Inspection on 29/11/07 for Morecambe Bay Care Home

This inspection was carried out on 29th November 2007.

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

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

Other inspections for this house

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 27/05/08

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 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Morecambe Bay Care Home Gleneagles Drive Off St Andrews Grove Morecambe Lancashire LA4 5BN Lead Inspector Mrs Jennifer Dunkeld Unannounced Inspection 29th November 2007 9:30 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.V355273.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People 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.V355273.R02.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 ****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.V355273.R02.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) 7th November 2006 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 a 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.V355273.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Four Seasons are the registered providers of this service and have identified some of the improvements that are required to ensure the home meets the needs of the people who live there. The managers’ post is currently vacant and this has had an effect upon the quality of the service. Grange House and Bare House were inspected against the National Minimum Standards for older people. Cartmel House was inspected against the National Minimum standards for younger adults. Torrisholme House was not visited during this inspection. The inspection focused on the key standards. This inspection was unannounced, that is neither the deputy manager, staff nor residents knew the inspection was to be carried out on 29th November 2007. Three inspectors took part in this inspection visiting three of the separate units. Before the visit took place, the service provider was asked to complete an AQAA (Annual Quality Assurance Assessment) this document is required to be completed annually and reflects how the services are provided. We (Commission for Social Care Inspection) sent surveys to a number of residents, their families, health professionals and staff to ascertain their opinion to various aspects of this care home. 14 completed surveys had been received at the time of writing this report. The inspection involved; • • • • • • Observations of care practices Discussions with the residents Discussions with visitors to the home Interviews with the staff and the manager. Examination of records that are required to be maintained including plans of care. A SOFI (Short Observational Framework for Inspection) was carried out on Bare unit. SOFI was designed for inspectors to record their observations during the inspection of care homes where people have dementia. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 6 Throughout the report there are references to the “tracking process” or “case tracking.” This is a method whereby the inspectors focus on a group of residents within each unit. All records relating to these individuals are examined, along with the rooms they occupy in the home. Residents are invited to discuss their experiences of the home with the inspector; this is not to the exclusion of the other residents who contributed in various ways. A similar approach was taken in respect of the staff group. What the service does well: What has improved since the last inspection? What they could do better: Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 7 There is a lack of security to the home which could be placing people and their belongings at risk. The front door is currently unlocked. It is good that visitors don’t have to stand outside in bad weather but the doors leading to Grange House need securing to prevent unwanted intruders. Aletrnatively the home should put in place measures to ensure residents safety and security An immediate requirement notice was issued at the time of inspection. This has been raised as an area of concern during inspections over the last 3 years. While staff endeavour to care for people appropriately, it was evident during this inspection and from the completed surveys we received that here are not enough staff to fully meet the needs of the people who live there. Comments received during the inspection included: ‘This has been the worse 12 months, staff just don’t have time to talk with us’ ‘We thought things would be better with Four Seasons, but they are worse than with the previous provider’ and ‘Diane (deputy manager) tells staff to get on with it, if they say they are short staffed’. There is a high staff turnover that has an adverse effect on continuity of care. One comment was received from a resident that indicated that some staff were difficult to communcate with. Recruitment and training processes should take this into account. Practices around the administration of medication need tightening to ensure all staff are aware of the need to ensure medication is securely stored at all times. On the day of this inspection the medication trolley on Bare unit was being left unlocked and unattended . An immedaite requirement notice was served in respect of this, to ensure the practice ceases immediately. The pre admission assessment of potential residents needs to be thoroughly recorded to ensure the home is able to meet the needs of the resident. Once the person is admitted to the home, a care plan should be developed involving the resident and/or their representative. There was evidence on Cartmel that people are not always involved in the development of their care plan. Care plans in general were quite comprehensive although very medically orientated and little is written about social interactions. Some residents we spoke to said that they went out on trips quite often. It was difficult however to determine if all the residents had the opportunity to go out regularly. There was no indication that two out of the three residents we case tracked on Cartmel were provided with this opportunity. Of the 9 surveys received from the residents 8 reflected that they get activities ‘sometimes’. