CARE HOMES FOR OLDER PEOPLE
Moss View Nursing Home 15/16 Moss View Ormskirk West Lancs L39 4QA Lead Inspector
Vivienne Morris Unannounced Inspection 09:30 28th June 2007 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 View Nursing Home DS0000069004.V333250.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 View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Moss View Nursing Home Address 15/16 Moss View Ormskirk West Lancs L39 4QA 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) 01695 579319 ExcelCare Service Limited Care Home 22 Category(ies) of Dementia - over 65 years of age (22) registration, with number of places Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 22 service users to include: *Up to 22 service users in the category of DE (E) (Dementia over 65 years of age). 3rd May 2006 Date of last inspection Brief Description of the Service: 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 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 Moss View, so that they are able to decide if the home is suitable for their needs. The scale of charges as at 28th June 2007 ranged from £370.00 to £500.00 per week. Additional charges were being incurred for hairdressing, chiropody and newspapers. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two regulatory inspectors from the Commission for Social Care Inspection conducted the unannounced site visit to this service over one day in June 2007. This visit formed part of the key inspection process. Due to the category of people living at Moss View it was not always possible to obtain their views about what it was like living at the home. However, during the course of the site visit it was possible to talk with three people living at the home, a relative and three staff members. 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. The inspectors sat in the communal areas of the home for periods of time observing the daily routines and activities, which took place. Comment cards were received from eight people involved with the service and their feedback is reflected throughout this report. The information provided by the home on the preinspection questionnaire has also been taken into consideration when writing this report. The inspectors ‘tracked’ the care of three people living at the home, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at Moss View and involved gathering information about the service from a wide range of sources over a period of time. The Commission for Social Care Inspection had received two complaints about this service since the last inspection, which resulted in a random inspection being conducted and some issues being investigated by the provider, using the home’s complaints procedure. What the service does well:
Detailed information had been obtained prior to people moving into Moss View Nursing Home so that the home was confident that the staff team could meet assessed needs. A good standard of both personal and health care was being provided to ensure that the needs of service users were being met and so that those living at their home were comfortable. The arrangements at the home ensured that the privacy and dignity of those living there was respected at all times, with particular regard to, the provision of health and personal care, maintaining contact with relatives and friends and consultation with external professionals and advisers. One individual, whose care was ‘tracked’, provided some negative remarks on the comment card about life at Moss View. However, in conversation with this person, it was explained that things had since changed for the better and that they had settled at the home. This person described the staff as ‘lovely’ and said, “They keep me going”. Other comments received included, “ I Enjoy trips
Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 6 out in my wheelchair, especially to library, as I am a keen reader”, “ I spend some time in the small lounge, as I find the condition of other people sometimes upsetting” and “I think the new owner is spending money on the place and it is improving”. The policies and procedures in relation to the protection of vulnerable adults were thorough enough to ensure that people living at the home were adequately protected from abusive situations. A wide range of mandatory training was being provided for staff so that they were aware of the policies, procedures and practices of the home to ensure that the health and safety of people living at Moss View was protected. What has improved since the last inspection? What they could do better:
The home could have involve residents or their relatives more in the assessment and care planning processes, so that they were given the opportunity to have some input into the care provided. The care plans could have contained more information about identified risks so that staff were fully aware of strategies in place to minimise or eliminate any hazards. Any hand written entries on Medication Administration Records should be signed, witnessed and countersigned to avoid any transcription errors. Photographs of residents should be attached to the medication charts so that staff can easily identify people when giving medications. Staff assisting people with their meals should sit with them so that they are on the same level; thereby creating a relaxed environment whilst people are dining and those choosing to eat in the lounge areas should be made
Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 7 comfortable so that they can manage their meals more easily. A choice of menu should be provided, so that those able can select their choice of meal. The complaints record should protect the identity of people involved and their personal details, in line with data protection. Some environmental issues, as highlighted within the body of this report need to be addressed in relation to the maintenance of the home to ensure continued safety and protection of those living at Moss View. Some areas of the home smelt very badly and so odour control measures should be reviewed and appropriate steps taken to provide a pleasant smelling environment throughout. The home should be working towards achieving a minimum ratio of 50 of care staff with a recognised qualification in care so that the assessed needs of people living at the home could be consistently met by competent care staff and so that there were a sufficient number of qualified care staff to ensure that newly appointed people were adequately supervised. The employment procedures need to be improved so that thorough checks are consistently conducted by the home before people are appointed, so