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Inspection on 23/04/05 for Moss Bank Elderly Persons Home

Also see our care home review for Moss Bank Elderly Persons Home for more information

This inspection was carried out on 23rd April 2005.

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.

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

What the care home does well

The care home continues to provide a good standard of care for its residents. There is an experienced manager and the staff group is relatively stable with a positive approach to their work. Residents spoken to had no complaint to make about their care and were complimentary about the staff at Moss Bank. The meals are of a good standard and the premises remain suited to its purpose. The residents were pleased with the standard of accommodation in the care home and visitors felt their relatives were well cared for. Moss Bank has comprehensive policies and procedures on the care of older people which safeguard the well being of residents in the care home.

What has improved since the last inspection?

What the care home could do better:

Care plans must improve to ensure that short-term residents are receiving the same level of care as other residents. Although medication procedures are generally correct some recording needs to be improved to safeguard the health of residents. When a resident has a particular wish in respect of bedroom furniture this need to be documented to show that the care home is basing its work on their needs. An improvement to visits by councillors would confirm their commitment to the well being of the care home. To ensure that the care home is safe for people living there, a further risk assessment of the premises is required and improvements to training opportunities for staff will ensure an increase in the knowledge of staff caring for residents.

CARE HOMES FOR OLDER PEOPLE Moss Bank Elderly Persons Home Victoria Avenue Moss Bank St Helens WA11 7BU Lead Inspector John Mullen Unannounced 21 & 23rd April 2005 st 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 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 F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Moss Bank Care Home Address Victoria Avenue Moss Bank St Helens WA11 7BU 01744 677816 01744 677968 Telephone number Fax number Email 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 Council Social Services Department 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 F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The care home to admit a maximum of two service users aged between 60 and 65 years of age. Date of last inspection 20th December 2004 Brief Description of the Service: Moss Bank care home provides accommodation and personal care for a maximum of 32 older people. It is owned by St. Helens Council and the registered manager is Ms. J. Quigley. There have been no changes to Moss Bank’s conditions of registration since the last inspection. It 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 four units containing accomodation for eight residents in each although one unit is currently closed. The ground floor has both service user and staff accommodation; the latter includes a well-appointed staff room. There are two units located on the ground floor as well as 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. At the time of the inspection there were only eighteen residents accomodated due to St Helens Councils decision to reorganise its residential provision for older people. Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 2 days and a total of six hours. It was a routine unannounced inspection. A tour of the premises took place; staff were spoken to and care records inspected. The registered manager, two assistant managers and four members of the care staff were interviewed. Nine residents were spoken to as well as three visitors. What the service does well: What has improved since the last inspection? Two new assistant managers have been appointed with additional responsibilities which will assist in the management of the care home. This is particularly important in ensuring that supervision of staff is being given at the required intervals. The premises have been further improved in terms of décor. There has been a reduction in the odours resulting from incontinent residents. Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 6 Decisions have been made to secure the future of the care home and this has been a relief to staff, residents and their relatives. 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. Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 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 standard(s) 3 & 4 The admission policies include a full assessment of residents’ needs, which enables staff to be familiar with the people in their care. This will be further improved when staff are allocated permanently to individual units. Moss Bank is only admitting residents who are suitable for the care home and it is important that this continues. EVIDENCE: An examination of a selection of case files found each to contain a full needs assessment which was detailed and gave care workers clear guidance on the individual needs of residents. Interviews with care staff found them generally familiar with residents’ needs, although the closure of one unit has meant some staff being transferred to other units where they are less familiar with the residents in their care. Residents interviewed felt staff were caring for them well and said that they were happy in the home. An examination of case files and interviews with residents, family members and staff confirmed that residents were properly placed in the home. At the time of the inspection there was one resident temporarily placed in Moss Bank while he waited to return home. He said he had been content with his care in Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 9 the home and felt well supported there. A number of care staff and managers said that the home had been under pressure to accept residents who they felt were not suitable for Moss Bank. Although this pressure has been resisted they felt uneasy about this. Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 9 Moss Bank keeps full care plans on its permanent residents but this is not the case for those on short-term stays which could compromise their care. Residents’ agreement with the plans is still lacking. The care home has sound policies on the administration of medicines but recording is not full which could potentially put residents at risk. EVIDENCE: Individual plans of care were available in the case files of the permanent residents of the care home. These had been reviewed monthly and included a monthly weighing of residents. The care plans had been completed thoroughly and clearly showed the action to be taken by care staff for each resident. The care plans are not being signed by residents or their representative. The case file for a resident admitted on a short term basis did not have a care plan within it and, in fact, had no papers except for an assessment document. Discussions with care staff showed that they were aware of the care plans of the residents. Moss Bank has correct policies on the administration of medicines as was shown by documents held in the care home and discussions with managers. Care staff have received training in the giving of medicines. The controlled Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 11 drugs register showed that these were being given correctly and being recorded appropriately. Because of the disabilities of residents, relatively few are responsible for their own medication but when this occurs the care home has appropriate procedures for this. An examination of medication sheets held on the units revealed, generally, they were being completed correctly. There was one exception to this when the reason a resident was not given medicine on three occasions was not specified which is an unsafe practice. Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 & 15 The visiting arrangements are good and take into account the needs and wishes of residents and their families. This results in residents being able to maintain contact with families as they wish. Meals and mealtimes are well managed to allow residents to enjoy meal time occasions. EVIDENCE: A number of relatives visiting the care home were spoken to and all commented favourably on their reception in Moss Bank. They said they were able to visit their relatives when they pleased and could always see them in private if necessary. Residents spoken to were happy about the arrangements for receiving visitors. A large number of residents were spoken to about the food in the care home and all were happy with the food served and the choices that they had. Observation of both a breakfast and lunchtime meal found them to be pleasant occasions. The atmosphere during meals was relaxed and enjoyable. An examination of the menus provided by the care home showed them to be varied and offering a healthy diet. Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16 & 18 Complaints are being managed correctly and the care home has both a full vulnerable adults procedure and trained staff to ensure that there would be a proper response to any suspicion or allegation of abuse. EVIDENCE: Moss Bank has a detailed complaints’ procedure, which requires complaints to be dealt with effectively. The complaints’ book showed that there had been no complaint since the last inspection and two over the last 12 months. Each complaint had been thoroughly investigated with the outcome clearly recorded. No complaint has been received by the Commission for Social Care Inspection. Residents and visitors spoken to had not made a complaint against the care home. St Helens Council has a thorough and complete policy on the protection of adults from abuse. Training records confirmed that all care staff have undertaken training in the area of elder abuse over the last 12 months. All members of the care staff interviewed were clear of the action to be taken in the event of an allegation of abuse although none had any experience of this. Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19, 24 & 26 Moss Bank is a comfortable, clean and well-equipped care home with a good level of hygiene. To ensure that residents are sufficiently comfortable the care home must provide full furnishings in bedrooms unless this is documented as against residents’ wishes. EVIDENCE: A tour of the premises found Moss Bank to be well decorated, comfortably furnished and well equipped. Since the last inspection one bedroom has been refurbished following the departure of an incontinent resident. The care home was clean and with the exception of one room, had no unpleasant odours. The bedrooms are well equipped being well furnished and pleasantly decorated. One resident does not have a comfortable chair in her bedroom. The registered manager said this was at her own request but this is not documented within her case file. The care home employs two domestics in the morning and one in the afternoon. This results in a high level of cleanliness. Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 Moss Bank employs a competent and experienced staff group in the correct numbers to allow residents to be well supported. Training opportunities have been made available to staff but this needs to be improved so that they can improve their knowledge in areas relevant to their work. EVIDENCE: Staff rotas showed that the correct numbers of staff are being employed in the care home. Two new assistant managers have been appointed on one year contracts with enhanced responsibilities, including the supervision of staff. The staff group has been relatively stable although three care staff are currently on long term sick leave. Interviews with care staff confirmed that they were experienced in their work and confident about their abilities. Interviews with residents and relatives showed a high level of satisfaction with the staff employed in Moss Bank. Interviews with care staff showed that they felt themselves well trained in their work. A high number of the staff are either undertaking or have completed professional training in the care of older people. Other relevant training included moving and handling, first aid and dementia care. Training records showed that most, but not all, care staff have received three days training over the past 12 months. It also showed that some refresher training in moving and handling is required. An interview with the registered manager confirmed that some training opportunities have not been taken up because of the difficulty of releasing staff on occasions. Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 37 & 38 Moss Bank is well led and well managed. It is a safe and secure facility for the care of older people but some further improvements to records are required to further reduce the risk to residents. EVIDENCE: There has been no change to the registered manager and she remains fully qualified for the post in terms of both her experience and qualifications. An interview with the registered manager showed that she was happy with the decisions made about the future of the care home and confident that she could lead Moss Bank positively in the future. Interviews with other managers and care staff showed a high respect for the registered manager and the way she was leading the staff team. Interviews with relatives and residents confirmed that the care home was well led and this was reflected in the attitudes of staff. An inspection of records kept in the care home showed that they were being maintained to a good standard. Fire drills and tests are being conducted as Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 17 required and accident books show very low level of accidents to residents over the recent past. Regulation 26 visits by the designated Councillor are not being made monthly. The care home has extensive policies and procedures for the minimising of risks to residents. A tour of the premises found Moss Bank to be a safe and secure facility. A food safety report dated 19th April 2005 was generally complimentary with some minor defects. There has not been a risk assessment of the premises since 2003 which could potentially put residents at risk. Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x 2 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x x 2 2 Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 19 Yes Are there any outstanding requirements from the last inspection? 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 30 Regulation 18 Requirement The registered manager to ensure that all staff receive a minimum of three days training a year. (Previous timescale of 1st April 2005 not met). The registered manager to ensure that care plans are signed by the service user or their representative. (Previous timscale of 1st April 2005 not met). The registered manager to ensure that service users either have a comfortable chair in their bedrooms or it is documented if they refuse this. (Previous timescale of 1st April 2005 not met.) The registered manager to ensure that MARS sheets are correctly completed. (Previous timescale of 1st February 2005 not met). The registered provider to ensure that Regulation 26 reports are done monthly. (Previous timescale of 1st February 2005 not met). The registered manager to ensure that all residents on short stays have a care plan. F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Timescale for action 1st December 2005 1st December 2005 2. 15 7 3. 24 23 1st June 2005 4. 9 13 1st June 2005 5. 37 26 1st August 2005 6. 7 15 1st June 2005 Page 20 Moss Bank Elderly Persons Home Version 1.30 7. 38 13 The registered manager to ensure that a risk assessment is undertaken on the premises. 1st June 2005 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 4 Good Practice Recommendations The registered provider is recommended to advise Care Management of the registration conditions that apply to the care home and that inappropriate applications should not be made. Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Burlington House, 2nd Floor, South Wing Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Moss Bank Elderly Persons Home F03 F53 Moss Bank S37920 V223003 21.04.05 Stage 4.doc Version 1.30 Page 22 - 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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