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Inspection on 02/03/06 for Moreton Hill Care Centre

Also see our care home review for Moreton Hill Care Centre for more information

This inspection was carried out on 2nd March 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users admitted to the home have a complete assessment to ensure that their needs can be well met. The care staff communicate well with the service users in the dementia units. The inspector observed the service users behaviour in a dementia unit and signs of well-being were seen in most of the service users; e.g. warmth and affection towards the staff, responding to others well and making contact, being helpful, bodily relaxation, remaining alert and purposeful and a sense of humour. One new service user was able to make jokes indicating social confidence within the group. Another new service user stated that "the staff are first class" and that he had "no worries". Two service users said the food was very good. The home gives considerable choice to service users in their daily life and they are supported to enjoy activities based on their wishes. Good recruitment procedures and practices ensure that the service users are protected. The home is well managed and makes every effort to complete requirements made, and quality assurance methods are regular and comprehensive. Service users meeting are held regularly and the outcomes influence how the home is run.

What has improved since the last inspection?

Eighty percent of the care staff had recently completed a dementia care course and a carer spoken to had some good ideas on how to improve care practices and the environment for service users. Air conditioning had been installed in all medication storage rooms improving the quality and safety of storage. One of the dementia units also had a new air conditioning system to provide a comfortable temperature at all times. All nursing staff have received wound care training and a new improved wound care record is in use. The head of the dementia care units is being supported by Barchester to complete a professional qualification in mental health nursing.

What the care home could do better:

The care plans seen in a dementia care unit need to be individual to ensure that care staff know how to deliver person centred care to each service user. Additional assisted bathing facilities are required in the general nursing unit on level 2. The zoning of the call bells should be completed for the benefit of everyone in the home. All toilet facilities should be permanently identified in the dementia units to enable service users to be independent for as long as possible. A recorded review of the staffing levels must be completed to ensue all service users needs are met in a dignified manner with sufficient staff. The staff should be careful not to use over familiar terms of endearment, which may be inappropriate and/or offensive to the service users.

