Inspection on 23/02/06 for Moreland House

This inspection was carried out on 23rd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Moreland House 11/10/07

Moreland House 03/04/07

Moreland House 09/05/05

Moreland House 14/03/05

Moreland House 04/02/05

Moreland House 30/03/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Moreland House 5 Manor Avenue Hornchurch Essex RM11 2EB Lead Inspector Sandra Parnell-Hopkinson Unannounced Inspection 08:00 23 February 2006 rd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Moreland House Address 5 Manor Avenue Hornchurch Essex RM11 2EB 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) 01708 442654 01708 443526 Moreland House Care Home Limited Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th May 2005 Brief Description of the Service: Moreland House is a large detached property in a residential area of Hornchurch. It is in keeping with other properties and does not stand out as being a care home. It is situated within walking distance of Gidea Park main line railway station. There is a small shopping area and library within easy walking distance of the home and the main shopping town of Romford is within easy access by bus or train. It offers accommodation to 16 elderly residents, the Manager ensures, by setting high standards, that the needs of service users are met within a comfortable and homely environment. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 4.5 hours. The inspector looked at the progress made in complying with the requirements made at the inspection in May, 2005 and tested the key standards which were not tested at the last inspection. The inspector discussed with the manager the registration process for her and was assured that the application would be made in the very near future. During the inspection the inspector was able to talk to four service users individually and to a group of service users. It was not possible to talk individually with care staff but the inspector was able to talk at length with the cook and the manager. A tour of the premises was undertaken and all of the rooms were clean with no offensive odours anywhere in the care home. A random sample of residents’ and staff files were checked, together with staff rotas, training schedules, activity programmes, records of maintenance and menus. Medication and complaints records were checked at the inspection in May, 2005 and these were found to be in good order. Three of the requirements made at the last inspection have been complied with. The fourth requirement “that the manager applies to the Commission for registration” remains outstanding. What the service does well: Currently all of the service users are elderly with varying degrees of care needs. The atmosphere at Moreland House is very welcoming and residents are offered a family-like environment. The new manager is ensuring that all staff undertake regular training and, therefore, staff have a good understanding of the service users’ care and support needs. From observations staff have a very positive relationship with each other and therefore with service users. The care plans were in good order and reviews had been undertaken on all residents during December 2005 and January, 2006. Some reviews had been Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 6 undertaken by the funding authorities, and these were very positive as to the progress made by their service users since residing at Moreland House. All of the service users spoken to said that “the food is wonderful, all home cooking”, “care staff work hard and are always kind” and “we are very happy at the home”. There is a regular programme of morning activities, and all residents are encouraged to participate in daily chair exercises to aid mobility. Particular attention is paid to nutrition and all residents are weighed monthly. Although residents see the dentist when necessary, the dental hygienist visits the home every two months to check on the oral hygiene of service users. Staff have also undertaken training in oral hygiene. There is a regular programme of maintenance and the home was clean and well decorated. New lounge chairs have been ordered and the residents were involved in the selection of the colour schemes. What has improved since the last inspection? What they could do better: The programme of activities should be expanded to include the afternoons, especially in view of the fact that during the group discussion with some residents several said “the afternoons are boring”. It would seem that many of the morning activities are organised in small groups, and perhaps attention could be given to afternoon activities being more focused on the individual. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 7 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. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Standard 6 does not apply to this service The inspector was satisfied that prospective service users have the information they need to make an informed choice about where to live. Assessments are undertaken prior to moving into the home and the opportunity is given for prospective service users to spend a day at Moreland House, together with relatives and friends. EVIDENCE: In the entrance hall to Moreland House there is a copy of the current statement of purpose, service user guide and last inspection report. In discussions with some of the service users they confirmed that they had a contract with the home and that they, and their relatives, had been able to visit the home prior to making a firm decision. Pre-admission assessments were undertaken as evidenced on a random sample of files inspected. However, it was evident that some service users had a diagnosis of dementia but the home was not registered for this category of resident. