Inspection on 28/03/08 for Morovahview Residential Home

This inspection was carried out on 28th March 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Morovahview Residential Home 02/10/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Morovahview Residential Home 1 Bar View Lane Hayle Cornwall TR27 4AJ Lead Inspector Melanie Hutton Unannounced Inspection 28th March 2008 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 Morovahview Residential Home DS0000069602.V362118.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. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Morovahview Residential Home Address 1 Bar View Lane Hayle Cornwall TR27 4AJ 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) 01209 843276 Mr Philip John Jefferies Mrs Caroline Anne Jefferies Mr Philip John Jefferies Care Home 16 Category(ies) of Dementia (3), Mental disorder, excluding registration, with number learning disability or dementia (3), Old age, not of places falling within any other category (16) Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care Home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE - maximum 3 places Mental disorder, excluding learning disability or dementia - Code MD maximum of 3 places The maximum number of service users who can be accommodated is 16. 2nd October 2007 2. Date of last inspection Brief Description of the Service: Morovahview is a large detached dormer style bungalow that has been adapted and extended to provide residential accommodation for up to a maximum of sixteen people. There is a chair lift up from the ground to the first floor. The home offers both long term and respite care to older persons three of who may suffer from a dementia or mental illness. The home has good access all round the premises and ample car parking space. The home is located up a quiet lane yet is close to all the amenities offered in Hayle. Residents and relatives are positive about the care provided. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service potentially experience poor quality outcomes. This was a planned unannounced key inspection that was undertaken by two inspectors over one day. We looked at records, care documentation, policies and procedures and inspected the environment. Observation and case tracking were used during the inspection. It was clear during this inspection that considerable progress had been made by the registered providers to meet requirements and recommendations identified at the last inspection. Numerous changes have been made within the ethos and running of the home, to improve the quality rating. On the day of the inspection there were fourteen residents at the home, with two members of the care staff and one cook on duty. We met with residents, staff and relatives. The registered providers are Mr and Mrs Jefferies who purchased the home in April 2007. Mrs Jefferies was present for the afternoon of the inspection and received feedback from us of our findings. A senior staff member who has worked in the home for many years assisted us during the morning. An Annual Quality Assurance Assessment (AQAA)) was completed by the Registered Provider prior to the last inspection in October 2007 and identified the amount of work that is planned. The last inspection required an improvement plan to be completed, this was detailed and returned within the time frame. Questionnaires for relatives and service users were sent prior to the inspection though these had not been distributed. The registered provider agreed that she would give them to people. We have received one completed survey from a resident. It was apparent during the inspection that people who use the service are referred to as residents. Therefore for the purpose of this inspection report we will use the same terminology. The current fees for the home are £325-£350. What the service does well: Residents and one relative told us that they are satisfied with the care provided at the home and that the staff listen and act on what people say. Residents were observed to be treated with respect and their dignity respected by the staff during the inspection. Favourable comments were made about the meals provided and the comfortable dining area. One resident told us that they are supported to attend activities within the local community and that the “owners have tried very hard to get people interested in joining in activities in the home”. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 6 Detailed information about the services that can be provided is given to potential residents and their relatives / representatives prior to being admitted into the home. This information is also available within the home in a prominent position along with the last inspection report. People’s needs are assessed prior to being admitted to the home, this is to ensure that their identified care needs can be met. The registered providers show commitment to improving standards at the home and improving their systems to ensure the health, safety and welfare of the residents. What has improved since the last inspection? What they could do better: Record keeping could be improved e.g. all records identifying the name of the person it relates to, signatures of the person developing the record, records stored securely in line with data protection and copies of documents issued to residents / representatives for signing be held on individuals files. The facility to meet health care needs should be met e.g. access to optician, dentist and specialist professionals for advice e.g. continence nurse, CPN (community psychiatric nurse) where needed. All areas of the home accessible to residents should be made safe e.g. hot water outlets, risks from hot surfaces reduced and external areas free form obstruction. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 7 Further evidence must be available to support that appropriate checks have been made of the home in accordance with health and safety legislation e.g. legionella, hard wiring and gas safety. The duty roster must be developed to reflect accurately which staff member (including their full name) is planned to be on duty, their role and reflect if the planned hours were worked. The training programme must continue to be developed to ensure that all staff are trained and competent to meet the needs of the residents. Trainers should be qualified to deliver the training and written evidence available of all the training staff have attended. The annual quality assurance survey has been started, the outcome should now be audited and published to interested parties e.g. residents, relatives, representatives, stakeholders and the commission for social care inspection (CSCI). A programme of regular supervision must be introduced for all staff and annual appraisals for staff implemented. A number of good practice recommendations have been made during this inspection and are listed at the back of this report. 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. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 8 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 Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are provided with written information prior to moving into the home so that they can make an informed choice about the care home. This information about the service is also available within the entrance hall for people to read. The registered person ensures that peoples care needs can be met, by undertaking a full care needs assessments prior to them moving in to the home. EVIDENCE: The service users guide and statement of purpose was easily available in the entrance area of the home, together with the last inspection report and visitors book. The service users guide and statement of purpose have both been reviewed and developed since the last inspection and the registered provider told us that each service user has been issued with a copy. Copies of these updated documents were provided to us during the inspection. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 10 The certificate of registration is displayed clearly within the entrance hallway. The contract provided to each resident has been revised and reissued. No completed contracts were seen on the resident’s personal files, the registered provider told us they were waiting for the signed copies to be returned. The template seen is included within the service users guide and includes the detail required by the national minimum standards. The format for recording information gained at the pre admission assessment has been revised and a completed assessment evidenced for the resident most recently admitted. Where it is not possible to visit the person prior to admission e.g. due to distance, verbal information is sought from relatives and other professionals and recorded fully. On admission to the home a full care needs assessment is undertaken. All assessment forms are signed and dated by the person completing them and where possible by the resident and / or their representative. People are encouraged to visit the home or experience a trial period prior to deciding whether they wish to stay permanently. Guidance on emergency admissions is contained within the service users guide. Intermediate care is not provided in this home, therefore this standard is not applicable. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care needs are identified within care plans that direct and inform staff as to the action they must take to meet those needs. Residents are protected by the homes policies and procedures regarding medication. EVIDENCE: Each resident has an individual care plan that identifies their personal care needs and most detail how staff are to meet those needs. One care plan inspected did not contain specific guidance for staff on how to de-escalate certain situations that may arise. The care plans are reviewed monthly and are signed and dated by the member of staff and resident - where possible. Currently there are two care plans for each resident. One is securely stored in the office and one in the kitchen for day to day use by staff. The use of two copies of the same document could lead to errors and confusion. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 12 New documentation has been introduced using assessment tools for nutritional screening, Tullamore Falls risk assessment, moving and handling assessments, personal profile and life history. Continence assessments were not seen to be in use. Throughout the home it was evident that communal pads were stored within some bathroom and toilet areas. A number of bedrooms had continence pads stored within them but limited or no information was contained within the care plan to guide staff on the use of the pads. One care plan and daily records identified that it would be advisable for a CPN to be involved in the care of the resident but it was not clear of the role of the CPN at this time. Another set of records identified that health concerns were observed and recorded but did not tell us what action was taken to resolve these concerns e.g. GP or district nurse involvement. The registered providers are in the process of securing visits from the optician and dentist for residents who require this service. A chiropodist visits regularly and people are registered with local GP’s – records are held of when