CARE HOMES FOR OLDER PEOPLE Moreton Hill Care Centre Standish Stonehouse Glos GL10 3BZ Lead Inspector Mrs Kate Silvey Unannounced Inspection 2nd March 2006 09:30 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 Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Moreton Hill Care Centre Address Standish Stonehouse Glos GL10 3BZ 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) 01453 826000 01453 826001 sue.stannard@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited To be appointed Care Home 67 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (37), of places Physical disability (5), Physical disability over 65 years of age (5) Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th September 2005 Brief Description of the Service: Moreton Hill Care Centre is situated on the outskirts of the small town of Stonehouse, close to Standish hospital. The home is set high on a hill with magnificent views across the countryside to the River Severn beyond.The building consists of an old farmhouse, which has been renovated and extended. The accommodation is on various levels and is furnished, decorated and maintained to a high standard. The majority of rooms have ensuite facilities. Most rooms are for single occupancy although couples can be catered for. All areas of the home are accessible with two lifts to all floors. There are five reception rooms, which serve all levels in the home.Outside there are various sitting areas, one of which is an enclosed courtyard with raised flowerbeds, plants and shrubs. Three parking areas surround the home and the nearby fields and stables are home to a collection of farm animals. There are level pathways for service users to walk safely or use wheelchairs at their leisure. Two of the wings Severn View and Cotswold Rise have been registered to accommodate residential clients with dementia. They have their own lounge, dining and kitchen areas, which have been well decorated and furnished to meet the needs of the service users. The service users also have access to an enclosed courtyard and a garden with sensory planting. Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced during one day with two inspectors. Fourteen standards were inspected in September 2005, therefore only nine standards were inspected this time to include, staff recruitment, care planning, choice, activities, and quality assurance. Time was spent observing communication in the dementia units and talking to service users and care staff. Care and recruitment records were seen. The new manager, who intends to become the registered manager, was interviewed. What the service does well: What has improved since the last inspection? Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 6 Eighty percent of the care staff had recently completed a dementia care course and a carer spoken to had some good ideas on how to improve care practices and the environment for service users. Air conditioning had been installed in all medication storage rooms improving the quality and safety of storage. One of the dementia units also had a new air conditioning system to provide a comfortable temperature at all times. All nursing staff have received wound care training and a new improved wound care record is in use. The head of the dementia care units is being supported by Barchester to complete a professional qualification in mental health nursing. What they could do better: 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. Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 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 Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The head of dementia care completes a detailed assessment for all service users before admission to the Unit’s to ensure that their needs can be met. EVIDENCE: A recent pre-admission assessment was seen on one of the dementia units, which included information from healthcare professionals and a ‘family tree’. The assessment was detailed and the need for additional health care support was identified. The head of dementia care was spoken to and stated that all service users have a complete assessment before admission to the Unit’s to ensure that their needs can be met. A medication review is completed soon after admission by the local GP who visits the home weekly. Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 The care plans are not individualised enough for care staff to follow, however, the outcomes for service users were good and the unit was calm and service uses showed many signs of well-being. The service users have the support from healthcare professionals when required and this enhances their well-being. EVIDENCE: Some care plans were seen in one of the dementia care units. Assessments had been completed and some detailed social histories were seen. The daily records were well recorded and healthcare professional support was evident. The units have close links with the community psychiatric services at the local dementia assessment hospital. The Community Psychiatric Nurses sometimes visit the home to assess service users when required. The care plans seen were generic, as before, and need to be individual so that care staff can see how each service users ‘person centred care’ should be delivered. A care plan should be clear, direct and realistic. It should describe what is to be done, when and by whom. Identifying likes and dislikes and individual strengths to boost service users self esteem, giving pleasure and Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 10 satisfaction and preventing difficult behaviour. The aim of a care plan is to maximise the services users well-being and minimise their ill-being. Urinary continence pathways had been implemented for one service user to improve continence. The inspector observed the service users behaviours and generally signs of well-being were seen in the service users; e.g. warmth and affection towards the staff was seen, responding to others well and making contact, being helpful, bodily relaxation, remaining alert and purposeful and a sense of humour. One service user showed some signs of ill-being which were, some anxiety and fear of the other service users, although she smiled at staff and obviously trusted them. Staff responded well to the service user, which reassured her. Risk assessments and planned action had been completed where appropriate. The care staff observed were able to respond appropriately as they were aware of the service users individual needs and personal requirements. It was evident that the staff also knew the service users social histories well, and were able to prompt them when required about their ‘family members’, for example. All the service users in Cotswold Rise were seen and spoken to. It was evident that the majority were relaxed in their environment and one new service user was able to make jokes indicating social confidence within the group. Another new service user stated that “the staff are first class” and that he had “no worries”. Two service users said the food was very good. Lunchtime was observed and staff ate their lunch with the service users providing a model behaviour them to follow. The lunchtime was calm and relaxed, staff gave gentle encouragement and communicated well with the service users. Many of the care staff had recently completed a distance learning dementia care course with a local college. A carer spoken to, who had completed the course, had some good ideas to improve care practices and the environment, which should be considered e.g. a permanent way to identify toilet facilities in the units which would be easily recognised by the service users. Air conditioning had been installed in all the rooms where medication is stored, which was required to ensure correct temperatures are maintained for storage. Cotswold Rise dementia care unit has air conditioning now which will ensure a comfortable temperature in the unit at all times. Cotswold Rise unit has an assisted bathing facility and showers. The manager stated that more bathing facilities are to be included in the general nursing unit as both specialised baths are upstairs and access for some service users is difficult. Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 11 The nursing staff on the general unit had received wound care training since the last inspection and the wound record used was detailed and included a report each time the wound was dressed and a pain identification chart. Medication disposal was discussed with the nurse in charge who was able to explain that the home was disposing of medication correctly, including the disposal of oxygen cylinders. The use of over familiar terms of address should be avoided, e.g. gorgeous and darling as service users may not feel respected and may not be able to deter staff from using them. Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 The staff are good at enabling the service users to have choice and control over their lives, which gives them self respect, pleasure and well-being. EVIDENCE: The dementia care Units. A copy of ‘welcome to memory Lane’ was seen and it was noted that the home states that it provides ‘highly specialised supportive care for people and their families experiencing dementia and related challenges with behaviour’. This aim it is said is built on a number of principles which included the values of choice, independence, self esteem, safety and comfort Service users who are able can exercise choice over their daily lives, and the daily activities in the home provide a range of events, which were age appropriate. The activity provided on the day of the inspection was well attended. The activity was a crossword but through the skill of the organiser widened to include a discussion, which included the opportunity for the service users to share some memories with others. The inspector also visited Severn View, one of the dementia units, and was advised that some of the service users are able to access the general activities Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 13 in the home, which are enjoyed by the more able. On the day of the inspection a bus trip had been organised and one of the service users from the dementia Unit went on the trip with support from a carer from the Unit. The home has produced considerable literature about service users rights and the values of the home. This is available to service users/relatives and where appropriate advocates. This information included a copy of the ‘Alerter Guide’, which was produced by Gloucestershire County Council and refers to the protection of vulnerable adults. The bedrooms exceed the minimum special requirements and therefore service users are able to bring some personal belongings with them. Service users are able to access their personal records. Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not inspected this time. Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not inspected this time. Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29 The homes is providing the care staff with some good training in dementia care and is supporting the head of dementia care to complete a professional qualification in mental health. The recruitment procedures were good and the records were complete ensuring that service users are well protected. EVIDENCE: Eighty percent of care staff in the dementia care units have completed a ‘Positive Dementia Care’ course supported by Cirencester College. The head of the dementia care Units stated that Barchester have staff who look at specialist training within the organisation, which includes developing more advanced dementia care training for staff managing dementia units. The recruitment procedures were inspected to provide evidence of the homes practice. Two recent appointments were seen and the documentation inspected. The records included the formal application, health and employment records. In each case two referees were nominated and the references, which had been taken up, were seen. There was also a record that Criminal Record Bureau checks had been made. The home had taken advantage of the POVAFirst initiative and there was a record of the relevant clearance. Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 17 Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 ,35 The home is well managed and the management staff make every effort to complete requirements made. The new manager who was spoken to was experienced in the care of the older person, but had not been formally interviewed by the Commission to ensure fitness to become a registered manager. The ongoing programme of quality assurance is good, ensuring that the home is aware of the service users views. EVIDENCE: The home has a new experienced manager who is a registered nurse and will be applying to the Commission to become the registered manager. The head of the dementia care Unit’s stated that he was completing a ‘return to nursing’ course to regain his Registered Nurse Mental Health qualification. Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 19 The home has a quality assurance policy and this included the ‘monthly audit’, which consists of a range of questions on predetermined topics in respect of the services provided by the home. The topic in January 2006 was Health and Safety, and in February 2006 it was Nutrition. There is a questionnaire and this is completed by relevant staff, which often included the trained staff, carers and ancillary staff. The objective of the monthly audit is to ensure that standards are being maintained and if necessary to raise issues which may need attention. The returned questionnaires are collated by the registered manager who would determine what action is required. The new manager had only been in post for a few weeks but was conversant with the audit tool and was positive about its purpose and application. The service users also have a monthly meeting and this is run by one of the activities organisers. The inspector met the current chairman of the service users group who felt that the meetings were useful. Service users were able to discuss matters and appropriate action was undertaken when required. An issue of food was discussed several months ago and the chef was asked to attend to respond to the questions raised. Service users are encouraged and, where necessary, supported to use this avenue to influence changes in the home. The activities organiser was seen by the inspector as someone who was competent to run the meeting and sensitive to the needs of the group. There was little doubt that the home is anxious to maintain high standards in each aspect of the service provided. The manager stated that the call bell system will be zoned for the benefit of everyone in the home and a quote for the upgrade has been obtained. The home does not directly manage service users personal monies. This is undertaken by the individual or a nominated relative. Where charges are incurred e.g. hairdressing, an account is raised and passed to the relative for reimbursement; two record were inspected. Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 20 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 4 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X x Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 21 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 OP27 Regulation 18.1 Requirement Timescale for action 30/06/06 2 OP7 15.1 3 OP22 23 The registered person must record a staffing level review, to include time/staff numbers required to meet service users needs and provide a copy to the Commission. (This was a requirement for 01/01/06) The registered person must 30/06/06 ensure that the care plans on the dementia units have sufficient information. (This was a requirement for 30/11/05) The registered person must 31/10/06 ensure that there are adequate bathing facilities on level 2. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The registered person should ensure that over familiar terms of endearment are not used inappropriately. DS0000016505.V285561.R01.S.doc Version 5.1 Page 22 Moreton Hill Care Centre Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Moreton Hill Care Centre DS0000016505.V285561.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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