CARE HOMES FOR OLDER PEOPLE
Moss Bank Elderly Persons Home Victoria Avenue Moss Bank St Helens Merseyside WA11 7BU Lead Inspector
Mrs Lynn Paterson Key Unannounced Inspection 14th March 2007 10:00 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 Moss Bank Elderly Persons Home DS0000037920.V295362.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. Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Moss Bank Elderly Persons Home Address Victoria Avenue Moss Bank St Helens Merseyside WA11 7BU 01744 677816 01744 677968 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) St Helens Metropolitan Borough Council Ms Jillian Margaret Quigley Care Home 32 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (22) of places Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users to include up to a maximum 22 OP and up to a maximum of 10 DE(E). One named male out of category service user with LD and under pensionable age. The Service may accommodate up to a maximum of 2 service users aged 60 years and over. Date of last inspection Brief Description of the Service: Moss Bank care home provides accommodation and personal care for a maximum of 32 older people. St. Helens Council are the registered provider of the service and the registered manager is Ms. J. Quigley. There have been no changes to Moss Banks conditions of registration since the last inspection. However, the care home has opened a day centre to provide a service to a maximum of five service users per day. The property is located in a distinct area of St. Helens with only a limited number of local facilities nearby. The premises are a two-storey building, which was purpose-built; a lift as well as stairs connects the floors. The care home is divided into three units, containing accommodation for eight residents in each. A fourth unit is now used as a day care facility. Two of the units accommodate permanent residents and one respite and transitional residents. The ground floor has both service user and staff accommodation; the latter includes a well-appointed staff room. There is one unit located on the ground floor as well as the day centre, a laundry and excellent kitchen. The upper floor also contains two units with sleeping accommodation and lounge areas. The care home has an appropriate number of aids and adaptations including grab rails to assist disabled residents users manage the premises. There is a call system throughout the care home. Fees are currently between £94.45 and £273.75 per week. Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection of Mossbank Support Centre was carried out on 14th March 2007. The inspection process involved meeting with the officers in charge of the centre, staff members who were carrying out their caring/domestic duties and residents who were either in permanent placement or utilising the respite or transitional services. Interviews were conducted with three of the management team and four of the care staff. Discussions were held with nine permanent residents, six people who were in a transitional placement and two respite residents. Policies, procedures, care plans and other records were examined and a tour of the premises was undertaken. What the service does well:
The service appeared to be tailored to the needs of individual residents with three different types of residential care being provided within the home. All residents spoken with said they were generally happy with the services provided to them. Respite residents said they looked forward to their next visit to the home as they felt comfortable and relaxed with the staff and service provided. Transitional residents said they were well looked after and placements certainly met their current needs. Permanent residents said they were comfortable and at ease although five residents who had recently been transferred from another local authority care home revealed they were happy but still getting used to the premises. Staff presented as being well trained and motivated to carry out their duties and the interaction between staff and residents was most pleasant. Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Due to the closure/ change of purpose of some Local Authority homes a number of staff and residents had recently transferred to Mossbank Support Centre. Residents advised that they were still settling in and getting used to the changes and it was noted that services and facilities were in the process of being amended to meet all individual need. Care planning information was recorded in differing formats dependent on how individual staff had been trained and in discussion, it was noted, only verbal re assessments of residents who had been transferred to the centre had been undertaken. Discussions with staff and residents revealed that the re assessments had not identified any change of dependency, however it would be recommended that all re assessment details be noted on file. Whilst this is not seen as a shortfall, it is essential that care records are consistent in their content and that social and health care needs are identified, planned and provided to ensure that all needs are fully met. Not all care plans viewed held signatures of the residents or their representatives to show that all care and support had been agreed. It is essential that care plans are drawn up in partnership with each resident and
Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 7 signature’s of all who have been involved are recorded on file to ensure that care is provided as appropriate to choice and capability. Residents said that they wished the centre would provide more interesting activities to suit individual need such as quiz games, entertainment and card games. Although the home had activity notice boards in prominent positions throughout the home not one held any information about the provision of daily activities. Staff said that activities did take place, however it is recommended that staff organise a daily activities programme in consultation with residents to ensure that they are provided with activities and stimulation each day. Medication record sheets were examined and were seen to be below the acceptable standard, and medication management of the storage of controlled drugs was inconsistent. This was discussed with the officers in charge and it was agreed that refresher training would be provided to all staff who held responsibility for medication and that spot checks would be carried out to ensure that medication was managed as per the policies and procedures provided by St. Helens Local Authority. Staff should continue their pursuits to refurbish the premises to include re carpeting of the upstairs corridor and general de cluttering of unwanted furniture. 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. Moss Bank Elderly Persons Home DS0000037920.V295362.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 Moss Bank Elderly Persons Home DS0000037920.V295362.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): 1.3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home provides clear information to enable people to make an informed choice about living in the home. Staff ensure that all prospective residents are subject to an assessment of need prior to admission to make sure that the home has the facilities to meet all assessed need prior to admission. EVIDENCE: Care files examined held information to show that pre admission assessments had been carried out prior to the resident being offered a placement in the home. The assessment documents were clear and the information recorded showed that all daily living tasks had been discussed with the resident and their representative and all care and support needs had been addressed. Residents spoken with were unclear about the pre assessment process however all care files looked at held information to confirm that a pre admission home/hospital visit had been carried out.
Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 10 It was noted however that residents who had recently been transferred to Mossbank Support Centre from other Local Authority Care Homes had not been reassessed for the purpose of the transfer. This was discussed with staff that advised that verbal reassessments had been carried out to ensure that residents would need the same level of service as previously provided. Moss Bank Elderly Persons Home DS0000037920.V295362.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): 7.8.9.10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans have been reviewed and amended and generally hold details of social and heath care need and of how this need will be met. However some care plans did not hold signatures of those who were involved in the care planning process. Medication is not currently fully managed as directed by the homes medication policy. EVIDENCE: Fourteen care plans were examined in detail and whilst they held similar details the information was recorded in differing ways. Some care plans did not hold signatures of the resident to show that they had participated and agreed to the plan and none of the plans identified that activities and interests had been acted upon.
Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 12 Most residents spoken with said they knew the content of the care plans and that all care was carried out as they wished it to be. Comments included; “Staff, look after me as I want them to. I knew exactly what they are doing and why they are doing it”. “Staff here are very good they always ask if it is OK before assisting me with anything, they treat me with respect”. However three residents said they were not aware of their care plan or of the assistance/support that had been agreed to be provided. Staff advised that they were aware of the differing systems of recording and storing information which led to an inconsistent approach to care planning and information sharing. It was agreed that staff would be provided with refresher training to ensure that care plans were consistent. Although the information was not consistent in it’s recording all care plans viewed held sufficient information to enable social and health care to be carried out as appropriate. Systems in place in respect of medication management were inconsistent as not all medication records sheets identified when and how some medication had been administered. Storage and stock rotation of medication was in need of update to ensure that medictaion re ordering was appropriate to need. This was discussed with the officers in charge and it was agreed that staff should receive refresher training in all aspects of medication management as a matter of urgency and spot checks should be introduced to ensure that any errors were quickly identified. Moss Bank Elderly Persons Home DS0000037920.V295362.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 adequate. This judgement has been made using available evidence including a visit to this service. Staff show a good understanding of residents needs and communicate well with each other to make sure these are identified and met. However care plans are not consistent in their recording of information about individuals social, cultural and recreational interests and therefore activities are not provided to meet individual need. EVIDENCE: Residents spoken with said they were happy with the food – provision, as it was always well cooked and tasty. Residents were observed eating their lunch and all appeared to be thoroughly enjoying their meals. Care plans did not identify individual interests or hobbies or of how these interests could be met. However plans did hold full information about religious, cultural, sexual and disability information to ensure that diverse needs were identified and systems put in place to meet individual needs wherever possible.
Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 14 Residents said they felt the home needed to provide more activities to ensure that they had things to do to stimulate them and comments included; “We don’t do much here. We play Bingo and that but we don’t do much else. I would like more quizzes and entertainment to help pass the time”. “They do their best for us but we don’t do much, perhaps Bingo but that’s about it”. “I wish we did more here, like have outings, entertainment and things”. It was noted that the home had activity notice boards on show in the home although nothing was written on them to show if any activities were in place. Respite and transitional residents said that not much happens in respect of activities or entertainment but it did not worry them, as they were only “short term” in the home. However staff spoken with showed they held clear understanding of the needs, wishes, preferences of all residents to include religious and cultural issues and discussions revealed they did their best to ensure that people enjoyed their daily living in whatever way they wished, wherever possible. Moss Bank Elderly Persons Home DS0000037920.V295362.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): 16.18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The organisation has policies and procedures to make sure staff are trained and competent to assist residents to express their feelings about the standards of service provision in the home. Staffs have received training in adult protection and understand how to protect residents from abuse. EVIDENCE: The local authority has a general complaints policy that explains the procedures residents and their representatives can follow in the event of concern. This policy was seen to be clear and explicit. Residents said they know how to complain if necessary. Staff said that all residents were provided with information on admittance to the home and revealed that they continue to prompt residents to let staff know if they had any complaints or concerns about the care, support and accommodation provided. Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 16 Staff spoken with, were clear about all aspects of adult protection and staff training records reveal that adult protection training is an ongoing process in the home. Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 17 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): 19.26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises presented as clean, hygienic and comfortable however communal rooms, which are currently being used as storerooms could impact unfavourably upon the health and safety of residents. Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 18 EVIDENCE: The premises were clean and hygienic at the time of the visit and residents said they were happy with the domestic arrangements of the home. It was noted that the home had benefited from some refurbishment since the last inspection however the upstairs carpet appeared loose and had signs of wear and tear and was in need of replacement. The sun lounge area in the respite unit and the kitchen/dining area of the 3rd lounge were being used as storage areas for unused furniture and furnishings, which could create a risk to the safety and well being of residents. Discussions were held with staff to ensure that these areas be de-cluttered as a matter of urgency. Moss Bank Elderly Persons Home DS0000037920.V295362.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): 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. Staffing levels are adequate to meet the current assessed needs of the residents and staff present as being well trained, motivated and hard working and totally committed to providing quality care for the residents. EVIDENCE: Staff rotas show that staff are supplied in sufficient numbers and skill mix to meet the individual needs of the residents and staff records identify that staff receive training and support to enable them to carry out their role. The homes recruitment and selection policy ensures that staff recruitment is a fair and equal process that incorporates relevant checks to ensure wherever possible, the protection of the people residing in the home. Residents said that staff were kind, helpful, courteous, pleasant and very hard working. Comments included; “Nothing is too much trouble for them” “They all work very hard to ensure we are comfortable”, “They know exactly what they are doing, they are hard working and most professional”.
Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 20 Staff identified in discussion that they were well trained and had full understanding of their differing roles. Staff, were observed carrying out their duties in a courteous and professional manner. Moss Bank Elderly Persons Home DS0000037920.V295362.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): 31.32.35.38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team is respected by staff and residents and the management team run the home in the best interests of the service users. EVIDENCE: The management team has changed since the last inspection and the management team now comprise of existing staff and an amalgamation of staff that have been redeployed from other Local Authority Homes. Staff say this appears to be working well although they fell it will take a little time to ensure a consistent approach to managing all the existing systems. Residents said they think the home continues to be well managed and they are generally happy and content within the home.
Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 22 Staff said that residents meetings would be resurrected to ensure residents could discuss forthcoming events and activities and have choices of menu preparation. Quality monitoring groups are in place and take place on a regular basis to discuss all the management issues of the home. The home has system’s in place to make sure that residents financial interests are `safeguarded and maintains clear records to ensure moneys and possessions are protected. Record show that the health and safety aspects of the home are generally well managed and all staff have received training in mandatory health and safety. Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 23 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X X 3 Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15 Requirement The registered manager to ensure that all residents have up to date care plans that hold signatures of all who have been involved in their compilation. The registered manager to ensure that MARS sheets are correctly completed and that medication is managed as per the Local Authority policies and practices. (Previous timescale of 1.6.05 and 1.12. 2005 not met). The registered manager to ensure that activities are arranged and listed in the units The registered manager to ensure that some areas of the home are re-decorated. Timescale for action 01/06/07 2. OP9 13 01/06/07 3 OP12 16(n) 01/06/07 4. OP19 23(2)(d) 01/06/07 Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that staff receive refresher training in respect of the recording and management of care files to ensure consistency of the information stored on file. Moss Bank Elderly Persons Home DS0000037920.V295362.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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
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