these professionals visit the resident. Medication is stored securely in the office in appropriate cupboards and a medicine trolley. MAR (medication administration sheets) are printed by the Alliance Pharmacy. Should hand written entries be necessary these are checked by two staff and two initials entered as evidence. MAR sheets were in good order. A controlled drugs (CD) cupboard is available and we discussed the use of the CD registered and CD cupboard with ‘borderline’ controlled drugs. The registered provider told us that a designated drugs fridge is on order. An up to date British National Formulary and Royal Pharmaceutical Society guidelines is available for staff to refer to. The registered person told us that all staff have now received medication training although this was not evidenced within the records. Staff were observed to treat residents with respect and observed their privacy and dignity. We saw staff knocking on doors prior to entering and preferred forms of address were recorded and used. A new telephone system has been purchased for the house and includes a cordless handset so that residents can make and receive telephone calls in private. We were told that residents mail is given to them unopened and assistance provided with reading it if necessary. Morovahview Residential Home DS0000069602.V362118.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A variety of leisure and social activities are provided to meet the residents needs. A wholesome and balanced diet is provided for the residents. EVIDENCE: The staff maintain an activities record sheet, which indicates that, regular and frequent activities are in place e.g. target game, bingo, reminiscence, music quiz. The local library regularly delivers books to the home and residents were seen to have their own books in their rooms. The entries made in the daily recording tend to be brief and do not always identify the level of participation in activities for all residents or their enjoyment of that activity. Further consideration should be given to elaborating the social / recreational information and ascertaining their wishes in respect of activities for each resident. We observed several visitors at the home on the day of inspection and the visitor’s book supported that this is a regular occurrence. Residents are able to Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 14 receive their visitors into the communal areas or their own homes as they wish. All residents currently handle their own affairs, with some supported by their family and / or other representatives. Further information should be provided to people regarding independent advocates who will act in their best interests if necessary. Resident’s bedrooms were seen to be personalised with pictures, photographs and ornaments. Residents are offered food from a two week menu that gives a choice of two meals at lunch time and team time. The cook told us that the residents are asked on a daily basis their choice of meal. A record of the food provided is updated daily and identifies what each resident chose to eat on that day. Further consideration should be given to widening the options available at lunchtime as currently it generally states cold meat salad as the option. The dining room is spacious and attractively decorated, with sufficient tables and chairs for all residents to eat their meal there should they choose to do so. The lunchtime meal of the day was observed to be a social occasion with staff available to assist residents should they need it. Residents told us that they like and are satisfied with the food provided. The kitchen staff record fridge and freezer temperatures and record the information on a daily basis along with a record of the kitchen cleaning. The cooker is not fully functioning at this time but the cook told us that the registered providers intend to purchase a new one. The kitchen is domestic in nature but copes with the current demand. The home has recently commenced ‘Safe Food Better Business’ training through the County Council. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People know how to make a complaint and are protected from abuse by the agencies policies, procedures and staff training programme. EVIDENCE: The home has a complaints procedure that is provided to residents and their relatives / representatives within the service users guide and statement of purpose. This provides information to the resident on how to make a complaint and the process of who to contact. The registered provider told us that no complaints had been received by the home. A complaints / compliments book is available in reception for anybody to complete. It is recommended that a complaints log is maintained by the home that identifies any complaint made, the date and identifies where the details of the investigation will be held. The agency has a policy and procedure regarding safe guarding adults. A poster is displayed in the hall that advises people who to contact should they be concerned that any abuse has taken place. Staff are provided with adult protection training during induction by in house trainers making use of external training material (Mulberry House). All staff should attend external local multi agency adult protection training. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21,22,23,24,25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a homely environment, some areas of the home pose a hazard to residents. EVIDENCE: During this site visit we observed all areas of the home and grounds. The home is located in a quiet part of Hayle away from traffic with satisfactory car parking at the front of the property. It was apparent that a significant amount of redecoration has been undertaken, with new furniture and carpets in place in some of the bedrooms. We were told that three more sets of bedroom furniture has been purchased and delivery expected in the near future. A programme of redecoration and planned works is needed. The facilities appear homely and comfortable, this was confirmed by one resident who also told us that they like the feel of the home. The communal Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 17 space is located on the ground floor and comprises a lounge at the front of the home, a dining room and conservatory at the rear. The conservatory does not appear to be used by residents as it was storing equipment and recently delivered packages. The front door was observed to be locked on the day of the inspection. No CCTV is used within the home. The grounds are not fully accessible to all residents due to changes in level and building rubble in certain areas. This should be cleared as it could pose a health and safety risk if residents venture outside, it also impairs some resident’s views from their bedroom windows. The lighting throughout the communal and private bedrooms is domestic in nature. The bedrooms are located on the first and ground floor, many were observed to have been personalised by the occupants. All sixteen bedrooms have a wash hand basin. There are several bathrooms and toilets distributed throughout the care home that are within a reasonable distance of the communal areas and resident’s bedrooms. One assisted bathroom has recently been upgraded, with another one due to be done – as yet the date for this work is not known. Bathrooms are clinical in appearance, with the bathing policy displayed on the wall and in some bathrooms and toilets communal pads in place. Liquid soap and paper towels are in place in the bathrooms and toilets to promote infection control. Equipment is in place to enable resident’s needs to be met and promote their independence e.g. a handrail, grab rails, bath hoists, raised toilet seats and a stair lift. Call bells are accessible to people when in their own rooms. Lockable spaces are provided in bedrooms as they are being redecorated. One member rof staff told us that all doors to resident’s bedrooms could be locked and a key provided if the resident wished this. There is no evidence available to support that residents have been given this choice. Consideration must be given to the type of lock in place, as the room should always be accessible to staff in an emergency. Since the last inspection window restrictors have been fitted to the first floor windows. Hot water does not appear to be regulated. The registered provider told us that restricted temperature valves have been fitted to all hot water outlets – no checks have been made to ensure these are set to the correct temperature. Not all hot surfaces e.g. radiators are guarded or of a low surface temperature. There is a steep stairs to the rear of the home with a gate, which can be easily unlocked. Environmental risks within the home have not been sufficiently assessed and advice has not been sought from the Environmental Health Officer (health and safety). Rooms have adequate natural light and ventilation. Generally there is a good standard of cleanliness. The home was free from odours on the day of inspection. There are no designated housekeeping staff, Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 18 care staff undertake generic roles within the home. Residents told us that the home was kept clean and tidy by the staff. There are no sluice facilities in the home. There is a laundry area next to the kitchen that is small but functional with domestic equipment in place. A Belfast sink and buckets are used for soaking laundry as the washing machines do not have a sluice facility. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Insufficient evidence is maintained to show that the induction training, ongoing training programme and staff recruitment records meets the needs and protects the current residents. Residents and their families speak highly of the staff and the care that they provide. EVIDENCE: At the time of this site visit, there were fourteen residents in the home. Generally there are two members of staff on duty. Staff carry out a generic role e.g. caring, domestic, laundry and preparing and serving the evening meal. Whilst the home was seen to be clean and odour free and comments from one resident and a visitor about the care provided were positive, it is important that the home can demonstrate sufficient care hours to meet the care needs of the residents. The duty rota does not indicate in what capacity staff are on duty. It was not clear from the duty rota the full names of the staff. Skills for care induction booklets are provided to new staff, there was no evidence that this training is organised and completed within the required timescales. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 20 Information was not readily available within the staff records, as to which staff had an NVQ qualification so it was not possible to ascertain if the home met the standard of 50 of staff qualified to NVQ Level 2 or above. It is recognised that the providers have developed the training programme considerably since the last inspection and are now making use of an external company’s training material (Mulberry House) to assist with the staff training. Some training is out of date, requiring to be validated or not provided by a competent person e.g. first aid, fire training, adult protection. A training matrix is on display in the office but it was noted that there are significant gaps within this plan e.g. first aid, basic food hygiene. The home has a recruitment procedure that is followed that includes a CRB check and at least two written references for each person. It was noted that when the application form or the reference request form does not identify the position of the person being given as a referee. This could lead to friends and previous colleagues as opposed to employers providing references. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The managerial, training and administrative aspects of the home require prioritising to ensure the health and safety of residents and staff. EVIDENCE: Mr. and Mrs. Jefferies bought the home in April 2007. Mr Jefferies is the Registered Manager and a Registered Nurse who has achieved the Diploma in Management (NVQ Level 4) from the University of Plymouth. He currently works in the casualty department at West Cornwall Hospital. He and Mrs Jefferies have sixteen years of experience in providing residential care for the elderly. Mrs Jefferies qualified as a State Enrolled Nurse & later as a Registered Nurse for the Mentally Handicapped, but is not currently registered. Mrs Jefferies was rostered for duty on the day of the unannounced inspection and arrived in the home in the afternoon. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 22 The registered manager does not identify in advance when he is planned to be on duty, the rota is completed when hours are worked. Staff spoken with were positive regarding their role within the home and the commitment to improving the service from the registered providers. We were told that many changes have been made within the home. Quality assurance surveys have been distributed to seek the views of the residents, their family and / or representatives and stakeholders as part of the annual development plan. The results of these surveys are not yet available. The registered provider is aware of the need to publish and inform people including CSCI, of the outcome of the survey. Residents are encouraged to maintain their independence financially for as long as they wish. The registered providers assist one person with their finances by being a signatory to the resident’s personal bank account. Personal monies can be held securely for residents. A record is kept of incomings, outgoings and a balance. No evidence was provided to show that internal auditing takes place. The registered providers manage the accounting and financial procedures of the home and an up to date insurance certificate is displayed in the entrance hallway. No records were available within the staff files case tracked regarding supervision sessions and the registered provider confirmed that this was yet to be started. One record showed a brief staff appraisal, this was not signed or dated. All records maintained in the home should be stored securely, identify the name of the resident the record relates to and be signed and dated by the person completing it. Accidents are recorded in an appropriate format although the storage of the record does not comply with data protection legislation. Records should be stored in individual files rather than in a loose ring file in the office. A fire risk assessment has been completed. A fires safety advisor visited the home in August 2007 and made some recommendations. No evidence was seen to show that these recommendations have been acted upon. The registered provider provides the fire training and undertakes fire drills within the home, no evidence was seen of the training the provider has undertaken to ensure competency within this role. Records are maintained and are up to date that evidence appropriate checks of fire prevention equipment e.g. fire alarms, fire doors and fire extinguishers. The inspector was informed that some staff require initial or update training in food hygiene, first aid, basic food hygiene, health and safety and fire. The registered provider stated that information obtained from the health and safety executive informed them that a trained member of staff in first aid does not Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 23 have to be on duty at all times – this was discussed. As previously mentioned in Standard 25 both within this report and following the last inspection, there are environmental issues which require risk assessment and management e.g. hot water. Oxygen cylinders were observed to be in the home in areas that did not evidence warning signs of their presence. Appropriate storage facilities with signs are located outside the building for the oxygen cylinders not in use. The registered provider agreed to forward to CSCI the gas safety certificate and hard wiring certificate as this was not available on the day of inspection. At the time of writing this report neither certificate had been received. We were told that no legionella checks have been made to date. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 24 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 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 3 2 1 2 STAFFING Standard No Score 27 1 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 1 3 X 1 2 1 Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 25 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 OP25 Regulation 13(4) Requirement It is required that the registered person shall ensure that unnecessary risks to health or safety of service users are identified and so far as possible eliminated. To include hot water temperatures, radiator surface temperatures, and removal of obstructions e.g. building waste in the grounds Previous time scale of 01/02/08 not met. It is required that the registered person must keep a copy of the duty roster of all persons working at the care home and a record of whether he roster was worked. Previous time scale of 01/02/08 not met. The staff rota must include the hours that the registered manager plans is rostered to be working in the care home and identify the full name of all members of staff. The registered person shall DS0000069602.V362118.R01.S.doc Timescale for action 23/05/08 2. OP27 17(2) Sch.4 23/05/08 3. OP28 18 23/05/08 Version 5.2 Page 26 Morovahview Residential Home ensure that the persons employed receive training appropriate to the work they are to perform e.g. first aid, basic food hygiene Previous time scale of 01/02/08 not met. This must be evidenced with written records and include NVQ level 2 training records for 50 of the staff. 4. OP33 24 It is required that reliable quality assurance measures and arrangements must be in place to annually audit the services and facilities provided and produce a written report of the findings for interested parties. Previous timescale of 01/02/08 not met. 23/05/08 5. OP36 18(2) 6. OP38 23(4) The registered person shall 23/05/08 ensure that all persons working at the care home are appropriately supervised. The registered person shall make 23/05/08 arrangements for all staff to receive suitable training in fire prevention. This should be provided by a person who is trained and qualified to do so. Previous timescales of 01/12/07 not met. It is required that paperwork is available to show that safety checks have been carried out e.g. legionella testing, gas certificate, hard wiring certificate. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP2 OP7 OP8 Good Practice Recommendations It is recommended that the registered provider holds a signed copy of the individual contract issued to each resident. It is recommended that clear and specific guidelines are consistently included in care plans to direct staff particularly on how to de-escalate certain situations. It is recommended that the arrangements for service users to receive dental and optical care to be formalised. This was a recommendation on the previous inspection report. It is further recommended that all residents have a continence assessment undertaken prior to the usage of continence pads and that the care plan reflect the type of pad to be used and when. Further advice should be sought form external professionals regarding continence when necessary. It is recommended that there to be a designated fridge for medicines. This was a recommendation on the previous inspection report. It is recommended that ‘border line’ controlled drugs to be recorded in the Controlled Drugs register and stored as controlled drugs. This was a recommendation on the previous inspection report. It is recommended that residents choices and preferred routines are consistently recorded. This was a recommendation on the previous inspection report. It is recommended that further recording is available to demonstrate the participation of individuals in activities and their enjoyment of the activity. It is recommended that information be provided to residents regarding how to contact external agents e.g. advocates who will act in their best interests. It is recommended that residents are offered a clear choice of main course and pudding at each meal, rather than the same option on a daily basis. This was a recommendation on the previous inspection DS0000069602.V362118.R01.S.doc Version 5.2 Page 28 4. OP9 5. OP9 6. OP12 7. 8. DO14 OP15 Morovahview Residential Home 9. OP18 10. OP19 11. OP24 12. 13. OP26 OP30 14. OP30 15. OP37 16. OP38 17. OP38 report. It is recommended that staff training regarding adult protection, should be provided by a trained trainer and external training provided by Cornwall County Council should be accessed by all staff. It is recommended that a programme of routine maintenance and renewal of the fabric and decoration of the premises is produced and implemented with records kept. It is recommended that consideration is given to the locks fitted to resident’s bedroom doors to ensure that they are suited to resident’s capabilities, accessible to staff in emergencies, residents are provided with keys unless their risk assessment suggests otherwise. It is further recommended that the programme of updating the bedrooms continue so that each resident has a lockable storage space should they require it. It is recommended that infection control be reviewed within the laundry area in particular the practice of soaking soiled laundry in buckets and Belfast sink. It is recommended that each staff member should be provided with an annual individualised training plan. This was a recommendation on the previous inspection report. It is recommended that an annual staff training and development plan should be put in place. This was a recommendation on the previous inspection report. It is recommended that all records reflect the name of the person they relate to and are signed and dated by the person who implemented the record on behalf of the care home. It is recommended that where Oxygen is in use appropriate labelling be evident, in adherence with health and safety legislation. This was a recommendation on the previous inspection report. It is recommended that first aid qualifications held by staff should be updated on a regular basis. This was a recommendation on the previous inspection report. Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Morovahview Residential Home DS0000069602.V362118.R01.S.doc Version 5.2 Page 30 - 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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