Inspection on 22/04/08 for Moresk House

This inspection was carried out on 22nd April 2008.

CSCI found this care home to be providing an Adequate service.

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

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Moresk House Pauls Terrace Truro Cornwall TR1 1HA Lead Inspector Lynda Kirtland Unannounced Inspection 22nd April 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Moresk House DS0000070677.V362807.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. Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moresk House Address Pauls Terrace Truro Cornwall TR1 1HA 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) 01872 271000 Underhill Care Ltd Mrs Thelma Richardson Care Home 21 Category(ies) of Dementia (10), Mental disorder, excluding registration, with number learning disability or dementia (10), Old age, of places not falling within any other category (11) Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC To service users of either gender whose primary care needs on admission to the home are within the following category of service only: Old age, not falling within any other category (Code OP) maximum 11 places Dementia (Code DE) maximum 10 places Mental disorder, excluding learning disability or dementia (Code MD) maximum 10 places The maximum number of service users who can be accommodated is 21. New service 2. Date of last inspection Brief Description of the Service: Underhill Care Ltd has recently purchased Moresk house and own another care home in Cornwall and in Devon. The responsible individual, Mrs Bradley visits the home on a regular bases to provide support to the registered manager, staff team and people who use the service. She is also introducing corporate systems that will be put in place in all Underhill Care Ltd care homes. The Registered Manager Mrs Thelma Richardson has worked at the care home for many years and takes the lead role in the day-to-day running of the home. She continues to be the registered manager with this new company. Moresk offers care to twenty-one older people some of who may experience confusion or mental health issues. The majority of bedrooms are for single occupancy and communal space is provided on the ground floor. There is reasonable access outside and inside the home for people who experience a disability. A passenger lift is also provided. The home is located near to the centre of Truro and offers some car parking. The outside garden has limitation given the access arrangements are not user friendly. However there is a patio area that people can access. The location provides easy access to the town, leisure facilities and health services. The responsible Individual confirmed during the inspection that the range of fees is £350.00 to £400.00 per week. Toiletries, newspapers and certain activities are the financial responsibility of the individual. Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The Commission approved the registration of Moresk House with the Underhill Care Ltd in November 2007. This was the first unannounced key inspection, which took place on 22 April 2008 and lasted for approximately seven hours. The purpose of the inspection was to ensure that People who use the service needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that people’s placements in the home result in good outcomes for them. Information received from and about the home since it’s opening has also been taken into consideration in making judgements about the quality of outcomes for the people living there. The inspection included meeting with some of the people currently living at Moresk House plus taking into account the surveys completed by them (8). On the day of inspection nineteen people were resident in the home. Discussions with relatives plus a survey received also occurred. Members of staff were interviewed and 2 surveys were received from them plus there were opportunities to directly observe aspects of people’s daily lives in the home and staff interaction with them. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the Responsible Individual in the registered manager absence. The principle method of inspection was “case tracking”. This involves interviews with a select number of People who use the service, staff caring for them and examination of records relating to their care. This provides a useful impression of how the home is working for service users overall. Three people were case tracked in detail at this inspection. The registered manager had requested that the Annual Quality Assurance Assessment, which is a questionnaire that the registered provider completes, was returned to the Commission at a later date, which was agreed and therefore was not able to be considered in this inspection. What the service does well: New people to the home confirmed that they met with the registered manager prior to admission so that they were aware of what care they would receive at Moresk House. Residents commented this was done in a ‘sensitive’ and ‘informative’ manner and did not feel this area could be improved upon. From Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 6 inspection of case records it was evident that the registered manager undertakes their own assessment. From this an individual plan of care that summarises the person’s needs is implemented. The care plan forms the basis of the care and support provided. People who use the service were positive about the care and support provided by the staff and said the staff was flexible and responsive to their needs. Some comments include ‘I get spoilt here’ and ‘staff are so helpful’. People who use the service also stated they were always treated with dignity and respect. Good arrangements are in place to meet individual’s health needs and people who use the service were confident that medical services are promptly accessed when required. From an observation of a medication round it was noted that a safe system is in place and staff that have been suitably trained administers medication. However the medication policy must be available at all times, as this could not be located. Flexible visiting arrangements are in place. People who use