Inspection on 18/11/08 for Moss View Nursing Home

This inspection was carried out on 18th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Moss View Nursing Home 28/06/07

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Moss View Nursing Home 15/16 Moss View Ormskirk West Lancs L39 4QA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vivienne Morris     Date: 1 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Moss View Nursing Home 15/16 Moss View Ormskirk West Lancs L39 4QA 01695579319 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: ExcelCare Service Limited care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE The maximum number of service users who can be accommodated is: 22 Date of last inspection Brief description of the care home Moss View Nursing Home is located in a quiet residential area of Ormskirk, close to the town centre and all local amenities. The home provides accommodation in both single and shared facilities on two floors, served by a passenger lift and stairs. There are spacious communal areas available, incorporating lounges and dining areas within the conservatory. The home provides personal and nursing care for up to 22 people requiring care associated with dementia. The service users guide, which contains relevant information about the home, including the most recent inspection report, is given to people who are thinking about living at Care Homes for Older People Page 4 of 31 Over 65 0 22 Brief description of the care home Moss View, so that they are able to decide if the home is suitable for their needs. The scale of charges as at 18th November 2008 ranged from 404 pounds to 1,980 pounds per month. Additional charges were being incurred for hairdressing, chiropody and newspapers. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means that the people who use this service experience good quality outcomes. The site visit to Moss View Nursing Home formed part of the inspection process and was conducted over one day in November 2008. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, as well as relatives and staff. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Care Homes for Older People Page 6 of 31 Comment cards were received from ten people who were living at the home and three staff members and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, known as an AQAA, which gives information to the Commission about how the home is meeting outcomes for the people using the service and how the quality of service provided is monitored. We observed the activity within the home and tracked the care of three people during the site visit, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time. There has been one complaint received by the Commission since the last key inspection, which was referred back to the provider to investigate using the homes complaint procedure. What the care home does well: What has improved since the last inspection? What they could do better: The management of medications could have been better to reduce the possibility of drug errors. The medicine trolley and drug keys could have been more securely retained to ensure that medicines were not freely accessible and a clearer audit could Care Homes for Older People Page 8 of 31 have been conducted when receiving medications into the home so that all medicines could be accounted for. Any hand written transcriptions on the Medication Administration Records could have been signed, witnessed and countersigned in order to avoid any transcription errors. The provision of activities could be improved by the appointment of a dedicated activities coordinator so that people living at the home could benefit from periods of uninterrupted stimulation and activity in order to promote interest and prevent boredom. The management of meal times could have been better by people being assisted with their meal in a timely fashion so that food is not left standing for long periods of time and so that staff members assist people with their meals on an individual basis. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are thoroughly assessed before they are admitted to the home to ensure that the staff team can deliver the appropriate care. Evidence: The care of three people living at Moss View Nursing Home was tracked during this site visit to the service. We looked at the care records of all three people, which showed that the needs of each person had been thoroughly assessed by the home before they were admitted, so that the managers were confident that the staff team could fully meet each persons individual needs. The information recorded gave a clear picture of peoples personal, health and social histories, so that staff were able to discuss with them things that mattered to them. The admission procedure was undertaken in accordance with the admission policy available at the home and those responsible for undertaking the pre-admission assessments were fully aware of how to gather the relevant information about people Care Homes for Older People Page 11 of 31 Evidence: before they moved into the home. People were given information about the preadmission process to help them decide if they wished to move into the home. We received comment cards from ten people who use the service, although due to mental health difficulties relatives did help some people to complete the comment cards. All ten said that they received enough information about Moss View before they moved in so that they could decide if it was the right place for them to live. One wrote, the staff were extremely helpful. When I first visited to look at Moss View I was given a tour of the home. When asked what the service does well, the registered provider told us, we have in place an up to date service users guide and statement of purpose, setting out our aims, objectives and philosophy of care. Potential service users who are referred to Moss View nursing home and their representatives are always provided with the information they need to make an informed choice about the home. They are invited to visit the home prior to an assessment and their questions are answered. If they are happy with the home, we then arrange a visit to wherever they are residing to carry out a full assessment of their current needs, wishes and suitability for the placement to ascertain that the home is able to meet their needs. We also encourage service users to have a trial period before making an informed decision. He gave some good examples of how this was achieved. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were fully met, their privacy and dignity being respected at all times and the management of medications was satisfactory. Evidence: The assessed needs of people whose care was tracked were recorded within the plans of care and clear guidance was provided for staff as to how these needs were to be met. The care plans were supported by a risk management framework, so that any potential risks to the health or personal care of people living at the home were identified and strategies were implemented to minimize the risk factor. The plans of care were well written documents, having been reviewed each month or more regularly if needed and changes in care needs were reflected well, so that staff were made aware of the current needs of people in their care. The records showed that good continence, nutritional and pressure care was provided to those requiring it and that where necessary, a wide range of external professionals were involved in the care of people living at the home, ensuring that health care needs were being consistently met. Care Homes for Older People Page 13 of 31 Evidence: The registered manager told us that regular meetings were held between a variety of professionals involved in the care of those living at the home and that relatives were invited to these meetings, should they wish to attend, so that they could have some input into the care of their loved one. People spoken to told us that they were more than happy with the care provided and they felt that all their care needs were being met. One relative commented, the care provided at Moss View is marvelous. The staff are patient and they really do care about the people living here and one person living at the home said, the staff are all first class. They look after us really well. When asked what the service does well the registered provider wrote, at Moss View Nursing Home we are able to meet the needs of all the service users. All service users have a care plan based on their health, personal and social care needs including risk assessments and management. All interventions are recorded in the residents file. All plans of care are reviewed on a monthly basis. Residents are also allocated a key worker to take responsibility for individual care plans and to ensure that all aspects of their life are catered for. Service users and their relatives are involved in the care planning process and they sign the care plan. We support residents to access information on general health issues, as well as to manage medical conditions, including access to GPs, chiropodist, optician and other specialist services. We respect the rights, privacy and dignity of service users at all times. Wherever possible we give residents ownership of their care with support and assistance. Comment cards were received from three members of staff, who felt that they had the right support, experience and knowledge to meet the differing needs of people who use the service. One of these people wrote, there is something new learned every day. When asked what the service does well, one member of staff wrote on the comment card, we promote love and independence. We meet all the needs of our clients, who all seem happy and comfortable at the home. Those who use the service and who submitted comment cards said that, in general, they received the care and support that they needed, including medical care. A relative wrote on the comment card on behalf of one of these people, staff have always been very helpful, kind and considerate and another commented, they (the staff) always call in the GP when this is necessary and they seem to have a good relationship with the surgery. They keep us informed if the GP has visited and what Care Homes for Older People Page 14 of 31 Evidence: the outcome has been. Another relative commented, mother has not been eating well recently because of ill health, but the staff have done all they can to address this with the help of the GP and dietitian and one of the residents said, the staff are all kind and considerate. Medications, in general, were being adequately managed. However, not enough care was being given to the security of the medication trolley or the medicine keys in order to consistently protect people from harm. Medications received into the home had not been recorded on this one isolated occasion, preventing a clear audit from being conducted. The amount given of variable dose medications was not recorded so that staff were able to monitor the level of medication required. Policies and procedures were in place in relation to the management of medications, which showed that if people living at the home were able and wished to do so then they would be supported to manage their own medications and where this was not possible we noted that reasons were entered into the plans of care. Controlled drugs were being managed well to ensure that a safe system was being used by all staff. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines of the home are flexible, but are not always planned around the needs of the people living there in order to satisfy their social and nutritional needs. Evidence: It was noted that the majority of people living at Moss View were highly dependent on the assistance of staff due to mental health problems. Therefore, a planned, varied activities programme was not in place as one would not be appropriate for this group of people. The manager told us that activities were planned on a day to day basis and he showed us records of things people had joined in. It was established that the care staff were responsible for providing some form of stimulation for the people living at the home, which was not entirely satisfactory. One staff member was seen throwing a ball to one or two residents, but then was taken away to assist with personal care needs, which interrupted the period of activity for these people without explanation. Two people we chatted to said that there was not much going on and that there was a tendency to get bored, although they did say that they are taken out occasionally in the better weather. We discussed the provision of activities with the manager of the home who told us that he was aware this area needed to be developed further, but that some improvements had been made. Care Homes for Older People Page 16 of 31 Evidence: We spoke to two relatives who said that they were very happy with Moss View Nursing home and one of them said, the staff are excellent. They both confirmed that they were always welcomed to the home and that they felt comfortable visiting their relative. We saw some staff members sitting with people and talking to them in an appropriate manner, which was good practice. The service users guide contained information about how the home met the spiritual needs of people, including those from ethnic minority groups, showing that equality and diversity is considered when assessing peoples individual needs. The daily routines of the home were seen to be flexible and people living there were offered a variety of choices throughout the day, so that they had some control over their lives and were allowed to exercise choice. We saw staff interacting well with visitors, making them feel included in the daily lives of the people living at the home. At the time of our site visit to the service there was one person using an advocate and information was readily available about access to advocacy services, so that people could use an independent person to act on their behalf, should they so wish. Lunch was seen being served when we noted that a high percentage of people living at the home required some level of assistance to eat their meals. It was pleasing to see staff sitting with the people they were assisting, engaging in conversation with them about everyday things, whilst encouraging them to eat their meals in a supportive manner. However, one staff member was seen assisting two people with their meals at the same time, which was not very dignified or person centered. One persons lunch was put on the table in front of him until a staff member was available to assist him. Again this action did not promote person centered care and could result in food being eaten cold. The menu offered a variety of nutritious meals, with choices being available on each occasion. We were told that people living at the home were not always able to select a meal from the menu because of their mental health disability. However, staff spoken to were very familiar with what food people liked and disliked, which was supported by the information contained in the plans of care. The plastic bibs being used to protect peoples clothing at lunch time were not very dignified and something less obtrusive may be better. Of the ten people living at Moss View and who submitted comment cards, six of them indicated that they always enjoyed the meals at the home. One relative wrote, Care Homes for Older People Page 17 of 31 Evidence: mother enjoys her meals (she always has) when she is well. A cooked meal was sampled, which was found to be fresh, well cooked, tasty and appetising. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are well managed and people living at the home are adequately safeguarded from abusive situations. Evidence: A clear accessible complaints procedure was prominently displayed at the home, which was also included in the service users guide, so that people were aware of how to make a complaint should they wish to do so. When asked what the service does well, the registered manager told us, complaints are well managed and he gave us some good examples of how this was achieved. He also told us that staff had attended training in relation to safeguarding people living at the home. The two relatives spoken to both said that they would know how to make a complaint, should they need to do so. All ten residents who submitted comment cards said that they would know who to speak to if they were not happy about something at the home and that they would know how to make a complaint, should they need to do so. One relative added to the comment card, the staff are all very approachable and if the person you speak to is the wrong one, they will soon tell you who you need to speak to. The owner of the home is also very approachable and comes to speak to any residents. A system was in place for recording complaints so that a clear audit could be conducted. There has been one complaint received by the Commission since the last Care Homes for Older People Page 19 of 31 Evidence: key inspection, which was referred back to the provider to investigate using the homes complaint procedure and which was managed appropriately. All three staff members who submitted comment cards said that they would know what to do if a person living at the home, their relative, friend or advocate had any concerns about the home. One of these people wrote, the carers would go to our nurse in charge or to the manager and tell them their concerns. Records showed that staff had been provided with relevant training in relation to safeguarding people living at the home and those spoken to were fully aware of what they should do if they felt that someone in their care was being abused. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is warm, comfortable and hygienic, providing a pleasant and safe environment for people to live in. The control of infection is managed well, so that people living there are adequately protected. Evidence: During the course of our site visit to this service we toured the premises, viewing a random selection of private accommodation and all communal areas. We noted that the environment had improved dramatically since our last visit to the service, providing pleasant surroundings for people to live in, which was commendable. A lot of areas had been tastefully decorated and several new carpets had been laid. The home was warm, comfortable, safe and fit for purpose. A friendly and homely environment was evident and people looked happy in their surroundings. People living at the home were able to bring a range of their own belongings with them, so that their individual rooms were personalised and homely. People spoken to were content with their bedrooms and said that they are cleaned regularly. The premises were clean and, in general, pleasant smelling, so that an agreeable environment was provided for those living at the home. Clinical waste was being disposed of in the correct manner and infection control policies and procedures were available at the home, so that staff were aware of how to reduce the possibility of cross infection and therefore protect the people living at the home. Records showed Care Homes for Older People Page 21 of 31 Evidence: that staff were provided with appropriate training in relation to infection control measures so that they were aware of how to prevent cross infection. The registered manager told us that the physical environment is fit for purpose and he gave some good examples to support this statement. We noted that some minor work is still needed, including: 1. the bathroom door on the ground floor was in need of painting; 2. the door of room 4 needed adjusting to prevent it slamming shut; 3. attention was needed to the flooring in the mens toilet on the first floor; 4. the cobwebs in the mens toilet on the first floor needed removing; 5. the door to room 6 needed painting; 6. the armchairs in room 9 needed replacing; 7. the carpet treads on the stairwell needed cleaning; 8. the external door of room 14 needed painting and 9. the corridor carpet on the first floor was in need of replacing. Nine of the ten people who live at the home and who submitted comment cards said that the home is always fresh and clean, one said that it usually is. One relative wrote, it is greatly improved under the present owner. The car park, grounds and garden are also improved since the current handyman took over and another commented, there have been a lot of improvements in the internal fabric under the new owner and new manager, particularly in the area of ventilation at the entrance. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people living at the home are met by the number and skill mix of staff and the recruitment practices adequately protect these vulnerable adults. Evidence: The registered provider told us, our home is always appropriately staffed, with mixed skills to meet our residents needs. There is a system in place for recruitment practice to protect our service users. We ensure that a CRB and POVA check is processed and appropriate references are obtained prior to the employment of new staff. New staff undertake an induction programme as required by skills for care standards and we encourage them to familiarise themselves with the homes policies. We have organised a comprehensive ongoing training programme providing staff with the necessary skills to meet residents needs. A staff rota was in place, showing which staff were on duty at any time of the day or night. However, the designation of staff members was not shown, therefore, the skill mix of staff on each shift could not be easily identified. At the time of our visit to the home there were seventeen people living there. The numbers of staff on duty and the qualifications and experience of the staff team together ensured that the needs of these people were being consistently met. Two staff members who submitted comment cards indicated that there were always Care Homes for Older People Page 23 of 31 Evidence: enough staff to meet the individual needs of all the people who use the service. One person wrote, yes we have the right amount of staff, but understandably every so often we have sickness, so we could be under staffed. All ten people living at the home who submitted comment cards said that there were either always or usually staff available when they were needed and all ten said that staff listen and act on what they say. One relative wrote on the comment card, there is always someone on hand to either speak to or ask for help or advice. All new employees had been guided through a detailed and structured induction process and a wide range of training was provided for all staff, so that they were able to carry out the duties expected of them and so that people received a good standard of service. Staff spoken to felt that sufficient training was provided, including mandatory courses and learning relevant to the specific needs of the individuals in their care. Three staff files were examined, which showed training that each had undertaken, by retention of training certificates. At the time of our visit to the home there were 36.5 of care staff who had achieved a recognised qualification in care and others were in process of obtaining this award. The records of three people working at the home were examined, so that recruitment practices could be assessed. We found that robust recruitment practices had been adopted and that all checks and references had been obtained before people started to work at the home, so that people living there were adequately protected. All three staff members who submitted comment cards said that their employer carried out checks, such as CRB and took up references before they started work and that their induction period covered everything they needed to know to allow them to do the job well. These staff members also said that training is provided, which is relevant to their role and helps them understand and meet individual needs and helps them keep up to date with new ways of working. One wrote, all our training is up to date and is relevant to the needs of our clients and if we want any other training, all we have to do is ask the manager. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed well so that the health, welfare and safety of the people living and working there is adequately protected. Evidence: The manager of the home had been registered with the Commission for Social Care Inspection and he had relevant qualifications to allow him to fulfill his role. He was competent and managed the home well, showing that he had a good rapport with the people living at the home. Staff spoken to felt that the manager was approachable and supportive so that they were able to obtain advice as they required it. The manager, provider and staff team had evidently worked hard to raise the standard of service provided, which was demonstrated by all seven requirements made at the previous key inspection being appropriately addressed. A business plan was in place at the home and an annual overview had been conducted, so that the quality of service provided could be monitored each year. A Care Homes for Older People Page 25 of 31 Evidence: wide range of policies and procedures were in place at the home, which had been reviewed and updated on a regular basis, so that staff were provided with up to date guidance and any changes in legislation. Staff spoken to were aware of how to access the policies and procedures or to obtain further information, as was needed. Surveys were conducted annually in order to obtain the views of people who use the service. We suggest that surveys now be conducted for staff and for stakeholders in the community, who have a professional interest in people living at the home, such as General Practitioners, so that their views are sought as to how the needs of people are being met. Some audits had been conducted, although we feel that this area could be broadened to incorporate a wider range so that the service could be more closely monitored. Monthly reports were presented by the owner following his visits and these were submitted to the Commission on a regular basis. However, copies should be retained in the home so that relevant people can see that the service is being monitored at regular intervals. A variety of meetings had been held, with minutes retained, so that information could be passed on and so that people could voice their opinions and discuss any relevant topics in order to improve the standard of service provided. We were told that the home does not keep any money on behalf of residents. However, there was a system in place which allowed people living at the home access to money if they wanted it, which was subsequently reimbursed by families using an invoice system. Receipts of expenditure were retained so that those reimbursing the home could see what had been spent. Health and safety guidelines were readily available within the home, so that any interested parties could easily access this information, if they wished to do so. At the time of our visit to the home, there was clear access to fire exits and corridors were free of obstacles, making the environment a safe place for people to live. A variety of training certificates were seen, including fire awareness and fire fighting equipment had recently been serviced, so that people were adequately protected against the risk of fire. A fire risk assessment was also in place so that any risks had been identified and strategies implemented to reduce the risk as far as possible. A random selection of service certificates were examined, which showed that systems and equipment within the home had been appropriately checked by competent people to ensure that they were safe for use. Care Homes for Older People Page 26 of 31 Evidence: Accident records were completed appropriately and were being retained in line with data protection. The registered manager wrote on the homes self assessment, the home is managed with regular input from the owner, the registered manager and deputy manager. The registered manager is currently undertaking the RMA. Residents, relatives and staff are formally consulted annually by questionnaire for the quality audit. The owner regularly meets with staff to discuss how the service is running and to find out if there are any issues that we need to deal with as well as to ensure that the overall management of the service is consistent. The owner empowers the staff team to use their initiative as well as providing them with opportunities for self development within their role. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be made for the safekeeping of medicines retained at the home. This must be done so that people living at the home are protected from harm. 18/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Hand written entries on the Medication Administration Records should be signed, witnessed and countersigned in order to avoid any transcription errors. A record should be retained of all medications received into the care home and the amount given of variable dose medications should be recorded so that a clear audit can be conducted. People living at the home should be provided with some form of uninterrupted activities in order to maintain interest and therefore prevent boredom. It is recommended that a dedicated person be employed to plan and implement a variety of suitable activities without needing to provide personal care. Page 29 of 31 2 9 3 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 5 15 19 The management of meals should be reviewed so that the dining experience is better for people living at the home. Continued progress should be made so that the minor works still recommended are addressed in order to improve the environment further still for the people living at Moss View. It is recommended that surveys be conducted for staff and stakeholders in the community so that their views can be sought on how peoples needs are being met. A wide range of audits should be implemented so that the quality of service provided can be closely monitored. 6 33 7 33 Care Homes for Older People Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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