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 10 This was discussed with the manager during the inspection, and the inspector was informed that the organisation would be shortly submitting a registration variation to enable people with dementia to be admitted. There will be a requirement in this report that the manager only admits residents within the registration category. Staff training was being arranged to enable such care to be given and a copy of the Commission’s guidance on caring for people with dementia has been sent to the manager. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 11. Standards 9 and 10 were looked at during the last Inspection. The inspector was satisfied that the health, personal and social care needs of service users are set out in their individual care plans and that the health care needs are fully met. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. EVIDENCE: The care plans for four service users were inspected and these were comprehensive and all had been reviewed either during December, 2005 or January, 2006. It was evident from the records that health and social care professionals visited the home on a regular basis, and these professionals included the GP, dentist and chiropodist. A dental hygienist visits the home every two months to check on the oral hygiene of residents, and has also undertaken staff training in this area. A resident has also been referred to the local falls clinic for assessment. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 12 During the inspection several emergency alarms were triggered by residents, and the inspector observed that these were answered very promptly. One such emergency was that a service user had slipped. The manager was called by a member of care staff and although an ambulance was called, the service user refused to go to hospital. Arrangements were immediately put in place to observe the resident over the next few days. Residents are weighed on a monthly basis and a record maintained of nutrition. Currently there are no service users suffering with pressures sores. Although some service users have continence problems, it was evident that toileting programmes are in place and that odour control within the care home is of a high standard, since there were no offensive odours observed during the inspection. Care plans indicated that discussions had taken place either with the service user or a relative regarding end of life issues, and training is being arranged for staff in the end of life and bereavement processes. One service user said that “the staff make sure that I am well looked after” and another said “if I sneeze someone makes sure that I don’t have a cold coming on.” Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The inspector was satisfied that service users are encouraged to maintain contact with family and friends, and that the lifestyle experienced in the home matches their expectations and preferences. Service users are helped to exercise choice and control and they receive an appealing balanced diet in pleasant surroundings. EVIDENCE: From viewing care plans and in discussions with service users and the manager, it was evident that the lifestyle experienced by residents generally suited their needs and preferences. During discussions with a group of residents they said “we can get up when we like and go to bed when we want to.” One resident chooses to stay in his bedroom and in discussions with the inspector he said “he was very happy at the home, liked his bedrooms and the staff and went out with his daughter in the summer.” All of the residents spoken to said that the meals were very good “and were home cooked.” They are offered choices of meals and can have snacks and drinks whenever they wish. The inspector was able to talk to the cook, and it was apparent that she took great care in the preparation of menus and meals and choices were discussed with individual residents. The kitchen was very Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 14 clean, and the installation of a separate wash hand basin in the kitchen will be done in the very near future. The dining room is well furnished and overlooks a well-kept garden. Dining tables were covered with a tablecloth and flower arrangements were on each table. Although there are no separate relatives’ meetings, relatives are encouraged to visit the care home for functions such as birthdays, Easter, Christmas and summer barbecues, as well as being encouraged to visit service users on a regular basis. The manager will consider the instigation of relatives’ meetings but did say that these were not very successful in the past. Service users are encouraged to participate in religious activities and a priest does visit one of the residents. Social activities are generally organised in groups and these include daily chair exercises, games, entertainment, bingo, discussions and the occasional afternoon of watching a video. During the summer residents are taken to the local shops. Several residents did tell the inspector that the afternoons “were boring” because they did not watch television and many of the other residents had a sleep. This was discussed with the manager who will be reviewing the activities programme to ensure that some arrangements for activities can be made for the afternoons, especially for those who want this. Some ideas could include card games, crafts, musical afternoons or one to one activities. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The key standards 16 and 18 were looked at during the last inspection. The requirement from the last inspection “the home must ensure that all staff in the home receive training in adult protection/abuse awareness” has been complied with. EVIDENCE: The inspector viewed the training programme and some staff records and it was apparent that staff had received training in adult protection and abuse awareness. There are several new members of staff who are still to undertake this training but arrangements are in hand. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21, 22, 23 and 24 The key standards 19 and 26 were looked at during the last inspection. The inspector was satisfied that service users have access to safe and comfortable indoor and outdoor communal facilities, that there are sufficient and suitable lavatories and washing facilities and that specialist equipment is available, if required, to maximise independence. Service users’ bedrooms suited their needs and were safe and comfortable. EVIDENCE: During a tour of the premises, the inspector observed that all of the bedrooms are single each with an en suite toilet and hand basin. The inspector was able to talk to two service users who were sitting in their own bedrooms, and both said “that they liked their rooms and were very comfortable.” It was apparent that service users are encouraged to furnish their bedroom with their own possessions, and there was evidence of photographs, Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 17 ornaments and furniture in bedrooms which obviously belonged to the individual service user. Many of the service users used a Zimmer frame and these were clearly marked with the relevant name of the user. Where wheelchairs were required, these were available and one service user had a special armchair. The two lounges are being fitted with new chairs, and the residents were involved in the selection of colours during the inspection visit. The dining room is well furnished and overlooks and well maintained garden which has a patio area. The kitchen is to be fitted with a separate wash hand basin for the cook and an insect repellent light is also to be fitted. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The inspector was satisfied that the needs of all of the service users are currently being met by the numbers and skill mix of staff. The home’s recruitment policy and practices support and protect service users and staff are trained and competent to do their jobs. EVIDENCE: During the inspection the inspector viewed the staff rota and it was evident that currently the staff numbers and skill mix are adequate to meet the needs of the residents. 50 of staff now have been trained to NVQ level 2 and two members of staff are undertaking training to NVQ level 3. There is a cook with sole responsibility for the meal preparation, and separate ancillary staff for the cleaning of the care home. Training programmes were viewed and recent training has included adult protection. Dental hygiene, medication, food and hygiene and bereavement. Moving and handling training is ongoing for all staff on an annual basis. A random selection of four staff files were inspected, and it was evident that the necessary interview, references and criminal records bureau disclosures had been undertaken prior to employment. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 34, 35, 37 and 38. The inspector was satisfied that the care home is currently managed by a person who is running the care home to the benefit of all service users, but this manager is yet to be registered by the Commission. The accounting and financial procedures of the home are in good order and as such safeguard service users and their financial interests. Record keeping, policies and procedures were in good order and the health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: The current manager is permanently employed and has registered to undertake the registered manager’s award at a date to be advised. However, this person still has to submit an application form to the Commission for Social Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 20 Care Inspection for registration under the Care Standards Act 2000 and relevant Registration Regulations. This will again be made a requirement in this report. It was apparent during the inspection that the manager has a good relationship with staff and with service users. The accounting and financial procedures of the home were inspected and these were found to be in good order and safeguarded service users. Currently the manager does not act as an appointee for any service user. Where necessary receipts are obtained and given to either service users or relatives if purchases are made on a service user’s behalf. Records such as care plans, fire alarm testing, equipment maintenance, lift, emergency call alarm system, gas and electrics were inspected and found to be up to date and in good order. Electrical pat testing of equipment is undertaken prior to a resident moving into the care home where the resident wishes to bring his/her own electrical equipment with them. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X 3 3 3 3 3 X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X 3 3 X 3 3 Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 22 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 OP3 Regulation 14 Requirement The manager must ensure that admissions to the home are in accordance with the registration conditions. The manager must apply to the Commission for registration. (timescale of 10/08/05 not met) Timescale for action 08/03/06 2. OP31 8 08/03/06 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 12 Good Practice Recommendations That the manager reviews the activities programme so that some activities are provided during the afternoons. Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Moreland House DS0000050729.V278666.R01.S.doc Version 5.1 Page 24 - 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. 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