Inspection on 20/03/07 for Moreton Hill Care Centre

This inspection was carried out on 20th March 2007.

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

Moreton Hill Care Centre 12/03/09

Moreton Hill Care Centre 02/03/06

Moreton Hill Care Centre 15/09/05

Moreton Hill Care Centre 04/03/05

Moreton Hill Care Centre 30/11/04

Moreton Hill Care Centre 13/05/04

Moreton Hill Care Centre 24/02/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

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 Moreton Hill Care Centre Standish Stonehouse Glos GL10 3BZ Lead Inspector Mr Adam Parker Key Unannounced Inspection 20th March 2007 09:50 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.V323667.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. Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 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 Ms Charlotte Tily 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.V323667.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd March 2006 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 residents 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. Current fees are £750.00 to £895.00. Hairdressing, chiropody, newspapers, toiletries and outings are charged extra. The home makes information about the service, including CSCI reports available to service users and their representatives through a service user guide and statement of purpose available in the home. Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was carried out by one inspector over three days in March 2007. The registered manager of the home was present for the final day of the inspection visit which consisted of a tour of the premises and examination of residents’ care files. In addition staff recruitment and training was looked at as well as documents relating to the management and safe running of the home. A sample of residents were selected for inspection against a number of outcome areas as a ‘case tracking’ exercise. Comment cards were received from residents, their relatives, staff working in the home and one from a General Practitioner (GP). The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Systems are in place for assessing residents’ needs and planning their care with their involvement or that of their relatives. The home has done well to provide air conditioning to maintain appropriate medication storage temperatures. The home provides a stimulating and variable programme of activities and some excellent work has been done in providing individual memory box displays in one of the units for residents with dementia. The home welcomes visitors to the home enabling residents to maintain contact with family and friends. In addition a clear complaints procedure enables any complaint to be raised by residents or on their behalf by relatives. Staff are trained in how to deal with any potential abuse issues and have relevant information about the local adult protection unit. The home provides a range of training for staff and actively follows up on mandatory training updates. Staff recruitment procedures are robust and in the interests of protecting residents. The home was well maintained and clean providing residents with a safe and comfortable environment. The home is well managed and through this and quality audits, the home can demonstrate that it listens to the comments of residents and their relatives and can work towards providing positive outcomes. The home has an excellent system for monitoring the servicing and maintenance of equipment in the home in the interests of health and safety. Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Moreton Hill Care Centre DS0000016505.V323667.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 Moreton Hill Care Centre DS0000016505.V323667.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admission procedure ensures that all service users are admitted to the home on the basis of a full assessment of their needs, so that they can receive the care that they require. EVIDENCE: The assessment documentation for residents recently admitted to the home was looked at. These had been completed following an assessment of the service user’s needs by the registered manager prior to admission to the home and included a medical history. In one case for example the assessment had been completed by the registered manager while the service user was still at home. Assessments are normally completed with input from the prospective resident or from a relative or representative. Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 9 The head of care stated that the home insisted on receiving copies of care plans and assessments from funding authorities where this was appropriate to the prospective resident. The registered manager cited examples of prospective residents who had not been admitted to the home following assessment usually where there were concerns about managing certain behaviours. In all of the surveys received from residents in the home, the indication was that they had received enough information about the home before moving in. The home does not provide intermediate care and so Standard 6 does not apply. Moreton Hill Care Centre DS0000016505.V323667.