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 8 The residents told us that the meals were ok on some days but not good on others. During this inspection the residents sat waiting for their lunch, which arrived an hour late. There was a lack of communication to the residents as to why this delay had occurred. The kitchen lacked space, equipment and cleanliness. We were told the kitchen was about to be refurbished. During the time of refurbishment the environmental health had advised on how the unit kitchens could be best utilised as a temporary measure. According to staff spoken with on Grange, there is a need for more slings for the hoist in order to have different sizes to meet the needs of the individuals. We looked at the homes complaints records and offered advice that all concerns/complaints raised should be recorded along with the outcome of the investigation. The use of the Tannoy system needs to be looked into, as this was disturbing especially for people with dementia. This is a large home spread out over a wide area including 4 separate units. Since the inspection the regional manager for Four Seasons has explained the intention to appoint an overall manager who will apply to be registered with the Commission for Social Care Inspection, who will be responsible for 2 deputy managers, 1 to oversee the Bare and Torrisholme units and the other to oversee the Cartmel and Grange units. 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. 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. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 9 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.V355273.R02.S.doc Version 5.2 Page 10 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 OP (older people) and 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. People would benefit from having a pre admission assessment that gives a total picture of their individuals needs. EVIDENCE: Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 11 We viewed a number of pre-admission assessments, which had been carried out prior to people moving into the home. In all the assessments we viewed there were large parts not completed, usually in social areas such as activities, relationships, individual preferences and religion. 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. The assessments we viewed did not contain enough information for person centred care to be provided. The completed surveys received from the residents reflected that a number of people did not receive enough information about the home before they moved in, to help them make a decision about becoming a resident. This service does not offer intermediate care. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 12 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 to be inspected at least once during a 12 month period 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. People would benefit from receiving services that fully meet their needs and where their medication is securely stored at all times. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 13 EVIDENCE: CARTMEL There were individual care plans in place for all the people we case tracked. Whilst these contained a good deal of information and detailed guidance in relation to peoples physical care needs there was very little information about people’s social needs. There was no evidence to demonstrate that residents or their representatives had been involved in the development of their individual plans. One resident said that she knew staff wrote things down about her but wasn’t sure why. We were unable to see any evidence that regular residents meetings take place. Residents we asked didn’t think that residents meetings were ever held and there were no record available of such meetings. Pre admission assessments and individual plans contained limited information about people’s personal preferences. Therefore their care could not be planned in a person centred way or in line with their own wishes. The individual plans we viewed contained good, well detailed information in relation to a persons health care needs and offered clear guidance to carers in most cases. However one person we case tracked had epilepsy. Whilst this information had been gathered during the pre admission assessment the information had not been put in the care plan about this condition such as the type of seizures experienced, the usual duration of the seizures or recovery time. We observed the staff nurse carrying out a medication round and noted very good practice in this area. The nurse was seen to refer to medication administration records before he administered each tablet. In addition, the nurse explained to the resident what he was giving them. The individual plans of people we case tracked confirmed that their medication had been regularly reviewed. One resident we spoke to told us that she was prescribed regular pain relief and that the staff always made sure she got this at the correct times. BARE Care plans are comprehensive although very medically orientated and little is written about social interactions. One resident’s care plan was examined and concern was raised that staff had written that the individual “enjoys spending time in her room”. It was unclear how this judgement had been reached. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 14 On arrival at the unit the treatment room was open and the medication trolley doors were also open. The staff nurse on duty had to be asked to secure these. An immediate requirement notice was issued. We noticed that footplates were not being used on wheelchairs and this could result in injuries to wheelchair users. This staff attended to this matter at the time of the visit. GRANGE The care plans viewed as part of the ‘tracking process’ reflected peoples needs and wishes, including their ‘after death wishes’. One person had stated what music was required for their funeral. Another person’s care plan outlined how the person becomes anxious when unfamiliar staff are looking after her and how to reassure her. One person being case tracked was having a ‘lie-in’ something she enjoys doing. Her wishes are respected. Risk assessments are included as part of the plan of care. For example one resident had a fall earlier in the year and the plan of care was reviewed following this. The plan reflects that staff are to remind the person to take care when self propelling the wheelchair, but at the same time promoting the persons independence and dignity. We observed people being appropriately administered with their medication. There are 2 medication trolleys for this large unit; both are stored in a locked room. The Medication records are signed at the time of medication. Records are maintained of any medication returned to the pharmacist. According to staff spoken with on Grange, there is a need for more slings for the hoist in order to have different sizes to meet the needs of the individuals. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 15 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. People would benefit from receiving a service where their social interests and activities are fully identified, reflected in their plan of care and met. People’s health would benefit from receiving wholesome, nutritious food in a timely manner. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 16 EVIDENCE: The manager told us in the questionnaire completed prior to the visit that the home tries to meet the social and cultural needs of the individual residents. A minibus is provided for use and a variety of opportunities are offered for people to participate in activities. Additionally each residents is allocated a named nurse/contact and its is this person who will support the preferred routines and activities of the individual. A choice of areas are available for people to receive visitors and visitors are made to feel welcome. BARE We noticed there was little indication of any social interaction or communal activity. Staff spoken with explained how some staff will not take one resident out as her shouting embarrasses them. This reflects the fact that staff require training in understanding the needs of people with a dementia. The behaviour needs to be reflected in her care plan with guidance on how best to manage it. CARTMEL There was little information in the individual plans of any residents we case tracked about their preferred pastimes and hobbies. Two of the residents we case tracked would benefit from sensory activities and intensive interaction, but their daily records indicated that the only activity they were involved in was watching television. One younger person we case tracked had in the past been very keen on rock music and had some favourite bands he had loved to listen to. However there was no reference to this in his individual plan. Carers should have been made aware of this so that they could arrange for him to take part in this valued pastime. Some residents we spoke to said that they went out on trips in the minibus quite often. There was no information in any of the people’s individual plans we viewed about their relationships. People’s plans should detail their valued relationships and the support they need to maintain these. We received a mixed response when we talked to residents about the meals provided at the home. One resident described the quality of meals as a bit hit and miss another said the food is good some days and not so good on others. During our visit we sat with residents at lunchtime. We were concerned that residents were left to wait for their meal for over an hour. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 17 GRANGE There was some evidence of social activities, however some of the residents stated they ‘get bored’ Comments received in the completed surveys from residents included: ‘There are very few activities’ ‘Staff shortages mean we don’t get any activities’ Of the 9 surveys received from the residents 8 reflected that they get activities ‘sometimes’. People need to have their chosen activities, hobbies and interests recorded in their care plan with the frequency that the individual requires these. Some of the surveys received from residents commented that some of the meals were poor: Comments included: ‘The food is good some days’ ‘Meals could be better’ ‘Meal portions are small’ We observed people sat waiting for their lunch for over an hour. No explanation was given to them. The regional manager explained to us that there had been staffing difficulties in the kitchen and on this day they had used an agency chef. We understand that once the home has a stable kitchen staff team and the kitchen is refurbished that this situation will greatly improve Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 18 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. People would benefit from receiving a service where their social interests and activities are fully identified, reflected in their plan of care and met. People’s health would benefit from receiving wholesome, nutritious food in a timely manner. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 19 EVIDENCE: The manager told us in the questionnaire completed prior to the visit that the home tries to meet the social and cultural needs of the individual residents. A minibus is provided for use and a variety of opportunities are offered for people to participate in activities. Additionally each residents is allocated a named nurse/contact and its is this person who will support the preferred routines and activities of the individual. A choice of areas are available for people to receive visitors and visitors are made to feel welcome. BARE We noticed there was little indication of any social interaction or communal activity. Staff spoken with explained how some staff will not take one resident out as her shouting embarrasses them. This reflects the fact that staff require training in understanding the needs of people with a dementia. The behaviour needs to be reflected in her care plan with guidance on how best to manage it. CARTMEL There was little information in the individual plans of any residents we case tracked about their preferred