the service are positive about the varied and nutritional menu that reflects their preferences and choices. Some saying the food is ‘good’ and we get ‘plenty of it’. The kitchen is suitably equipped and good standards of cleanliness are maintained. People who use the service and relatives said that if they had any concerns they felt able to discuss them with the registered manager or staff and were confident that the registered manager would listen to them and act upon any issues raised. Staff are provided with good information and guidance about abuse and the providers are taking steps to make sure that all staff are appropriately trained. The care home comprises of two buildings that are in close proximity to each other. The main building accommodates individuals that require regular care and support. The smaller accommodation is for those people that do not regularly require personal care and support. These individuals choose to spend the day in the main house. The environment is homely, clean and comfortable and the people who use the service said they were satisfied with the accommodation provided. The communal space is on the ground floor and bedrooms are located on all floors of the house. People who use the service said they were satisfied with the care provided and that staff are ‘kind’, ‘supportive’ and ‘helpful’. It is clear that positive and trusting relationships have been established between the staff and people who use the service. The care home is well managed by an experienced, qualified, registered manager who has the confidence of the People who use the service, relatives Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 7 and staff. The Responsible Individual also plays an active role in the day-today operations. What has improved since the last inspection? What they could do better: As this is the first inspection a number of statutory requirements and recommendations were identified to further improve the service that Moresk House provides. The Responsible Individual stated that the registered manager is currently updating the homes Statement Of Purpose and Service Users guide which will inform people who use the service and prospective enquirers of the services and facilities that Moresk House provides. The person’s statement of terms and conditions of residency are also currently being reviewed. Once completed copies of these should be sent to the Commission. The home’s assessment, care plans and reviews do not make clear who was present or participated in these meetings. It is recommended that this occurs as this would provide evidence that the person who uses the service and their family, or representatives, were involved in the assessment/ care planning and review process and are therefore involved in the decisions making process about their care needs. In addition care plans are required to be updated to accurately reflect current care needs and direct, guide and inform staff in how to meet the particular care need in a consistent manner. From discussion with the Responsible Individual new corporate polices and processes will make this process clearer. Once a risk has been identified i.e. in the area of mobility, or management of behaviours these must be cross-referenced to the care plan so that staff receive appropriate guidance as to how to mange this risk in a consistent manner. On the day of inspection the home was operating with insufficient staffing. Staff and people who use the service all commented that the care of people who use the service would benefit from an increase in staffing especially at breakfast and mealtimes. Staff and people who use the service also commented that due to the staffing levels things have been missed i.e. people have not been weighed for some months, planned activities are cancelled (as occurred on the day of inspection) and some commented that they would like to retire to their rooms in the afternoon but fleet this would place extra pressure on staff and so stayed in the main lounge. Some people who use the service are in their rooms but many individuals made comments that they only see staff when a caring task is needed, ‘there is no time to chat’. Staff also Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 8 echoed this. The Responsible Individual is currently advertising for more staff and is aware of this issue. However staffing levels must be reviewed. In respect of the environment the Responsible Individual has undertaken an environmental audit and identified furnishings/ décor that needs to be replaced and is actively addressing this. It is of priority that the stair/hall carpet is replaced as it is worn in places and could present as a tripping hazard. It is recommended that a fly screen be installed to the kitchen window and door to promote infection control. The homes recruitment checks were unable to be inspected, as they could not be located in full. The Responsible Individual was aware that references have been received for new members of staff but these could not be found. All staff have a CRB and application form. New supervision documentation is being introduced. The registered manager must complete her registered Managers Award. The registered manager is enrolled and participating in this course. The Responsible Individual and staff were unaware of the process of accessing people who use the service finances in the absence of the registered manager, plus no records could be located. What is of concern is that various documents such as staff records and medication policy could not be located in the registered manager absence, however it is appreciated that the Responsible Individual is new to the home but the long standing staff should be aware of where these records are held. A large box of confidential information was stored in a toilet, which was accessible to all who used this facility. Confidential information must be stored securely at all times. As this is a new service Underhill Care ltd want to implement a range of policies and procedures to promote peoples health and wellbeing plus improve safe working practices in the home. Training will need to be given to staff in these new working practices. It was observed that fire doors were wedged open which poses a health and safety risk of fire. This must not occur. The inspector would like to thank people who use the service, relatives, staff and the Responsible Individual for their kind assistance and cooperation during this inspection process. Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 9 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. Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 10 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 Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 11 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): 3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are assessed so that they can be assured that the home can provide adequate care. EVIDENCE: From discussions with people who have recently come to live at Moresk House, they confirmed that managers from the home visited them and discussed their care needs. Documentation evidenced an assessment had occurred taking into account prospective residents physical, emotional, social and diverse needs. The home’s assessment does not make clear who was present at the assessment. This would provide evidence that the prospective resident and their family, or representatives, were involved in the assessment to ensure that their diverse needs were recorded. People who use the service however, feel that the home involved them in their care arrangements. The Responsible Individual stated that with the introduction of new paperwork/systems the prospective individuals pre admission assessment will Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 12 be separated from the care planning process which will identify more clearly a persons needs and their views prior to admission. The Responsible Individual stated that the contract or a statement regarding the terms and conditions of residency is being reviewed and therefore was not inspected on this occasion. Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 7,8,9,10 Care plans would benefit from further expansion, as they do not clearly inform, guide or direct staff in the caring interventions that they need to undertake with individual people. Evidence of reviewing care plans was lacking. There are satisfactory arrangements to ensure people who use the service have access to healthcare service. EVIDENCE: All the people case tracked had written care plans. The care plans did note peoples personal routines and preferences and their religious beliefs on admission. The care plans would benefit from further expansion so that care staff are informed, guided and directed as to what caring interventions are needed to ensure consistent care to individuals. For example in the management of peoples behaviour there was minimum written guidance in how to approach a person when exhibiting certain behaviours but in speaking to staff some where knowledgeable as to how to do this. There was also no reference if consultation with CPN or doctors had occurred in how to manage this care need. Some of the care plans gave contradictory guidance to staff in Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 14 what the current care need was i.e. one stated the person used a walking stick and went to dinner in the lounge but elsewhere said that the person was in bed and had meals there. It was unclear which one was the current care plan to use as it was undated and not signed. There is currently a lack of evidence that they are reviewed on a monthly bases. In discussions with staff they acknowledged that the care plans are ‘all over the place’ and that old information is on the file with new information and therefore there is a potential for confusion as to what the current care need is for an individual. Staff agreed that the information they have must be condensed, as there was duplication of information, so that it is easily accessible to staff in order that consistent care is being provided to people who use the service. However in discussions with staff, as they are a stable staff team, they knew the individuals well and were able to describe what assistance a person needed. However staff were aware that new staff would be joining the team and could appreciate that they would not have this knowledge and therefore care planning needs to be written accurately. The responsible Individual showed the new format of care plans that will be introduced to the home. These are more detailed and will inform, direct and guide staff in what caring interventions are needed for each individual and if used appropriately should improve on this area of care greatly. People who use the service said they were satisfied with the care and support they receive and many were positive about the manner in which the staff undertakes their duties and responsibilities. A number of people who use the service commented they felt in control of the care provided and were able to direct the support and care they receive. It is recommended that when people who use the service or their representatives are consulted in the care planning or review process that this be recorded so that the home can evidence their participation more fully. Risk assessments were present on files and did identify if a certain activity was a low, medium or high risk and what actions/ equipment is needed to assist a person for example if they had a fall. This information needs to be transferred to the care plan so that staff are aware of what actions they need to take. Again the responsible Individual showed new risk assessments that will be implemented in the home, which will improve the current process. The daily records for people who use the service summarised if care had been provided that day. It is recommended that the registered manager monitor the detail of these records to evidence what care the resident has experienced during the day plus any activities that they have participated in. People who use the service are registered with local GP practices. People who use the service felt that their health care needs were monitored and attention Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 15 obtained promptly when needed. When a care need has been identified which may need involvement form a