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good individualised care planning system in place which provides staff with the information to meet residents’ needs. The home works well to meet residents’ health needs and liaises with health care professionals. Medication administration procedures in the home provided by trained staff should ensure that residents’ medication needs are met although some improvements need to be made in relation to the recorded directions for administration. Care is given in such a way as to promote the privacy and dignity of residents. EVIDENCE: Care plans were specific, individualised and comprehensive covering all assessed needs of residents and had been reviewed on a monthly basis or in Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 11 response to a change in condition. A new type of care plan format has recently been introduced into the home and one of these had been completed for one resident who had problems with sleeping and this was very detailed relating to individual needs. Where appropriate care plan reviews are arranged with relatives on a six monthly basis and one was being arranged for a resident of Cotswold Rise during one of the days of the inspection visit. A daily living profile is completed where a record is made of baths, showers, hairdressing and dental appointments. Risk assessments had been completed for pressure areas, moving and handling and falling and related care plans had been produced where the need indicated this. In relation to pressure area care the condition of residents’ skin is examined on admission and a record made. There was recorded evidence of residents having input from health care professionals such as GPs, mental health nurses and chiropodists. Where one resident of Cotswold Rise was having input from a mental health nurse it was unclear if there were Care Programme Approach arrangements in place in relation to this. The home should check if this applies and request copies of any relevant documentation. Out of 13 surveys received from residents in the home, nine said they always received the care and support they needed and four said they usually did. Out of 37 comment cards received from relatives of residents, 36 indicated that they were satisfied with the overall care provided and one indicated that they were not satisfied. One comment from a relative of a resident stated “ The care my Mother has received at Moreton Hill has been Excellent” Residents are weighed monthly and any weight loss along with any pressure sores are required to be reported to the head office of the provider for monitoring. Medication administration and storage arrangements were looked at. Medication is stored in several locations in the home and air conditioning has been provided at these locations to maintain appropriate storage temperatures. Where medication was stored in refrigerators, records had been kept and these indicated that temperatures were within the correct range. However it is recommended that the temperature of one storage cupboard situated on the outside wall in the Level 2 nurses station should be monitored to ensure correct storage temperatures particularly during spells of hot weather. It was noted that bottles of liquid medication had been dated on opening except for one bottle, however it is accepted that it is the usual practice in the home to date bottles on opening with a view to preventing their use after expiry dates. Hand written entries on medication administration sheets had been signed in some cases but not dated and with others there was no date or signature. These entries should be checked to ensure accuracy and prevent any possible administration errors. This issue had been covered in a training document entitled “Meeting the Standards for medication” provided by one of the supplying pharmacies. It was noted that where medication had not been Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 12 administered an appropriate code had been used or an explanation recorded on the administration record sheet. In Cotswold rise there were residents who had been prescribed medication for anxiety symptoms with variable doses to be given on an ‘as required’ basis however there were no care plans or protocols in place to guide staff in when to give this medication. In Severn View however such a plan did exist although the information about the frequency of the dose did not match with the medication administration record. The home uses two different supplying pharmacists and training had been provided by both. In addition evidence was seen of care staff receiving accredited training in control and administration of medication. A drug assessment is planned with all staff in the home who have responsibility for administering medication. Random audits had been carried out on medication procedures and an action plan produced. Staff were observed treating residents with respect and up-holding their privacy. On this subject one resident confirmed that his privacy was respected and said about the home “It looks after me but leaves me alone”. Another resident confirmed that staff knock on her bedroom door before entering. Moreton Hill Care Centre DS0000016505.V323667.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 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Varied and stimulating activities are provided to occupy the residents and enhance their quality of life. The home takes an active part in encouraging residents’ contact with family, friends and the local community, which provides a good degree of social contact. Depending on their ability, service users are able to maintain choice and control over their lives. The meals are nutritious and varied with residents eating in a variety of locations in the home depending on choice or need. EVIDENCE: The home offers a wide range of activities for residents both inside and outside of the home, these include art and craft activities, seasonal activities such as Mothering Sunday and an Easter Bonnet Competition. Trips out of the Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 14 home include theatre performances, garden centres and mystery tours. During one day of the inspection visit residents were going out on the Home’s minibus to view wild daffodils. An annual trip to a seaside resort also takes place with Woolacombe being the destination in