pastimes and hobbies. Two of the residents we case tracked would benefit from sensory activities and intensive interaction, but their daily records indicated that the only activity they were involved in was watching television. One younger person we case tracked had in the past been very keen on rock music and had some favourite bands he had loved to listen to. However there was no reference to this in his individual plan. Carers should have been made aware of this so that they could arrange for him to take part in this valued pastime. Some residents we spoke to said that they went out on trips in the minibus quite often. There was no information in any of the people’s individual plans we viewed about their relationships. People’s plans should detail their valued relationships and the support they need to maintain these. We received a mixed response when we talked to residents about the meals provided at the home. One resident described the quality of meals as a bit hit and miss another said the food is good some days and not so good on others. During our visit we sat with residents at lunchtime. We were concerned that residents were left to wait for their meal for over an hour. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 20 GRANGE There was some evidence of social activities, however some of the residents stated they ‘get bored’ Comments received in the completed surveys from residents included: ‘There are very few activities’ ‘Staff shortages mean we don’t get any activities’ Of the 9 surveys received from the residents 8 reflected that they get activities ‘sometimes’. People need to have their chosen activities, hobbies and interests recorded in their care plan with the frequency that the individual requires these. Some of the surveys received from residents commented that some of the meals were poor: Comments included: ‘The food is good some days’ ‘Meals could be better’ ‘Meal portions are small’ We observed people sat waiting for their lunch for over an hour. No explanation was given to them. The regional manager explained to us that there had been staffing difficulties in the kitchen and on this day they had used an agency chef. We understand that once the home has a stable kitchen staff team and the kitchen is refurbished that this situation will greatly improve Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 21 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 poor This judgement has been made using available evidence including a visit to this service. People would further benefit from living in a home where complaints are taken seriously, recorded and acted upon. EVIDENCE: The home has a good and comprehensive written policy for dealing with complaints. However our evidence suggests that at times the policy is not always being fully followed through. We viewed the home’s record of complaints and found that two complaints had been made in relation to the quality of food provided to residents on the Cartmel Unit. There was no evidence that these complaints had been acknowledged or investigated. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 22 We spoke to a relative of one resident who told us that she had made a complaint as she was unhappy with the standard of personal care provided to her loved one. There was no record of this complaint any where in the home. The assistant manager acknowledged that this complaint had been made but stated that she did not think it was a ‘formal complaint.’ We received some information to indicate that some personal items belonging to residents such as toiletries and clothing had gone missing on a number of occasions. Managers had failed to carry out any investigation into these incidents. That being said we were able to find evidence to suggest that the complaints that had been formally received were appropriately recorded and investigated following the complaints procedure Some residents who live at the home need help to manage their finances and when such assistance is provided records are kept. We viewed records and found that these were in need of improvement. We advised the deputy manager that whenever cash is withdrawn for residents they should sign wherever possible. All transactions carried out by staff should be witnessed and countersigned by a second staff member. Since the inspection the homes administrator has explained that records are signed and witnessed by two people. This is a good improvement that will benefit and maintain appropriate safeguards for residents and staff alike The regional manager looked into an issue where a resident was being charged to use the homes minibus. Following her information gathering, the home had decided to waive the charge and agreed that in future use of the minibus would be free of charge, as per company policy. 2 of the 9 completed surveys received from residents reflected they did not know how to make a complaint. The remaining 7 commentators chose not to comment on the issue of complaints Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 23 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. The residents could benefit from living in an environment that is free from the disturbance of a Tannoy system and banging doors. EVIDENCE: Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 24 CARTMEL We carried out a tour of the unit and found all areas to be clean, warm and comfortable. Everyone living in the unit has their own lockable room although it was confirmed that no resident actually hold keys for their bedrooms. The management team are looking into this matter. We viewed a number of residents’ bedrooms and found these to be nicely decorated. In addition, people’s bedrooms were personalised reflecting the personality of the occupant. Part of this unit 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 the outdoor space independently particularly the people who smoke. We spoke with the managers at the home and asked that they consider how this area can be made more accessible. The relaxation room has been re furbished and will be used for the occupants of Cartmel and also people who live on Bare and Torrisholme who would benefit