CARE HOMES FOR OLDER PEOPLE
Moriah House Care Home Deep Furrow Avenue Carlton Nottingham NG4 1RS Lead Inspector
Dee Shelvey Unannounced Inspection 18th January 2006 11:00 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 Moriah House Care Home DS0000064718.V275258.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. Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Moriah House Care Home Address Deep Furrow Avenue Carlton Nottingham NG4 1RS 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) 0115 9110078 Moriah House Limited Mrs Susan Elizabeth Victoria Broddel Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st June 2005 Brief Description of the Service: Moriah House is a care home for older persons, providing accommodation and personal care for up to thirty nine service users. The home is situated in Carlton, close to shops and local amenities. Accommodation is on two floors, the upper floor accessed by shaft lift, stair lift or stairs. There are five lounges available to residents and a large conservatory. Dining space is included in these areas. There are twenty five single rooms and seven shared rooms in the home. Some rooms offer ensuite facilities. There is patio area to the front of the home with seating available. Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over four hours. The inspector spoke with two service users in private and also sought the views of two visitors. Two members of staff were spoken with and discussions took place with the home manager and the company Quality manager. In addition policy documents and statutory records were examined. A tour of the building was made but only included a sample of bedrooms. What the service does well:
A comprehensive needs assessment takes place before service users are admitted to the home. Service users spoken with said they had been involved in this process. Prospective service users can visit the home with their family, on these visits they would be made to feel welcome by the staff. Staff have the skills and knowledge required to meet the needs of the service users, They were aware of the care plans and there are systems in place to ensure that staff know key information and any changes to care plans or risk assessments. The personal case files examined showed that health care is monitored and appropriate referrals for specialist help made as necessary. Community nurses and GP’s visit the service users on a regular basis. Other professionals involved in the service users care included Dentists and Opticians. Service users spoken with said the food at the home is good with special diets and preferences well catered for. It was also said that alternatives to the main menu would be offered. All service users and relatives spoken with were aware of how to complain and who to complain to if they weren’t happy with the service delivered. Additionally they were confident that their concerns would be taken seriously and solutions found. All staff spoken with at the time of the inspection demonstrated an understanding of the needs of the elderly and were enthusiastic about their jobs. The senior supervisors enjoyed taking responsibility for designated tasks and were self-motivated. The supervisor responsible for co-ordinating training explained the training needs audit and the matrix that highlighted when new courses needed booking. Training is given a high priority. The staff were seen by the inspector to be kind and respectful towards service users and service users spoken with said they liked the staff and the manager. Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 6 The environment was pleasant, well maintained and contained furnishings and fitting that were of a high quality. The service users spoken with expressed satisfaction with their accommodation. The arrangements for the testing of fire equipment and fire drills was in place and well organised. During the tour of the building no potential safety hazards were seen. 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.
Moriah House Care Home DS0000064718.V275258.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 Moriah House Care Home DS0000064718.V275258.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): 1 and 2. Prospective service users would receive sufficient information about the home to inform their choice. The terms and conditions are clear and people would know what services are included in the cost. EVIDENCE: The statement of purpose was seen to contain all the elements required by statute; it had last been reviewed on 27/06/05. Each service user had a satisfactory signed contract. Moriah House Care Home DS0000064718.V275258.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, 9 and 11. Service users had a comprehensive care plan and they would be protected by the homes policies on dealing with medicines. EVIDENCE: Service user care plans were based on comprehensive assessments of need. Once a need was identified the service user and staff agreed on how it would be met and this was included in the plan. Care plans were reviewed regularly and the service user and family were involved in this process. Medication is delivered to the home weekly in a monitored dosage system. On arrival the medicines are cheek against a delivery slip and signed in by the senior member of staff receiving them. Satisfactory records of administration of medication were seen. A pharmacist visits the home quarterly to check their practice. There were also satisfactory policies and procedures for the storage, handling and administration of medicines. On admission the manager raises the issue of severe illness and dying with the service user. She demonstrated an awareness of the sensitivity of the subject but also of the need to determine a persons wishes whilst they are fully able to express them. The residents wishes were recorded in the care plan. The family are fully informed at these times and are welcome to sit with their relative for as long as they wish.
Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14. Service users are able to retain optimum control of their lives and are satisfied with their lifestyles. EVIDENCE: Those residents spoken with said there were no set routines for the day. They got up and went to bed at their choice and although there were meal times they could ask for a meal to be delayed if they wished. The visitors and residents confirmed that people were made very welcome at the home. Hospitality was offered and families had enjoyed a huge Christmas party with the service users. In the lounge one service user had photographs of her grandchildren place on the wall near her chair. Another resident said she could have her processions in communal areas if she liked. Service users spoken with expressed satisfaction with the activities on offer. The photographs of the Christmas shopping trip were pointed out. Service users were given information on how to contact other agencies for independent advice.
Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 11 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): 16 People were confident that concerns would be taken seriously and acted upon. EVIDENCE: A service user and her visitors said, without prompting, that any concern raised with the home was listened to and a resolution found. They had every confidence that the staff team would be a protection for vulnerable adults. Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 12 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): 19,22,23,25 and 26. Service users had safe comfortable bedrooms, sufficient specialist equipment and the home was clean. EVIDENCE: The tour of the building showed that the home was kept warm, comfortable and clean. Both service users and visitors spoken with confirmed that this was the norm. Individual bedrooms seen were well furnished and contained the residents personal belongings. Service users expressed satisfaction with their rooms and said there was positive encouragement to take in small items of furniture and ornaments. The home had a selection of specialist equipment from wheelchairs to bath hoists and the manager confirmed that should a service user require an aid it would be provided. An emergency call system was installed and was accessible from each bed.
Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 13 The service users would be able to control the heating, lighting and ventilation. Where necessary restrictors had been fitted on windows. All radiators were covered to prevent accidental burning and the hot water delivery was control by thermostatic valves. The laundry room was tidy and well equipped. Laundry baskets were clearly marked to keep soiled line, kitchen linen and articles from M.R.S.A. residents separate. At the inspection of 21st June 2005 a requirement was raised to accept the recommendation made after an inspection by gas service engineers that two gas boilers be replaced. The manager had stated that plans were in place to carry out this work however the job had not been done and there were no timetabled plans for it to go ahead. If these boilers should break down a significant number of service users could be without heat or hot water. Although alternative arrangements would be made within the home service users would be seriously inconvenienced. If the proprietors do not intend to accept the engineers report another inspection must take place and assurances as to safety and reliability must be given. Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 14 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 and 30 The staff were well trained and service users were in safe hands. EVIDENCE: All staff spoken with at the time of the inspection demonstrated an understanding of the needs of the elderly and were enthusiastic about their jobs. The senior supervisors enjoyed taking responsibility for designated tasks and were self-motivated. The supervisor responsible for co-ordinating training explained the training needs audit and the matrix that highlighted when new courses needed booking. Training is given a high priority. The staff were seen by the inspector to be kind and respectful towards service users and service users spoken with said they liked the staff and the manager. Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 15 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): 32,33,34 and 35. The manager runs the home to the benefit of the residents and safeguards the health and safety of everyone in the home. EVIDENCE: The service users spoken with were complimentary about the staff and manager. They said the manager was easy to talk to and described staff as patient and kind, “always willing to help”. Observations made during the inspection showed an open management style and there appeared to be good working relationships in the staff team. Service users who cannot manage their own finances are either assisted by their families or Nottingham County Council. The home has small amounts of cash in safe keeping for immediate use. This cash was properly stored in a safe and the records were examined and found to be satisfactory.
Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 16 The home has satisfactory policies and procedures for health and safety and infection control. All safety equipment was tested at appropriate intervals and staff received relevant training. The home runs a thorough self-auditing programme approved by I.S.O. and the views of residents are sought at regular meetings. There was some discussion about expanding the quality assurance to families, visiting professionals and to residents to allow them anonymity. Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X 3 3 X 3 3 STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 3 3 X X 3 Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? Yes 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 OP19 Regulation 13 Requirement The proprietors must accept the recommendation of the gas service engineer and replace the two identified boilers. Timescale for action 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP33 Good Practice Recommendations To expand the current quality assurance system to include families, visiting professionals and give service users the opportunity to give their views with anonymity. Moriah House Care Home DS0000064718.V275258.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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