the previous year. A number of musical entertainers also visit the home. The home has started to keep a record of service users’ interests in a life history document which is part of the new care plan format. The home has an activities organiser and an assistant who are able to work at weekends and evenings when activities may be taking place. Information about activities is circulated on a weekly basis to all rooms in the main house and to notice boards in the Cotswold Rise and Severn View where residents are reminded verbally about activities on offer. One resident spoken to described how he felt free to exercise choice whether to join in activities or not. Another resident who was relatively new to the home described how she had enjoyed a trip out, another described how she attended art classes in the home and was learning how to use a laptop computer. Residents receive visits from religious representatives on a regular basis. A number of activities are tailored for the abilities of residents with dementia and the activities organiser reported some positive outcomes for these residents in relation to this. Some excellent individual work had been done in Cotswold Rise with ‘memory boxes’ being put together and displayed on the wall near certain residents rooms. These included items relating to the residents lives that may provide recognition and used as an aid to conversation of reminiscence work. In addition several other displays had been put together that related to important past roles of residents. This is a commendable piece of work in relation to the needs of residents with dementia. The home enables service users to maintain contact with family, friends and representatives. Visitors were welcomed into the home and were able to visit service users in communal areas or their individual rooms. Out of 38 comment cards received from relatives of service users, all indicated that staff welcomed them into the home at any time and that they could visit their relative in private. Facilities exist in the home if relatives wish to stay overnight when visiting and relatives are also encouraged to go out on trips with residents. There is some involvement in the home by local community groups with a local school visiting to perform a concert and the local Alzheimer’s Society using the home for Coffee Mornings. Due to the varying abilities of service users in the home, some are unable to control their own finances relying on relatives and representatives for this. The home has information available on how to contact advocacy services who may act in their interests. Evidence was seen of service users bringing their own personal possessions into the home including items of furniture. Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 15 The serving of lunch was observed in the main dining room. The atmosphere was calm and relaxed with tables laid attractively and staff offering various degrees of support to residents. Plenty of drinks were on offer including wine and staff were offering residents a choice on other beverages. Soup was served as the starter or fruit juice and there was a choice of main course. A vegetarian option is also available and special diets can be catered for. The main dining room was large with plenty of space between tables. Some service users took meals in their rooms either through choice or frailty. The serving of lunch was also observed in Cotswold Rise and here there was also a relaxed atmosphere with attentive staff. The home views mealtimes as a highlight of the day and the provider gives a great priority to providing high quality meals with homes in the Barchester group competing for an award status and the production of a cook book based on recipes from various homes in the group. One resident spoken to said “The food is good”, another said the food was “very good” and was happy to have smaller helpings of her choice and another described the variety of meals on offer. It was noted that one service user was receiving a vegetarian option although a record of this had not been kept as an alternative. This was apparently the only ‘special diet’ being prepared at the time. However since the inspection visit the home has supplied the inspector with a document to record any vegetarian option given. Moreton Hill Care Centre DS0000016505.V323667.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): 16,17 & 18 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure and views this as a method of reviewing quality to improve the service offered to residents with some positive outcomes evident. The home ensures that residents’ legal rights are protected and actively supports them to participate in elections. The home gives a high priority to protecting residents from abuse through information and staff training. EVIDENCE: Out of 38 comment cards received from relatives of residents, 28 indicated that they were aware of the home’s complaints procedure and 10 were not. The complaints procedure was clearly displayed in the reception area of the home. Complaints are recorded and a sample of these were seen. The registered manager stated that dealing with complaints is viewed as a quality assurance issue and this was demonstrated in the good outcomes reported for one service user following a complaint that they had made themselves. Residents meetings are held in the home where any general concerns may be aired initially. The registered manager operates an ‘open door’ policy for residents relatives to discuss any issues and tries to meet any complainants Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 17 personally with the intention to resolve complaints by the management of the home although complaints may be taken to the registered provider. The activities coordinator described how the home actively supports residents to partake in the political process by taking them to polling stations to vote as well as the use of postal votes. In addition information on advocacy services is available in the home. The home provides training to all new staff at induction and this is followed up with yearly updates. The training makes reference to the ‘No Secrets’ guidelines and the alerters’ guide produced by the local authority adult protection unit, which was displayed elsewhere in the home. The home’s policy on protecting vulnerable adults was seen. This was clear in describing who to contact in the event of any abuse taking place and again described the role of the local adult protection unit. There had been no reported incidents of abuse in the home. Moreton Hill Care Centre DS0000016505.V323667.