that those living at Moss View are adequately protected by the recruitment practices adopted by the home. The induction process needs to be more detailed, in line with Skills for Care so that those appointed are provided with sufficient information to allow them to carry out the duties expected of them in a competent and confident manner. The registered person must progress with appointing a suitable manager to take day-to-day control of the home so that it is run in the best interests of people living there. The quality of service provided should be monitored more thoroughly by introducing regular meetings, with minutes retained, by conducting clear audit trails and by obtaining the views of those using the service and those involved in the care of people living at the home. The registered person must prepare a written report on the conduct of the home at least once a month and a copy must be supplied to the Commission for Social Care Inspection. Policies and procedures should be fully completed and should be reviewed periodically so that staff are provided with up to date information and guidance. Accident records should be retained in line with data protection in order to maintain confidentiality at all times. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 8 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 View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 9 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 View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 10 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): 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of people had been thoroughly assessed before admission; so that the home was sure that the care required could be delivered. However, residents or their relatives had not been involved in this process to allow them to have some input into planning the care to be provided. EVIDENCE: The care of three people living at the home was ‘tracked’ during the course of the site visit. Records showed that detailed information had been gathered about each individual before they were admitted, so that the home was confident that all assessed needs could be adequately met by the staff team. However, there was no evidence available to show that people wishing to move into Moss View or their relatives had been given the opportunity to be involved in the preadmission assessment process conducted by the home, so that they had some input into the care being provided.
Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 11 Eight comment cards were received from relatives of people living at the home. Four said that sufficient information was always provided to them and four said that information was usually or sometimes provided. One relative stated, “Any changes are usually discussed with us by senior staff”. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people living at the home, in general, were being consistently met and staff respected the privacy and dignity of people in their care. EVIDENCE: The care of three people living at the home was ‘tracked’ during the course of the site visit. The inspectors were pleased to see that significant improvements had been made since the last inspection in relation to care planning. The plans of care seen were very well written documents, providing staff with clear guidance about how the needs of people could be appropriately met. They recorded detailed, individualised information, showing that the care provided was person centred. However, although a wide range of assessments had been conducted in relation to care needs, the risks identified had not always been included in the plans of care, to show that the care planning process involved all assessed needs of those living at the home. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 13 Recorded evidence showed that a variety of external professionals were involved with the care of the people living at Moss View and that medical investigations were conducted as needed to ensure that health care needs were being consistently met. Eight comment cards were received from relatives of the people living at the home. Three stated that people’s needs were always met; four indicated that people’s needs were usually met and one said the needs of people were sometimes met. One stated, “They (the staff) are very aware and attentive to my relatives requirements”. Five relatives said that they were always kept up to date about the care of their relative and three said that they were usually kept up to date. One relative added, “The home gives over and above the support and care expected, considering my relatives attitude”, and another said, “My relative receives the care that we would expect. We have discussed her needs recently with the new manager”. Care staff had reviewed, in general, the plans of care once a month and evidence was available to demonstrate that any changing needs were reflected appropriately, so that up to date information was provided for staff to ensure that the current needs of people were being met. However, residents or their relatives had not always been involved in the care planning process so that they had the opportunity to have some input into the care provided. We saw that those living at the home appeared well groomed appropriately dressed and looked comfortable. A relative of one person whose care was ‘tracked’ was spoken to. She said that she was more than happy about the care provided, adding, “They (the staff) do a good job and they look after my relative very well. He looks so much better since he came here. He has even started to eat and drink again”. We found that, in general, medications were being appropriately managed to ensure the safety of those living at the home. However, hand written entries on the Medication Administration Records had not always been signed, witnessed and countersigned, to reduce the possibility of transcription errors. Photographs of people living at the home were not available on the Medication charts so that staff could easily identify people when giving medications to avoid any drug errors. The plans of care demonstrated that those living at the home were treated with respect and dignity. Staff were seen respecting the privacy of residents and appeared to have a good rapport with them, gaining their trust and confidence. The service users’ guide incorporated information in relation to respecting the privacy and dignity of those living at the home. Staff were seen to be knocking on people’s doors prior to entering in order to promote privacy and dignity and staff were sensitive to the needs of people.
Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 14 The policies and procedures of the home demonstrated that relatives and friends of those living at their home were able to visit in private or in the communal areas of the home, according to residents’ wishes. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 15 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The routines of the home were planned around the resident’s individual needs and wishes, encouraging them to make choices about their lifestyle and to keep in touch with family and friends. However, the provision of activities needed to be improved, so that people were stimulated in order to prevent boredom. EVIDENCE: The home did not employ a dedicated person to be responsible for the planning and organisation of activities. It was evident that the care staff were expected to take on such duties and that the provision of activities was not structured, but more on an ad hoc basis, which did not demonstrate that people were encouraged to continue with their interests whilst living at the home. However, an activities book was maintained, which showed that a few things did take place and although freedom of movement within the home was encouraged where possible, in general, the provision of activities was lacking. On the day of the site visit there was little stimulation evident for residents as care staff were busy attending to people’s care needs. The pre-inspection questionnaire indicated that the only activity provided was library access, which evidently was not suitable for everyone living at the
Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 16 home. The plans of care did not detail a lot of activity provided, although social care assessment had been conducted, which created a clear picture of residents’ past life, interests and social contacts so that staff could develop a good understanding of individuals living at the home. Comment cards were received from eight relatives. One stated, “Not much mental stimulation seems to occur. There is no visiting occupational therapist or such like worker”, and another said, “We feel that there is a lack of mental stimulation for these residents who could benefit from it. Putting the TV on and leaving it on does not constitute stimulation, especially when many residents cannot see it or can no longer understand it. Some music or songs the residents might remember would be good some times”. One resident said that there were never suitable activities provided. People’s preferences were included in the plans of care and residents were seen being offered a variety of choices by staff and when necessary were assisted in making decisions about their daily life. Evidence was available to show that Holy Communion was provided for those wishing to join in and that clergy of various denominations visited the home so that people’s religious needs were being met. People were provided with information about local advocacy services so that they could appoint someone to act on their behalf, should they so wish. Records showed that one advocate had been involved in a multidisciplinary meeting, so that a decision could be made on how to best protect a particular resident’s finances, as he was no longer able to manage his own affairs. The service users’ guide told people about visiting arrangements and records showed that staff supported one person to keep in touch with her relatives on a regular basis and as she requested to do so. One visitor spoken to said that the staff were all very friendly and that she felt comfortable visiting the home at any time. We noted that there was a good rapport between staff and those living at the home and that people were able to eat when and where they preferred. Records showed that the routines of daily living were flexible within the home in order to promote individual choices and create a homely environment. On the day of the site visit one person did not wish to eat at lunchtime and so arrangements were made for him to have a meal later, when he felt more like eating. Another person whose care was ‘tracked’ was observed being assisted at lunchtime with her meal and although she showed no awareness of her surroundings and was displaying some agitated behaviour, the staff member with her supported her in a gentle manner ensuring that she received a nutritious diet. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 17 Meals served were well presented in order to aid in nutrition and to promote appetite. The menu provided a good nutritious diet, although choices of meals were not included on the menu. However, alternatives were seen to be provided as required and staff spoken to were aware of individual dietary preferences, which were also recorded within the care records. Independent eating was being encouraged supported by the provision of specialised cutlery and plate guards, whilst staff were supporting people with meals were necessary to ensure an adequate dietary intake. However, some staff members were seen standing by people whilst assisting them with their meals, which did not create a relaxed environment, whilst people were dining. Other staff members were observed sitting with people and chatting to them whilst helping them with their food, which was more appropriate. Staff spent long periods of time helping people with their meals, so that they could eat at their own pace and were not rushed. Two people were seen eating their lunch in the lounge area and were having difficulty in managing to eat whilst balancing their plates on their knees. This needs to be addressed so that everyone is comfortable whilst eating their meals. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of complaints could have been better. However, the policies and procedures were thorough enough to promote the protection of those living at the home. EVIDENCE: The pre inspection questionnaire showed that policies and procedures in relation to complaints and safeguarding adults were in place at the home, so that people knew how to make a complaint, if they wished to do so and so that staff knew what to do should an allegation of abuse be reported. The pre inspection questionnaire showed that one complaint has been received by the home in the last twelve months and that this had been responded to within 28 days, in accordance with the policies of the home. A system was in place for recording and monitoring complaints received to ensure that a thorough investigation was conducted and appropriate responses were provided. However, the record retained was not in line with data protection so that people’s identity and personal details were protected. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 19 One comment card was received from a resident, who stated that she would know how to make a complaint, should she wish to do so and seven out of eight relatives said that they too would know how to make a complaint. Four relatives indicated that any concerns raised were responded to appropriately and the other four felt that improvements could be made in this area. Staff spoken to knew what to do should an allegation of abuse be received. Information was provided for staff in relation to the management of physical and verbal aggression to promote the safety of service users, staff and visitors. Staff had undertaken specific training in relation to the protection of vulnerable adults to ensure that they were aware of correct procedures to follow. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 20 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were not provided with a consistently safe, well-maintained and pleasant environment in which to live. EVIDENCE: A programme of routine maintenance had been developed and submitted to the Commission for Social Care Inspection, showing that the provider intended to raise the standard of the environment for the people living at Moss View. The pre inspection questionnaire showed that that one bedroom had been decorated since the last inspection and that the lounge and dining areas were in the process of refurbishment and general decoration was in progress. This was confirmed by our visit to the home. The maintenance of the environment needed to be improved and some areas of the home needed to be up-graded, so that people were provided with safe and pleasant surroundings in which to live.
Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 21 The resident who submitted a comment card said that the home was usually fresh and clean. However, at the time of the site visit there were areas of the home, which smelt very bad and therefore did not provide a pleasant environment for people ton live in. We noted that some requirements and recommendations made at the last inspection in relation to the environment had been appropriately addressed. However, some areas still needed attention. The wash hand basin in one bedroom was worn and the carpet was badly stained. This bedroom also smelt very bad and therefore did not provide the person living in this room with a pleasant environment. The wall tiles in the bathroom on the ground floor did not match. One bath panel was damaged and still in need of repair and there was no panel on the other side of the bath, which did not provide people using this bathroom with pleasant and safe surroundings. Many of the bathrooms and toilets were dark, uninviting and antiquated and in need of up grading, so that people living at the home were afforded pleasant facilities. Cobwebs were noticed in one toilet and a toilet alarm cord was out of reach, which did not allow people using this facility to call for help, should they require it. A set of filing cabinets were stored in the medi-bathroom and the wall was in poor condition, which did not provide a homely atmosphere for people living at the home. The curtains in two bedrooms still needed re-hanging in order to create a homely environment for the people living in these rooms. An adhesive film was still present on the window in one bedroom and there was no lampshade in this room, which made this person’s environment uninviting. The furniture in two bedrooms was in poor condition. The wooden commode chair was rotting and chairs were badly ripped, which did not provide hygienic and pleasant areas for these people to live in. The floor covering in the bathroom on the first floor was in need of attention and this area was in need of decoration, so that people could bathe in pleasant surroundings. One bedroom was very poorly lit, despite the risk assessment for the person living in this room indicating that she required a bright light for her safety. A piece of equipment being used by the person living in this bedroom was
Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 22 unstable and had not been risk assessed. This needs to be addressed in order to promote the health and safety of this individual. The acting manager told us that the laundry department flooring had been replaced since the last inspection in order to promote good hygiene and infection control. Some staff had received training in infection control to ensure that policies and procedures were being followed. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 23 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff on duty was sufficient to ensure that the assessed needs of people living at the home were appropriately met and staff had received sufficient mandatory training to ensure that they were competent to do their job. However, the recruitment practices were not thorough enough to protect those living at the home. EVIDENCE: The staff rota was examined at the time of the site visit, which showed that the numbers of staff deployed were sufficient to meet the needs of the people living at the home, including one person receiving 1:1 care ensuring that this individual’s safety and the safety of others was adequately protected. The staff rota showed that twenty four care staff were employed, with five of these people having achieved a recognised qualification in care so that there were staff working at the home who were appropriately qualified. However, the home should have achieved a minimum ratio of 50 of care staff with such a qualification, so that the assessed needs of people living at the home were being met by appropriately qualified and competent care staff and so that newly appointed staff were adequately supervised by qualified care staff. We were informed that other care staff were in the process of completing a recognised National Vocational Qualification. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 24 Comment cards were received from eight relatives, three of which indicated that staff were appropriately experienced and had the right skills to provide adequate care. Five relatives said that staff usually or sometimes had the right skills and experience to do the job expected of them. One relative stated, “When the residents become aggressive they (the staff) are able to calm the situation fairly quickly”, and another said, “We say this on the basis of observation. The majority of staff are very conscientious and caring and are very open to having visitors around whilst they are working. Obviously there are occasional staff who have difficulty with this type of caring, but they tend not to stay. Some staff will be better qualified and/or experienced than others. What matters is their attitude towards the residents.” The pre-inspection questionnaire showed that a variety of additional training was available for staff. One staff member spoken to told us that the amount of training provided had improved since the change of ownership and another confirmed that all staff were provided with a booklet about dementia care, so that people working at the home were aware of the type of care required by the category of resident living at Moss View. One staff member said that there was a lot of training planned, specific to the needs of people living at the home. Training records and certificates confirmed that a variety of mandatory training courses were provided for staff to ensure that they were aware of the policies, procedures and practices of the home. Induction records were examined on staff files. These were in the format of a checklist and did not show a detailed induction process, in line with Skills for Care. A letter was seen on one staff members file indicating that she accepted the need to complete Skills for Care Induction, but the new owners did not know about these induction standards when asked. This area needed some additional work so that people appointed received an in depth induction programme to ensure that they were sufficiently trained to provide adequate care to those living at the home. General Social Care Council codes of conduct were available for care staff and contracts were issued to all staff so that they were aware of their responsibilities and terms and conditions of employment. The files of three new staff members were examined, which showed that the recruitment procedures were not thorough enough to ensure the protection of the people living at the home. Application forms did not ask prospective staff for the months and years of previous work history so that any gaps in employment could be identified and explored. Criminal Record Bureau disclosures for two people had been accepted from a previous employer and there was no check against the Protection of Vulnerable Adults register for one person. Two references for one person were very old as
Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 25 she had been employed by the home previously and one reference was obtained after employment. If a member of staff leaves the home and then returns to work, then each appointment must be treated as new employment, with a new application being completed and all checks and references being conducted again to ensure that people living at the home are adequately protected. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 26 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, 33 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of service provided was not being sufficiently monitored to ensure that the home was run in the best interests of the people living at Moss View. The health and safety of residents was adequately protected, although confidentiality was not consistently promoted. EVIDENCE: Standard 35 was not applicable to this service as the home did not manage the finances of anyone living at Moss View and did not hold any monies on behalf of residents, so no records were retained. Relatives or advocates took on this responsibility, but if anyone living at the home needed any money, then they would be given what they needed out of the petty cash float and then the relatives would reimburse the home.
Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 27 At the time of the site visit there was no registered manager appointed to take day-to-day control of the management of the home. However, the registered provider and acting manager were taking responsibility of the home during this period, until a suitable replacement is appointed. Staff spoken to felt that several improvements were being made and one said, “Things have settled down since the change of ownership”. The pre-inspection questionnaire showed that there were policies and procedures available at the home for staff reference, so that those working at the home were able to obtain relevant information, should they so wish. The policy and procedure file was examined, which had been reorganised so that it was easy to use for staff. The key policies and procedures had been signed and dated by those working in the home indicating that they had read and understood the information provided, which was considered to be good practice. However, some policies in the main part of manual, such as, Infection Control and Aggression were not fully completed, as spaces had been left in the policy document, for example where the lead persons name should have been entered and not all policies were dated and signed by the person who had written or reviewed them, showing that they contained current information and guidance. The policy for monitoring the quality of service provided indicates that meetings would be held twice a month and that surveys would be sent out at intervals. However, there was no evidence to show that this policy was being followed in day-to-day practice. There was no evidence to show that the registered person was consistently conducting and recording monthly visits to the home, in accordance with regulation 26 of the care homes regulations or that any systems were in place to monitor the quality of service provided. Some meetings had been held, so that people were kept up to date with the change of ownership process. A record of such meetings was available, so that people were aware of what was discussed. However, there was no evidence available to show that the views of people had been sought on how the home was achieving its goals for the people living there. The pre-inspection questionnaire showed that systems and equipment had been appropriately serviced so that the health and safety of both residents and staff was adequately protected, and this was confirmed by examination of a random selection of service certificates
Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 28 Accidents occurring to residents had been recorded so that the home could monitor their frequency and identify any recurring patterns. However, the accident book was not being completed in line with Data Protection to ensure that confidentiality was maintained. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 29 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 X X 2 X X N/A 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X N/A X X 2 Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 30 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 OP3 Regulation 14(1)(c) Requirement The registered person must ensure that people wishing to move into the home or their relative have been given the opportunity to be involved in the pre-admission process, so that they can have some input into planning their care. The registered person must ensure that all identified risks and assessed needs are included in the care plan, so that staff are fully aware of how people’s needs are to be met and how risks are to be minimised. The registered person must ensure that those living at the home or their relative are given the opportunity to be involved in drawing up the care plan, so that they have some input into the care provided. (Previous timescale of 31/05/06 not met). The registered person must ensure that the care home is maintained to a good standard
DS0000069004.V333250.R01.S.doc Timescale for action 31/07/07 2 OP7 15(1) 31/07/07 3. OP7 13(4)(c) 31/07/07 4. OP19 16(2)(k) 23(2)(b)(d) 31/08/07 Moss View Nursing Home Version 5.2 Page 31 5. OP29 19(1)(a)(b) (i) Schedule 2 6. OP31 8(1)(2) 7. OP33 26(4)(c), 5(a) of repair and decoration and that all parts of the home are kept clean and free from offensive odours. (Previous timescale of 31/05/06 not met). The registered person must not employ a person to work at the care home unless he has obtained in respect of that person two current written references, a Criminal Records Bureau disclosure conducted by the home and a Protection Of Vulnerable Adults register check. (Previous timescale of 31/05/07 not met). The registered person must appoint an individual to manage the care home and must give notice to the Commission of the person’s name and date on which the appointment is to take effect. The registered person must prepare a written report on the conduct of the home at least once a month and shall supply a copy of the report to the Commission for Social Care Inspection. (Previous timescale of 31/05/06 not met). 31/08/07 30/09/07 31/08/07 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 OP9 Good Practice Recommendations A second member of staff should witness all hand written entries on Medication Administration Records to avoid the possibility of transcription errors.
DS0000069004.V333250.R01.S.doc Version 5.2 Page 32 Moss View Nursing Home 2. 3. OP9 OP12 4. OP15 5. OP16 6. OP28 7. OP30 8. OP33 9. OP33 10. OP38 Photographs of residents should be attached to the Medication Administration Records so that staff can easily identify people when giving medications. The provision of activities for those living at Moss View should be improved, so that people are given the opportunity to continue their interests whilst living at the home and so that stimulation is promoted and boredom is prevented. The management of meals should be reviewed so that people are comfortable whilst dining and so that a relaxed and friendly environment is provided for those being assisted with their meals. A choice of meals should be displayed on the menu so that people able can select the meal of their choice. A system should be implemented for recording complaints so that the identity of people concerned and their personal details are protected in line with data protection. This system should be able to easily identify if any complaints records are mislaid or removed. The home should be achieving a minimum of 50 of care staff with a recognised qualification in care, so that the needs of people living at the home are fully met and so that there are a sufficient number of qualified care staff to supervise newly appointed persons. The induction process should be more detailed, in line with Skills for Care, so that new people working at the home receive sufficient information to allow them to competently and confidently carry out the work expected of them. The registered person should implement systems in the home so that the quality of service provided can be closely monitored, such as audit trails, more frequent meetings with minutes retained and recorded monthly visits by the registered person. The views of residents, their representatives and stakeholders in the community should be formally sought on how the service is achieving goals for people living at the home. The policies and Procedures of the home should be fully completed, reviewed and up dated periodically so that current information is provided to staff. Policies and procedures should be followed in day-to-day practice so that the home provides a consistent service. Accidents should be recorded in line with data protection in order to maintain confidentiality. Moss View Nursing Home DS0000069004.V333250.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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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