district nurse or nutritionist this must be crossreferenced to the care plan. Staff acknowledged that people who use the service have not been weighed for some months. A medication round was observed and staff were competent in the administering medication and it’s recording. Staff responsible for administering medication has been suitably trained and clear records are maintained. There is a clear audit trail of PRN medication so that all medication kept in the home tallies with MAR records. The Pharmacist safely disposes of any medicines that are no longer required. Staff were unable to locate the medication policy and therefore it was not inspected on this occasion. The policy should be available at all times. People who use the service and their relatives made positive comments on the skills and caring qualities of staff. People who use the service felt well cared for and reported that staff delivered care sensitively, respected their privacy and dignity and listened to their concerns. People who use the service said that staff were “lovely” and “kind”. Examples of staff providing skilled and sensitive care were observed during the inspection. Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are supported in a lifestyle, which accords as far as possible with their own expectations and preferences. People who use the service stated in the main they are satisfied with the range of activities that takes place that meets their social, religious and recreational interests. The diet provided is varied and nutritious with attention to individual preferences EVIDENCE: Some people who use the service felt that they had control over their daily lives and were supported to make choices about their routines and activities. They felt comfortable with the routine of getting up/ retiring to bed. A comment was made that it would be nice to go back to bed in the afternoons for a rest, which was relayed to the Responsible Individual who said she would look into this. Some people who use the service felt that there was ‘enough to do’ and all commented on how they like the trips out of the home. Individual care plans detail their social and activity interests. Staff agreed with people who use the service that some planned activities have not occurred due to staffing Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 17 shortages and for example the activities on the day of inspection was not occurring because of this reason. The home plans to provide a range of planned activities such music, bingo, beetle juice, painting and karaoke. People who use spoke positively about a recent outing, and liked the bingo as they People were observed during the inspection to watch TV in the some socialised with each other. as outings, the service won prizes. lounge and People who use the service and a relative said that they found the visiting arrangements open and flexible. They felt that visitors were made welcome. People who use the service confirmed they have a lockable facility for small items of value. They can bring in possessions and furniture at admission by agreement with the provider. Many people and their families had personalised their bedrooms and were aware that they could lock their rooms if wished, but have chosen not too. People who use the service were complimentary about the quality and quantity of food provided, comments such as ‘good’, ‘there is a daily choice’ and the portions were ‘the right size’ were given. They confirmed that they were aware of the meals provided each day, of which a menu is on display, and that they choose from the menu their preference. Each person’s preferences and choices are recorded. People who use the service are encouraged at the residents meeting to provide ideas for the menus, which will be reviewed again with the appointment of the cook. A mealtime was observed to be an unrushed and social occasion with staff providing sensitive support in a pleasant manner. Staff knew peoples’ likes and dislikes. Hot and cold drinks are served between meals. A cook has just been appointed and is due to commence work soon. A carer has taken on this role in the meantime and says she will provide an induction to the cook. The carer working in the kitchen stated she has relevant qualifications in food hygiene. Kitchen staff are available daily and therefore undertake the preparation of the main meal and tea in the home. She demonstrated an awareness of peoples’ likes/ dislikes of food and any special dietary requirements. A recent environmental health inspection identified some minor issues, which have since been addressed. Records of food temperatures etc are kept. A new oven has been purchased and a fridge is on order. It is recommended that fly screens be fitted to the window and the door to promote infection control. Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in pace to deal with any concerns or complaints positively. Staff are aware of the importance of ensuring that People who use the service are protected from abuse and have received training in this area. EVIDENCE: The complaints procedure is appropriate. People who use the service, their relatives and surveys, said that if they had any issues of concerns, or ideas for improving the service that they were able to approach the management team and felt that they would be listened too. People commented that they were pleased with how well the ownership of the home change over had occurred and that they felt able to approach the management team if they had any worries. No formal complaints have been received. The Responsible Individual is reviewing the homes adult protection policy and procedure. The Responsible individual was very aware of what procedure needs to occur if there is a suspicion/ allegation of abuse as was staff. The responsible individual will ensure that staff attend the relevant external and internal training in this area. Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 19 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 and 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is accessible, well maintained and safe. A homely, clean and comfortable environment is provided that is maintained to the required standard EVIDENCE: The care home comprises of two building in close proximity to each other, which are located on the same site. The majority of care takes place in the main building and the smaller separate accommodation offers a home to people that are independent and do not require regular care and support to meet their needs. During the day people who are in the smaller separate accommodation come to the main unit during the day and at night waking care staff visit the unit on a regular bases with sufficient on call facility available. The environment is furnished and maintained to a satisfactory standard. People who use the service describe the accommodation as comfortable and many Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 20 have personalised their own bedrooms. People said they ‘liked and ‘were happy’ with their rooms. The majority felt that there could be no improvements made to the environment. Communal space is located on the ground floor and comprises of a sitting room and a dinning room. Both are popular areas for People who use the service. There are a range of toilets and bathrooms distributed throughout the homes that are within a reasonable distance from people’s bedrooms and the communal areas. The space and layout of certain bathrooms have some limitations but there are a number of bedrooms that have their own en-suite facilities. A range of aids and adaptations are provided at the home to assist people to be as independent as possible. In additional individual people are provided with disability equipment when this is required and following a specialist assessment. Windows have been replaced and the garden area has been landscaped. The Responsible Individual has completed her own internal audit of the home and is aware of the maintenance work and redecoration that is needed throughout the home. She showed me one room that has recently been redecorated and this has been done to a good standard. The carpets in the hallway/ stair area need to be replaced as they are worn in places and could become a tripping hazard plus the design needs to be reviewed as the home caters for people who experience confusion. Good standards of health and hygiene are maintained at all times and People who use the service are very satisfied with the cleanliness of the environment. The housekeeper and care staff were aware of the importance of cleanliness, promoting infection control and COSHH. Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The managers are aiming to increase staffing levels at particular times of the day to meet people’s needs safely. Staff are qualified and competent to work with the People who use the service. They are recruited on the basis of fair, safe and effective recruitment and selection policies and practices. They have good access to ongoing training to maintain their knowledge and skills. EVIDENCE: On arrival the senior carer acknowledged that there was insufficient staff on duty that day. There should have been a person in charge of the shift, 3 carers, cook and domestic on duty. However the registered manager was on leave as was the domestic therefore the senior carer was acting as the person in charge of the home plus undertaking caring tasks along with 2 carers of whom were also undertaking domestic tasks. At midday there was going to be the senior carer plus one carer. The senior carer contacted numerous staff to try to get more cover for that day but was unsuccessful. However she contacted the Responsible Individual who agreed to come to the home as an inspection was occurring and to provide support. This then meant that the senior carer could resume her carer responsibilities. It was noted that one member of staff had worked for 10 days without a break. The Responsible Individual acknowledged that 2 carers are insufficient and that the registered persons have agreed for a third carer to be on duty in the mornings. Staff interviews for a cook, handyperson and night staff carers were Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 22 successful last week and they are awaiting appointments to be confirmed once relevant checks have been made. Re-advertisement for carers is in process as they are still vacancies in this area. It was explained by the Responsible Individual that the company aims to have two team leaders on duty, to allow the registered manager to undertake her management duties, with 3 carers in the morning and two in the afternoon. The company would ideally also like to employ a member of staff who could cover for holidays/ sickness between the two Cornwall care homes. From surveys completed plus discussion with people who use the service, their relatives and staff it was noted that all raised the need for an increase in staffing levels generally. People who use the service felt that staff were ‘busy’ and that contact with staff was when a particular physical care need was being undertaken. People who use the service said that staff do not have time to talk and on the day of inspection due to the shortness of staff the planned activity did not occur. I was told that this is occurring more frequently as staff do not have time to do this. A comment was made that they would like to go back to bed in the afternoon but felt this was not possible as this would put extra pressure on staff as they would need to check them in their rooms and some commented that staff liked them to be in the main lounge area so that they could be checked on more easily. This was raised with the Responsible Individual who said she would look into this. People who use the service were very positive about the staff and it is clear that positive and trusting relationships have been established. People who use the service said they felt the care and support they received was sensitive, positive and reliable. The homes recruitment records were unable to be inspected, as they could not be located in full. The Responsible Individual was aware that references have been received for new members of staff but these could not be found. All staff have a CRB and application form. New supervision documentation is being introduced. Staff at the home said they were well supported and were clear about their roles and responsibilities. It is clear the staff group are committed to helping people maintain their independence as far as possible. Care staff have either achieved a minimum of NVQ at level 2 or are in the process of completing it. Staff confirmed that there has been recent training and the Responsible Individual was aware of training the team need to complete and was addressing this so that staff maintains their knowledge and skills. Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 23 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): 31,32,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The services and facilities are well managed by the registered manager and the Responsible Individual plays an active role in supporting the people who use the service and staff. Underhill Care Ltd are reviewing and implementing new policies and procedures. Certain documentation was unable to be located which under regulation should be available at all times. EVIDENCE: The Registered Manager has worked at the care home for many years and is positively viewed by people who use the service and staff. They were also positive about the manner in which the home is run and had confidence it was managed for their benefit. The Registered Manager has completed her Registered Managers Award. The Responsible Individual plays an active role in the management of the home and visits the home on a regular basis. Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 24 As this is a new service quality assurances systems are not yet in place. However they have regular meetings with people who use the service and staff to gain their views. The Responsible Individual and staff were unaware of the process of accessing people who use the service finances in the absence of the registered manager, plus no records could be located. What is of concern is that various documents such as staff records, fire records and medication policy could not be located in the registered manager absence, however it is appreciated that the Responsible Individual is new to the home but the long standing staff should be aware of where these records are held. It is to be noted that the registered manager office is small and the location of information in this office was difficult to find. A large box of confidential information was stored in a toilet, which was accessible to all who used this facility. Confidential information must be stored securely at all times. As this is a new service Underhill Care ltd want to implement a range of policies and procedures to promote peoples health and wellbeing plus improve safe working practices in the home. Training will need to be given to staff in these new working practices Measures are in place to promote safe working practices and the equipment and services to the care home are regularly maintained and serviced. The risk assessment and risk management arrangements require improvement as specified in the health section. The Responsible Individual has plans to introduce new risk assessments processes. The staff at the home said that they have regular fire training although records to confirm this could not be located. It was observed that fire doors were wedged open which poses a health and safety risk of fire. This must not occur. Moresk House DS0000070677.V362807.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 X X 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 2 2 2 Moresk House DS0000070677.V362807.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 OP7 Regulation 15(1) Requirement All People who use the service must have an up to date, detailed care plan. This will ensure that they receive person centred support that meets their needs. Staffing levels must be reviewed to ensure that suitable, qualified and sufficient, staff are on duty at all times to meet the physical and emotional needs of people who use the service. Records required as per Care Standards Act regulation should be available at all times. Timescale for action 30/08/08 2 OP27 18(1)(a) 30/08/08 3 OP38 4 OP38 17 (1)(a)(b)( 2)(3)(b) 19 (4)(b) 13, 12 30/05/08 5 OP38 6 7 OP37 OP38 Staff must be aware of the location of policies and procedures, eg medication, so that they can refer to them when needed. 23(4)(a)(c Fire doors must not be wedged )(i) open as this poses a fire risk to People who use the service, staff and visitors to the home. 17(1)(b) Confidential information must be stored securely at all times. 37 (all) All incidents/ events must be notified to the Commission as DS0000070677.V362807.R01.S.doc 30/05/08 30/04/08 30/04/08 30/04/08 Moresk House Version 5.2 Page 27 described under regulation 37 of the Care Standards Act 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 4 5 6 Refer to Standard OP1 OP2 OP7 OP8 OP12 OP26 Good Practice Recommendations Once the Statement Of Purpose and Service Users guide are completed copies of these documents should be sent to the Commission for their information. Copies of the reviewed Statement of terms and conditions of residency should be sent to the commission for their information. Views of People who use the service, and their advocates should be sought and recorded in the pre admission assessment, care plan and its subsequent review. People who use the service should be weighed on a regular bases so that any health issues can be easily identified and addressed. Planned activities should take place when arranged. In addition a review of the range of activities on offer would benefit from review. A fly screen should be installed on the kitchen door and window to promote infection control. The hall/stair way carpet should be replaced to prevent a tripping hazard Staff should have a minimum of six recorded formal supervision sessions per year. Staff should be made aware of the process of accessing people who use the service finances so that this is available to them at all times. The Responsible Individual and registered manager should continue to update the homes polices and procedures and then provide appropriate training to staff. 7 8 9 OP36 OP35 OP38 Moresk House DS0000070677.V362807.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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