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): 19,24 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of living in a well maintained and clean, environment with personalised individual rooms. EVIDENCE: A tour of the premises was conducted. All areas of the home inspected were found to be clean, well maintained with appropriate and attractive decoration. There are a variety of communal spaces available for service users throughout the home with small sitting areas as well as larger lounges. One room known as the Seven Counties Bar has been used for tea dances and is also used as an area for families to visit residents. Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 19 Outside there are well maintained gardens including an enclosed courtyard area with a water feature and seating accessible from the reception area. The home has two units for the care of residents with dementia, Cotswold Rise and Severn View, these are separated from the rest of the home by coded doors. Severn View has an enclosed courtyard area accessible to residents. Individual residents rooms were looked at, many of these contained personal items including items of furniture. The condition of pillows, pillowcases and bed clothing was looked at in a number of rooms and these were found to be clean and of a good standard with at least one resident using their own bed clothes. The home was clean and free from offensive odours with handwashing facilities provided in appropriate locations. The laundry was clean and well organised with hand-washing facilities available. Although the laundry wall surfaces were washable, the whole floor could not be readily cleaned due to a large door mat which had some edging missing. In addition some of the beading on a grating in front of the washing machines was missing. These areas must be attended to improve the integrity of the floor surface in the interests of infection control. This was discussed with the maintenance manager who was aware of the issues involved. Moreton Hill Care Centre DS0000016505.V323667.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents needs are met by the numbers and skill mix of staff. The level of staff training including NVQ training should ensure that residents are in safe hands. Residents are protected through robust recruitment procedures. Induction and other training should ensure that staff are trained and competent to meet residents’ needs. EVIDENCE: Normal staffing levels for the main house were reported as being seven care assistants and two registered nurses for the main house plus the head of care for the day with activities workers providing additional support at lunchtime. There are two care staff in each dementia unit with extra help provided at meal times when required. At night there is one registered nurse and three care assistants for the main house plus one care assistant in each dementia unit with one carer working until 10 pm to support staff. The provision of staff in relation to residents needs and numbers is calculated using a staffing ladder document and this was seen. The registered Manager Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 21 gave examples of where extra staff had been used in relation to residents’ individual needs such as one resident who required one-to-one input for a while and where the head of care is used to provide specific palliative care. There are also plans to review the arrangements for staffing the home in the morning. The home also provides domestic, catering, administrative and maintenance staff. Out of 38 comment cards received from service users relatives, 24 thought that there were always sufficient staff on duty and 11 did not with 3 not providing a response to the question. The level of care staff who have achieved NVQ training at the time of the inspection was reported at 40 . In addition there are a number of staff working in the home as care staff who have been trained as nurses overseas. The records for the three most recently recruited members of staff were examined. All the required information and documentation had been obtained with all required checks made including checks against the protection of vulnerable adults list and criminal records checks for which the home uses a disclosure tracking form to monitor progress. The home provides induction training to new staff using the ‘Skills for Care’ programme which is clearly linked to national specifications in terms of the Common Induction Standards. Progress with induction is clearly documented and the completion of the training is monitored. The home employs a training coordinator and a small training room is situated near to her office. She was clearly motivated and organised in her role and used a computerised system to ensure that staff received updates on mandatory training where required. In addition other training is provided and training in dementia is compulsory for staff. Moreton Hill Care Centre DS0000016505.V323667.