in a number of areas. A number of people who responded to our written survey told us that they felt standards had improved at the home over recent months. One person wrote ‘Standards seem to have improved since the appointment of the new manager.’ This was also the view of people we spoke with during our visit, One staff member said ‘’Things feel so much better. Staff morale is better and there is much less sickness.’’ Throughout our visit the acting manager was able to give a number of examples of work she had completed to address issues within the home and shared her plans to make further improvements. In addition, the acting manager responded positively to requirements and recommendations we made following this inspection. There are a number of systems in place to help the manager and representatives from Four Seasons monitor quality. These quality assurance systems are in place to identify areas for improvement and development and also recognise areas in which the service performs particularly well. The acting manager has considered ways in how residents and their relatives can be involved in these processes and is in the process of organising a residents’ committee. We viewed a sample of records relating to residents’ finances and found these to be in good order and well maintained. Safety and maintenance certificates were sampled and the acting manager was aware of the responsibilities for maintaining all health and safety certificates of service for fire, equipment, electric, gas and nurse call systems. It was also confirmed that the home has a fire risk assessment in place which is available to all staff residents and visitors. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 29 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 3 2 x 3 2 4 x 5 x 6 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 ENVIRONMENT Standard No Score 19 3 20 x 21 x 22 x 23 x 24 x 25 x 26 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 x 33 2 34 X 35 3 36 X 37 X 38 3 Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 (1) Requirement It must be ensured that all residents and where appropriate their representatives have the opportunity to be involved in their care planning so that they can have their say about things that are important to them. Previous timescale of 14/02/08 not fully met. Residents’ care plans must provide a holistic picture of their care needs including needs and preferences relating to social aspects of their lives. Medicines must be given to residents as prescribed because receiving medicines at the wrong dose, wrong time or not at all can seriously affect their health and wellbeing. Records of medicines received into the home, administered to residents and disposed of must be accurate to help checks take place to show that medicines are being given to residents correctly. Medicines prescribed for one resident should not be administered to other residents DS0000068322.V366495.R01.S.doc Timescale for action 25/07/08 2. OP7 15 (1) 30/09/08 3. OP9 13(2) 08/07/08 4. OP9 13(2) 08/07/08 5. OP9 13(2) 08/07/08 Morecambe Bay Care Home Version 5.2 Page 31 6. OP12 16(2)(m) 7. OP15 16 (2) (i) 8. OP16 22 (2) 9. OP22 13 (5) 10. OP26 23 (2) (d) 11. OP27 18(1)(a) 12. OP30 18(1)(a) 13 OP31 8 (1) because it is against the law and it increases the chances of mistakes. All residents should be offered regular opportunity to take part in activities both inside and outside of the home. (Previous timescale of 14/02/08 not fully met). It must be ensured that residents are offered a nutritious and well balanced diet at all times. It must be ensured that all people have equal access to the complaints procedure by providing it in a variety of formats suitable for people’s needs. (Previous timescale of 14/02/08 not fully met). It must be ensured that staff have access to the appropriate equipment to meet people’s needs safely at all times. (previous timescale of 14/02/08 not fully met). It must be ensured that all parts of the home are kept clean and free from offensive odours at all times. Staffing levels at the home must be adequate to meet residents needs including needs relating to social aspects of their lives at all times. It must be ensured that at least 50 of carers at the home hold National Vocational Qualifications in care at level 2 or above. The provider must ensure that application is submitted to the Commission for the registration of a manager in respect of the home. 25/07/08 25/07/08 25/07/08 25/07/08 25/07/08 25/07/08 01/11/08 31/07/08 Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 32 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 OP1 Good Practice Recommendations With regard to feedback received by the Commission in relation to the outcome area ‘Choice of Home’ it is recommended as part of the home’s quality assurance processes that the quality of information provided to people considering a move to the home be examined and consideration be given as to whether this information could be improved. It is recommended that professional advice be sought regarding the review of menus to ensure that residents are being offered a nutritious and well balanced diet. Consideration should be given as to how the communal areas used for watching television by resident in the Cartmell unit can be improved. Consideration should be given as to how the outdoor space on Cartmell Unit can be made more accessible for residents who use wheelchairs. The home’s infection control procedures should be reviewed to ensure that they are in line with the Department of Health guidance ‘Essential Steps.’ It is strongly recommended that staff working unusual shift patterns for example, 12 hour days should be closely monitored and regularly consulted during supervision. 2. 3. 4. 5. 6. OP15 OP19 OP19 OP26 OP30 Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Lancashire/Cumbria Hub office 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ 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. Morecambe Bay Care Home DS0000068322.V366495.R01.S.doc Version 5.2 Page 34 - 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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