from this relaxing environment. As this is to be a permanent feature the management may wish to apply to de register the bedroom that is used as the relaxation room, as only 16 people can now be accommodated on Cartmel. BARE The environment is generally reasonable and people were observed to be comfortable with their particular environment. There are no issues over cleanliness although some areas particularly bathrooms lack the ‘homely’ feel. The Tannoy system was noisy and disturbing for people with dementia. In addition some doors were banging, possibly due to door fasteners needing attention. According to staff this is a particular problem at night as it wakens residents. The outside environment was untidy with broken or disused equipment, for example there were mattresses, a wheelchair, an old trolley and broken branches outside. Residents do not use this area nor do they overlook it. However this mars the overall look of the home. This unit’s courtyard had been left over the winter with little or no maintenance and was beginning to look unkempt The reception area was cluttered with chairs from the mini-bus. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 25 The management team at the home have arranged to have these areas tidied and this will result in a much-improved environment. The dining room looks much improved following redecoration. The lounge is currently being redecorated but no one appears to be able to advocate for residents who have to work around the painters and not the other way round. Staffing levels at night mean staff do not have time to do any maintenance cleaning such as wheelchairs and lounge chairs. These chairs cannot be cleaned during the day because they are being used. Management are aware of the need to address this issue for the benefit of the people who live in the home. Grange We toured the premises and found them to be clean. There were two cleaners on duty who explained that when 2 of them are at work they are able to meet the required standard of cleanliness. The dining room was well presented, with condiments, tablecloths and the like. The majority of the completed surveys received from 9 of the residents reflected that the home is ‘usually’ clean. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 26 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 poor This judgement has been made using available evidence including a visit to this service. The residents would benefit from living in a home where the skills mix and numbers of staff meet their needs. EVIDENCE: CARTMEL During our visit staff on the unit were extremely busy and did not have sufficient time to spend with residents socially. We asked some residents if carers ever had the time to sit and talk to them and were told they were Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 27 usually too busy. One resident said ‘’I don’t think there are enough of them on.’’ We spoke to one staff member who expressed concern about the staffing levels. The staff member said ‘’people are well cared for because we work hard, but it is very hard.’ Another staff member expressed concerns about the high turnover of staff. This person said staff morale is low, we have a lot of agency staff who don’t know the residents and that makes it harder still. The high turnover of staff was also mentioned by a relative of one of the resident who said ‘’It seems to be different faces all the time. You just get used to people and then they seem to change again.’’ BARE There appears to be a lack of experienced staff on this unit. Staffing on day of site visit: 1 Staff nurse worked at the home for 8 months as a bank nurse. 1 carer – only began her employment at the home 3-4 weeks ago. 1carer only began her employment 2 days ago. 1 student nurse – on placement 1 agency carer 1qualified 1carer at night. One resident commented that they had difficulty communicating with a member of overseas staff. This is being addressed by the care home during the individuals’ supervision sessions. However the rotas should be maintained so as to ensure that residents and staff can make themselves understood at all times Whilst at the home we witnessed an inappropriate action that was intended by the care staff to support a resident who had particular mobility difficulties. It was opportune that the nurse in charge was on hand to advise the care staff of the correct course of action to take. The nurse agreed to ensure that the care plan for this person provided clear information about moving and handling, positioning and security to avoid staff making similar errors whilst supporting the resident. GRANGE All the written surveys written to the Commission for Social Care Inspection reflect that there is a shortage of staff throughout the home. In particular Grange was mentioned with comments such as: ‘It’s very hard work, there is no time to sit and talk on Grange’ Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 28 ‘There’s not enough time to talk with the residents on Grange’ ‘Staff are always on the go’ ‘Even agency staff don’t like working on this unit as it is too hard’ One resident commented on the shortage of catering staff, which has been addressed under an earlier section of this report; see ‘Daily Lives and Social Activities’. It is evident that the current low morale at the home is having an adverse effect on the staff and residents at this time Recruitment practices could usefully include consideration about the need to ensure the appointed staff are able to communicate with the residents. When recruiting peoples whose first language is not English consideration should be given to the skills mix of the people rostered for duty at any given time. This would go some way to ensure people can understand each other. The supervision record for one member of staff reflected: ‘communication skills have greatly improved in English language’. This is a good example showing support for the member of staff. The staff files viewed as part of the ‘tracking process’ reflected Criminal Record Bureau clearances are taken up prior to commencing work or the person works supervised until Criminal Record Bureau clearance is received. There are 39 care staff employed at the home. Only 2 of the current care staff and 7 senior care staff have achieved a National Vocational Qualification in care. This is no doubt contributed to by the high staff turnover. This is an issue that the service providers may wish to consider in an effort to improve the consistency of care for the people who live at Morecambe Bay Care Home. GENERAL Completed surveys received by the Commission for Social Care Inspection included the following comments: ‘More staff needed. Really more trained staff needed who have done this kind of work before.’ ‘We need more staff, to be able to care for the people properly’ These comments indicate that the service providers need to look into the staffing arrangements at the home so that they are able to meet the needs of the people receiving care. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 29 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 poor. This judgement has been made using available evidence including a visit to this service. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 30 The residents and service as a whole would benefit from the home being well managed and effectively organised. EVIDENCE: The changes in the management of the home in the last 12 months have had an adverse impact on the standard of care One comment made by a relative during the inspection stated ‘It is like a ship that is adrift without a captain’. This comment is indicative of the lack of effective management. And whilst some good work still prevails at this home the continued lack of leadership and guidance has taken its toll. We are however encouraged that the home is in the process of appointing a new manager and it is hoped that this person will remain in the home and give a clear leadership steer in order to affect the improvements that will result in a happier more motivated workforce and a raised level contentment in the residents We viewed the financial records for the home, that were available at the time of inspection these reflected that Records of Withdrawal were not always signed by residents and only by one member of staff. Residents need to sign for transactions where possible and be counter signed by a member of staff. Some residents are putting into a weekly draw run by the home but the deputy manager seemed to know little about previous winners. Through records of this must be kept to demonstrate fairness and to show that all residents are receiving their winnings. The service providers may wish to look into the legalities of running such a financial draw. Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 31 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 X 2 X 3 2 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 ENVIRONMENT Standard No Score 19 1 20 X 21 X 22 X 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 X 33 1 34 X 35 2 36 X 37 X 38 1 YES Are there any outstanding requirements from the last Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 32 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 YA2 Regulation 15(1) Requirement During the inspection in November 2006 the following requirement was made: ‘Care plans must be reviewed regularly and reflect the care that is being given to each resident. Residents and relatives must be involved in the planning of care and the subsequent reviews.’ This has not been acted upon at the time of this inspection; a new time scale for implementation is given. Timescale for action 14/02/08 2. OP30 18(1)(a) During the inspection in November 2006 the following requirement was made: The service provider must ensure that 50 of the staff achieve the National Vocational Qualification level 2. A new time scale has been given for the compliance with this requirement. During the inspection in November 2006 the following requirement was made: The service provider must ensure there are sufficient staff DS0000068322.V355273.R02.S.doc 01/11/08 3. OP27 18(1)(a) 28/02/08 Morecambe Bay Care Home Version 5.2 Page 33 at all times of day to meet the residents needs including meal times. A new time scale has been given in order to comply with this requirement. 4. OP19 13(4)(a) During the inspection in November 2006 the following requirement was made: The service provider must ensure the home is safe by not leaving access for intruders. An immediate requirement notice has been served in respect of this. The residents must be provided with meals that are nutritious and appetising in adequate quantities, at such times as may be reasonably required The residents must be offered activities in house and external of the home that meet their needs and preferences. All complaints received by the manager/provider must be thoroughly investigated and the outcomes recorded, to ensure people are satisfied with the care they receive. The complaints procedure must be readily available and appropriate to the needs of the residents. Equipment must be provided to meet the needs of the residents, such as providing slings for the hoist, that are of the required size for the individual 29/11/07 5 OP15 16(2)(i) 14/01/08 7 OP12 16(2)(m) 14/02/08 8 OP16 22(3) 31/01/08 9 OP16 22(2) 14/02/08 10 OP22 23(2)(n) 14/02/08 Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 34 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 Refer to Standard OP19 OP19 OP27 Good Practice Recommendations The use of a Tannoy system needs to be addressed as people find this disturbing especially people with dementia. The environment outside Bare is untidy and should be kept tidy, safe, attractive and accessible to the residents. The people employed in the care home should be able to communicate with the people who live there. Or the staffing rosters should ensure that staff whose first language is not English are supported when on duty Morecambe Bay Care Home DS0000068322.V355273.R02.S.doc Version 5.2 Page 35 Commission for Social Care Inspection National Enquiry Line: 0845 015 0120 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.V355273.R02.S.doc Version 5.2 Page 36 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!