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): 31,33,35 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed with a variety of quality assurance audits in operation to ensure that the home is run in the interests of residents. The home has arrangements for ensuring that residents’ financial interests are safeguarded. Safe working practices and good maintenance systems ensure residents’ safety. EVIDENCE: Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 23 The registered manager is a first level registered nurse with over 30 years experience. She has worked in the care of older people in a variety of settings including management positions in Australia. She has a Certificate in frontline management and is currently undertaking the registered managers award. She has recently had training in health and safety for managers and has completed a first aid course. The home uses a variety of quality audits, these include audits of health and safety, medication, documentation, personal care and professional practice and infection control. The results of all audits are sent to the provider’s head of quality for monitoring. The provider offers a series of awards to homes in the group that have achieved a certain level of quality in the areas of catering, care and the gardens. The home is currently aspiring to achieve the highest award for catering and a comprehensive audit document was seen in relation to this. A customer satisfaction survey is sent out to residents and their relatives and the findings of this are produced in a report which was seen during the inspection visit. One issue that had been brought to the attention of the management of the home was that some residents were experiencing delays in answering call bells. The registered manger was using a computerised system to monitor the response times to every call bell and had instructed staff to make an initial response to every bell to assess the need of the resident. This was confirmed by one service user although it was evident that she had waited some time to be attended to. Another resident spoken to did not have a problem with the response times to call bells. The home provides secure facilities for residents’ money and valuables but during the inspection visit this facility was only being used by one resident, appropriate records had been kept in relation to this. The home is not involved in paying any resident’s money into a bank account and generally all finances are handled with the support of relatives. The maintenance manager has a computerised system for monitoring the servicing and maintenance of equipment in the home. This includes ensured electrical and heating systems and appliances as well as hoists and the lift. Regular checks are made on hot water temperatures and these are recorded along with a number of other safety checks such as window restrictors. The home has a system in place for managing any risk to the residents from Legionella and the maintenance manager carries out actions in relation to this in conjunction with an outside specialist consultant. Regular checks are made on water temperatures and samples are sent away for testing. The home keeps a record of accidents and incidents and monitors these with an audit. Hazardous substances are stored safely and securely in line with relevant regulations with no decanting of substances into unmarked containers which is wholly appropriate to protect residents with dementia in the home. Domestic staff have undertaken training in controlling hazardous substances. Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 24 The home has a comprehensive set of risk assessments for the environment including security of the premises and uses the services of a security firm to monitor the premises. Staff have received health and safety training as well as training in infection control, moving and handling, control of hazardous substances, food hygiene and fire training. Moreton Hill Care Centre DS0000016505.V323667.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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 3 18 3 4 X X X X 4 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 4 Moreton Hill Care Centre DS0000016505.V323667.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 OP9 Regulation 13 (2) Requirement The registered person must ensure that in order to protect service users from possible medication errors all hand written directions should be signed and dated by the staff member making the entry. The registered person must ensure that written care plans or individual protocols are in place for the administration of medication given on an ‘as required’ basis for anxiety and that the care plan accurately reflects the stated dosage. The registered person must ensure that improvements are made to areas of the laundry floor to produce an impermeable and cleanable surface. Timescale for action 30/06/07 2. OP9 13 (3) 30/06/07 3. OP26 13 (3) 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 27 No. 1. Refer to Standard OP7 Good Practice Recommendations The home should check if the resident in Cotswold Rise who is receiving input from mental health services is subject to Care Programme Approach arrangements and if so request a copy of any documentation. The storage temperatures for medication stored in the cupboard mounted on the outside wall in the Level 2 nurses station should be monitored particularly in spells of hot weather. Hand written entries on medication administration charts should be checked and signed by a second member of staff. 2. OP9 3. OP9 Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Moreton Hill Care Centre DS0000016505.V323667.R01.S.doc Version 5.2 Page 29 - 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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