Inspection on 03/04/07 for Moreland House

This inspection was carried out on 3rd April 2007.

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 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 23/02/06

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 Mrs Sandra Parnell-Hopkinson Key Unannounced Inspection 3rd April 2007 08:45 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.V334878.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 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 morelandhouse@btconnect.com Moreland House Care Home Limited Miss Jane Mbugua Care Home 16 Category(ies) of Dementia - over 65 years of age (16), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (16), Old age, not falling within any other category (16) Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd February 2006 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 some local shops and a library, of Gidea Park main line railway station and by car is within easy reach of the A127 and the M25. The main shopping centre of Romford is within easy access by bus or train. The home offers accommodation to 16 older people in single rooms with en suite toilet and handbasin, well furnished communal areas and a large well maintained rear garden. There is limited car parking facilities to the front on the home. The fees at the time of this inspection range from £450. to £550. per week. Further information regarding this service can be obtained on request from the home. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was undertaken on the 3rd April, 2007 over 7 hours. The inspection process took evidence from a tour of the premises, observations, and discussions with the manager, residents, relatives and staff and from viewing a variety of records and documents. The home was well maintained and there were no offensive odours anywhere in the building. People in the home appeared well cared for but there is a limited programme of activities for them, and regimes within the home appeared rigid according to the views of some of the people living there. However, the inspector is confident that the manager and the organisation will work co-operatively to comply with any requirements made in this report to ensure service improvements for the benefit of people living at the home. What the service does well: What has improved since the last inspection? What they could do better: There is still room for improvement around the activities which still seem to be organised into large groups with very little focus on the needs and choices of the individual people. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 6 It is essential that the communication needs of people with dementia are recognised and improved upon. Some work has been done around the production of pictorial menus but this needs to expand to other areas such as the service user guide, the complaints procedure and the general signage throughout the home. The care of people living with dementia, and indeed those living with a mental disorder or old age problems, is about understanding each person as an individual and not just to the area of need. That is why a person centred approach is essential since it means that the lives of people are valuable, that people are treated as individuals, appreciating that all people have a unique personality and life history, and therefore individual needs. It is essential that people living at Moreland House are encouraged and enabled to be as independent as is possible, and that their individual choices are encouraged and promoted. All staff at the home must be reminded that Moreland House is the home of the people living there, and that it does not operate for the convenience of the staff. Generally people said that the food was acceptable but “we don’t have traditional English food such as puddings and sponges” and one lady said “I would love to have Yorkshire pudding on a Sunday and a roast dinner.” Another said “we don’t often have cakes or biscuits.” It is essential that all staff undertake equality and diversity training. It was apparent that at the time of the inspection the ethnicity of the majority of the staff team was different to that of the people living at the home. The management must ensure that the spiritual, dietary, cultural, sexual and any other needs of the people living at Moreland House are understood by staff, and appropriately met wherever possible. 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. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 (Standard 6 does not apply to this service) People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people who wish to use this service generally have the information they need to make an informed choice about where to live. However, such information must be made available in different formats for people who have dementia. Assessments are undertaken prior to people moving into the home and the opportunity is given for people to spend time at Moreland House, so that they can make an informed decision on whether the service will meet their needs. EVIDENCE: In the entrance hall at Moreland House there was a copy of the current statement of purpose and service user guide. However, there was not a copy of the last inspection report in evidence. The statement of purpose and service user guide were in a standard format which would not necessarily be suitable for people who are living with dementia. It is essential that all information available in the home for people living there is produced in various formats Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 9 such as large print for those people who may have a visual impairment, and pictorial format which may be beneficial for those people who are living with dementia. From viewing some of the files it was evident that people have a contract but more work needs to be done to ensure that such contracts are in line with the Care Home Regulations and the Commission’s guidance “Provision of fee information by care homes” which is based on concerns highlighted by the Office of Fair Trading (OFT) in their 2005 report. It was evident from case tracking that people have a pre-admission assessment undertaken before moving into Moreland House. The statement of purpose was being reviewed at the time of this inspection, and the manager is reminded to ensure that the revised document will go beyond the basic level in that it recognises the rights of people and gives an indication of how the service will value individuals. It should also specifically refer to areas that demonstrate good dementia care, good care for those with a mental disorder as well as good care for those older people through old age are living at the home. This document should also include details of specialist treatments the home can deliver with a commitment to person centred planning, and refer to the skills and ability of the staff group. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The healthcare needs of all people are met and clearly recorded in each person’s care plan, but personal support is not always responsive to the varied and individual needs and preferences of the people using the service. The medication policies and procedures ensure that all people are protected. EVIDENCE: The files of five people were examined and all had a care plan, which covered various aspects such as personal care needs, health care needs, communication, nutrition and mobility. There was some evidence that these care plans are reviewed on a monthly basis by the manager, but there was not always evidence that the individual person had been involved in the reviewing of his/her care plan. It is essential that the individual person is always Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 11 included in any reviews of his/her care since all care delivery should be person centred to ensure that the correct type and level of care is being given at any one time. All people are being weighed on a monthly basis, and more frequently if the need is indicated. Input from dieticians and nutritionists was indicated on the care plans where necessary. People receive regular visits from the GP, chiropodist, dental services and the optician. There was also clear evidence on the files that where a person needed to attend a local hospital or clinic they were able to do so with the necessary support from either staff or relatives. Where there were concerns around continence input from the Continence Service was always sought and the recommendations followed. It was clear from discussions with the manager, and from observations and discussions with people living at the home, that the need to maintain good health is of prime importance. For instance all people living at the home participate in regular morning “armchair exercises” which is followed by a snack of prepared fresh fruit. However, it was also evident from observations and discussions with some people that they felt that they had to participate. One lady said “I can’t do the exercises but feel I should sit in that lounge.” Whilst it is important that people are encouraged to remain as active as possible, staff must be clear that encouragement does not become coercion. One person did have a problem with her mattress. Although this had been discussed with the manager and a new mattress had been provided, this was still not suitable as it was covered with a plastic which could not be removed. Because of this, the individual was getting very hot at night and could not sleep. This was discussed with the manager during the inspection and she has undertaken to ensure that the mattress is changed, and that all mattresses being used were not covered in plastic. Some staff spoken to had a good understanding of the needs of the people living at the home, but because of limited skills around speaking and understanding English this was more difficult for other members of staff. This was also a concern to some of the people living at the home, for instance one lady said “I am sure they mean well but I do not always understand what they are saying, and they do not always seem to understand me so they just smile.” The manager must ensure that people living at the home are not put at risk through lack of appropriate communication between staff and between staff and people who are residents. However, all people spoken to said that all staff were very kind, and always treated them with respect. Privacy was maintained through lockable toilets and bathroom doors. Residents were able to keep their room doors locked and keep the key on them if they wished. Relatives and visitors are able to visit the home at any time. Medication records were inspected and these were found to be in good order, and it was evident that the manager undertakes a weekly audit of medication Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 12 records and medicines. However, one observation is that where the prescription indicates one or two tablets, or one or two 5ml spoons of medicine, the member of staff should record the actual dosage administered. There was little evidence that end of life had been discussed with either people or their relatives, and it is acknowledged that this can be a difficult and sensitive area. However, it is an important part of a person’s care plan and more consideration must be given to this area. End of life care planning is not just about the actual wishes after death, but the desired plan of care leading up to the process of dying and death. Staff may benefit from some training in this area and the registered manager is directed to the guidance currently given by the Department of Health and the Commission for Social Care Inspection, both of which can be found on the respective web sites. In discussions with the registered manager it was evident that any person wishing to remain at Moreland House rather than being transferred to hospital would be enabled to do so with the appropriate care being given and support for family, friends and staff. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not always find the lifestyle experienced in the home matches their expectations and satisfies their social, cultural, religious and recreational interests, which impacts on their choice and control over their lives. However, they are encouraged and assisted to maintain contact with family and friends. A wholesome appealing balanced diet is provided in congenial surroundings, but this should be more in keeping with the choices of the people living at the home. EVIDENCE: From viewing some of the care plans there was some evidence that recreational interests and activities had been recorded. However, there were no comprehensive life histories which could inform the type, frequency and choice of activities available to people living at the home. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 14 Some improvements have been made in that there are regular group activities available both in the mornings and in the afternoons. During the inspection there was a quiz taking place which some of the people enjoyed. However, in discussions with a group of people living at the home, and also with some individuals, the activities are not always what they want. For example I was able to speak to at least 8 of the people living at Moreland House and some said that the “house rules mean we cannot go out when we want to, or have windows open.” One lady said “I like some fresh air but can’t go out into the garden as the door is always locked, and the windows are rarely opened.” Several of the people said “we can’t watch television until 6p.m. in the evening unless there is some special sports programme or other such major event.” Another said “I would like to go out for a walk sometimes, but never can.” Several people said “we have to get into our nightclothes after tea, and we don’t like this.” One lady said “I would like to go to church especially over Easter, but no arrangements have been made.” People also said that no minister of religion ever visits the home. Two other people said “we enjoy reading a newspaper but none are delivered to the home.” On arrival at the home breakfast had just finished and one lady who was still sitting in the dining room said “I quite enjoy living here and that people are very kind.” It was possible to observe lunch being served and the food was well presented and it was obvious that staff were aware of the likes and dislikes of the individual people. However, one person had a pureed diet and all of the food was mixed up and served in a bowl. It is important that all meals, including pureed, look appetising and that the different parts of the meal are served in separate portions on the plate. Menus were available in both written and pictorial formats, but the menu displayed differed from the meal served in that the menu said pork chop but the actual meal was a pork casserole. This was very confusing to people. People said that the food was generally “not bad”, but several people said that it would be nice to have “sponges, puddings and especially Yorkshire pudding sometimes.” Again it is essential that the cook, and any staff member employed on a temporary basis to do cooking, is aware of the cultural needs of the people living at Moreland House with regard to food. Also from discussions with some of the people it was clear that they are not always involved in the menu planning. Drinks are available throughout the day but it was not evident that snacks were always available. It is essential that a substantial snack is offered to all people living at the home with their evening drink because the time between tea and breakfast is more than twelve hours. The above areas of concern were discussed with the manager who seemed surprised at the comments being made by some people. She did confirm that no minister visits the home, and that she thought that the provision of a Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 15 newspaper was the responsibility of relatives. She said that people do not have to change into their nightclothes after tea, but that they are encouraged to do so. However there was no clear explanation as to why people needed to change into their clothes at times not of their choice. Encouragement can also seem like coercion to vulnerable people. It does appear that the service currently presents as being run by the staff and for the staff, with little consideration given to the wishes and choices of the people living at Moreland House. The routines in a care home should not be rigid, but be flexible to ensure that people living there are enabled to exercise choice and control over their lives. Staff must be clear that the home is that of the people living there and not of those who work there. Staff must be responsive to the social, religious and cultural needs of people and ensure that these are being met in the most appropriate way according to individual wishes. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally people and their relatives can be confident that their complaints will be listened to, but not always acted upon to make changes at the home. People are protected from abuse but some staff have a limited understanding in this important area which can lead to inconsistent practice within the service. EVIDENCE: The complaints log was viewed and it was evident that only major complaints are being recorded. It is essential that even what seem to staff as minor complaints are being recorded, so that the manager and the staff team can be clear as to where the improvements are to be made. From talking to many of the people living at Moreland House it was clear that they have many areas of concern that do not appear to be being resolved. For instance having to get into nightclothes when they do not want to, lack of appropriate activities, absence of some foods that they like and often a rigid routine. These are complaints which must be listened to and resolved to ensure that the people living at Moreland House are enjoying the type of lifestyle according to their individual needs and choices. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 17 The complaints policy and procedure is displayed in the reception area of the home, but this does need to be produced in other formats such as a pictorial one, larger print so that all people can be informed that complaints will be listened to, take seriously and acted upon. During discussions with some of the staff it was evident that some had received training in the protection of vulnerable adults, but not all staff had a good understanding of this important area. This was due to lack of training but also due to English being a second language for several of the staff members. However, it was evident from observation and from talking to people living at the home that staff treated them with respect and kindness, and people spoken to said that staff “were very kind and gentle, and that they always felt safe.” Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, well-maintained environment that is clean and hygienic and are able to have their own possessions around them and to personalise their bedrooms. This does support people in viewing the home as their own. EVIDENCE: A tour of the home was undertaken and it was very apparent that the home was maintained to a good standard, with regular maintenance being undertaken. The home was clean and there were no offensive odours anywhere in the home. Bedrooms are single and all have en suite toilet and hand basin. It was possible to speak to several people in their own bedrooms and these had been personalised by the individual person and appeared very homely. There is Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 19 currently a programme of furniture replacement in some of the bedrooms, and the people spoken to said that the new furniture was very nice. There is a large dining room that overlooks the rear garden, and this does make a pleasant room in which to have meals. The garden is well maintained, and a new pathway has been laid which will make it easier for people to move around the garden. There are two lounge areas, which are only separated by a short wall with an opening at either end. Both areas have been refurnished with new lounge chairs. Because of the layout of the lounges it can be difficult for activities to be undertaken in one area without having some impact on the other area where people may want to watch television or sit quietly. The manager should give some thought to a wider use of the dining area, and to do this in consultation with the people living at the home. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people using the service and are in sufficient numbers and of good quality. All of the toilets viewed had a good supply of toilet paper and hand washing facilities. People said that there was never a shortage of hot water. The kitchen was clean and the food in the refrigerators was clearly labelled. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are satisfied that the care they receive generally meets their needs, but sometimes staff do not understand the need nor have the skills to meet those needs. This indicates some shortfalls in staff training. Generally the home’s recruitment practices support and protect people living at the home, but there are areas that need attention with regard to references and application forms. EVIDENCE: Some of the staff files for newly appointed staff were viewed and generally these were found to be in good order with POVA and criminal records bureau disclosures being recorded on the files. However, there are some staff who are being recruited abroad without the real involvement of the manager. The inspector had a discussion with the manager around the provision of references and how these were being verified, and also around the gaps in employment history on one of the application forms. It was evident that the company’s policy was not clear on these issues, and it is essential that the manager is made aware of the systems around recruitment and as to how verifications are being made. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 21 Although people using the service were generally satisfied that the care they receive is adequate, from discussions with some staff it would seem that they have many areas of concern. For instance a member of staff working in the kitchen was also expected to undertake domestic duties in the home after lunch and before tea. This means that on some days the toilets, bathrooms and bedrooms are not being cleaned until the afternoon. In discussions with the manager it would seem that night staff undertake some of the cleaning duties, and another member of staff said “night staff are hoovering the corridors and this keeps many of the residents awake.” Several people who live at the home confirmed this to the inspector. One lady said “one of the ladies is always coming into my room at night because staff are not around.” It is essential to meet the needs of the people living at the home, that the manager ensures that staffing numbers and skill mix of qualified/unqualified staff are appropriate at all times. Sufficient staff will enable people to enjoy a better quality of life, participate in community and internal activities and exercise more choice and control over their lives. Domestic staff must be employed in sufficient numbers to ensure that standards relating to food, meals and nutrition are fully met, and that the home is maintained in a clean and hygienic state without being detrimental to people living at the home through activities being undertaken at inappropriate times. There is not a reliance on agency or temporary staff, and where vacancies occur in the rota permanent staff are asked to cover if possible. This does endeavour to ensure that people are being cared for staff that know them. There was evidence of some staff training such as medication administration, food hygiene, fire safety and manual handling. However, some of the staff on duty had not received any training on dementia care or on caring for people with a mental disorder. In discussions with the manager it was evident that she was aware that there are some gaps in the training programme and that plans were in place to deal with this. The manager must ensure that staff working at the home receive the necessary training so that the needs of all of the people using the service can be met. This must include training in equality and diversity issues, primarily because the ethnic mix of the staff group is not representative of that of the people living at the home. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home can be sure that the home is run and managed by a person who is of good character and who is able. However, to ensure that the needs of people are more fully being met, the manager must introduce more flexibility into the daily routines, more person centred care and ensure that staff are appropriately supervised and receive the necessary training. The financial interests of people are safeguarded and generally the health, safety and welfare of people and staff are protected. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager has now achieved registration with the Commission, and the home is now registered to admit people requiring care through old age, dementia and mental disorder. Some work has been undertaken around staff training, and the manager recognises that more training is required so that people living at Moreland House receive person centred care that meets their needs in all aspects. It was evident in discussions that the manager does recognise that the interests of people using the service are of paramount importance, and that this is her main aim. However, the methods of achieving good quality care should be more flexible with much more importance being put on the individual wishes and choices, and less on the rigid routines of the home. A review of staffing levels and skill mix would help to achieve better quality outcomes for people, and hopefully more job satisfaction for staff. Some staff appear to receive some supervision but this is not always consistent and a member of staff said “we don’t really have staff meetings where we can express our views.” It is important in the management of a care home that all staff feel engaged and able to express views which they feel will be listened to and acted upon. Various forms of supervision are effective ranging from 1:1, group and work based observation. It was evident from discussions with people, observation and records that the manager is aware of the need to promote the health and well-being of people, and is improving and developing systems to improve practice and compliance with the care plans. She is aware that more work is needed in this area in relation to end of life, life histories and night care plans. There is a quality assurance system in place and surveys are undertaken with people living at the home. Also regular monthly visits are made to the home by the responsible individual with the necessary report being produced. However, from comments made by some people living at the home they do not feel that the responsible individual takes on board their views, and often say that he does not speak to us. For a quality assurance system to be effective it is essential that it asks for, and takes on board the views of people living at the home, and that it is also inclusive of all staff members and relatives/visitors to the home. In fact these visits should be as a mini inspection, and a copy of the Commission’s guidance on Regulation 26 visits can be obtained from the Commission’s website. www.csci.gov.uk Maintenance records for lift, fire, electrics, gas, aids, emergency call alarm system and other equipment were inspected and found to be up to date. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 24 The accounting and financial procedures of the home were inspected and these were found to be in good order and safeguarded people living at the home. The manager does not currently act as an appointee for any of the people using the service. Where necessary receipts are obtained and given to either people or relatives if purchases are made on an individual’s behalf. A discussion was had with the manager around the recently introduced Mental Capacity Act 2005 which becomes effective for those people who do not have a family or friends from April 2007, and for everybody from October, 2007. She was aware of this new legislation and has plans to discuss this with people living at the home, staff and relatives. It is also important that the organisation ensures that staff undertake adequate and appropriate training in this important area where everyone is deemed to have capacity to make decisions unless it can be shown otherwise. The inspector is confident that the manager and the organisation will work effectively to ensure that any requirements made in this report are complied with. Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 25 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 1 2 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 1 X 3 2 X 3 Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4(1)(a)(b) (c) 4(2) Requirement The registered persons must produce an up to date statement of purpose and service user guide in formats which will be meaningful to all people living at the home, and a copy of the revised documents to be sent to the Commission. The registered persons must ensure that the service user guide includes a contract with clear information as to the amount and method of payment of fees or other arrangements are different depending on funding arrangements where this is appropriate The registered persons must ensure that care plans are made available to people living at the home, that they are reviewed with the involvement of the individual person so that people can be clear about the care they are receiving. Care plans must also include end of life issues, night care and life histories. The registered persons must consult with people living at the DS0000050729.V334878.R01.S.doc Timescale for action 06/06/07 2 OP2 5 (1)(b)(c) 06/06/07 3 OP7 2 (a)(b)(c)( d) 06/07/07 4 OP12 16(2)(m) 06/06/07 Moreland House Version 5.2 Page 27 5 OP12 16(3) 6 OP12 16(2)(n) 7 OP15 16(2)(i) 8 OP16 22(2) home about their social interests, and make flexible arrangements to enable them to engage in local, social and community activities. People living in Moreland House must be able to exercise choice and know that their wishes will be acted upon. The registered persons must ensure that people living at the home are given the opportunity to attend religious services of their choice. This may mean making arrangements for an individual to be taken to a place of worship, or for visiting clergy to visit the home. The registered persons must consult with people about the programme of activities arranged by or on behalf of the home, and provide facilities for recreation. The routines of daily living and activities should be flexible and varied to suit an individual person’s expectations, preferences and capacities. The registered persons must ensure that pureed meals are provided in an appropriate manner so that they appear appealing and nutritious to people on that diet. Meals must also be provided at flexible times if required by an individual, and must meet the cultural needs of the people using the service. The registered persons must ensure that the complaints procedure is appropriate to meet the needs of all people living at the home. This must include those people with dementia, or who may have a visual impairment. All people living at the home must be sure that their complaints will be listened to and DS0000050729.V334878.R01.S.doc 06/06/07 06/06/07 06/05/07 06/07/07 Moreland House Version 5.2 Page 28 9 OP27 18(1)(a) 10 OP29 19(1)(b) sch 2 11 OP30 18(1)©(i) 12 OP32 10(1) 13 OP33 24(1) acted upon. The registered persons must ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers so that health, welfare, religious, cultural and social needs of all people living at the home are met. The registered persons must ensure that two written references are obtained, including where applicable, a reference relating to the person’s last period of employment which involved work with vulnerable adults of not less than three months duration. Also a full employment history, together with a satisfactory written explanation of any gaps in employment. This is so that vulnerable people can be protected as far as is possible The registered persons must ensure that care staff receive training in caring for people with dementia and a mental disorder. Also that all staff receive training in equality and diversity issues so that the needs of people living at the home can be met according to their wishes and choices. The registered manager must ensure that the management approach of the home creates an open, positive and inclusive atmosphere. This will be to the benefit of people living at the home and to staff working there. The registered persons must ensure that there is an effective quality assurance system in place. This should be one of the continuous tools used by the organisation to ensure that the DS0000050729.V334878.R01.S.doc 06/05/07 30/04/07 07/08/07 07/06/07 07/07/07 Moreland House Version 5.2 Page 29 14 OP36 18(2)(a) home is run in the best interests of people living there. The registered manager must ensure that all persons working at the home receive regular and appropriate supervision. This will identify poor practice, future training needs of staff and will ultimately benefit people living at the home and staff. 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Moreland House DS0000050729.V334878.R01.S.doc Version 5.2 Page 31 - 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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