Inspection on 14/09/05 for The Moorings

This inspection was carried out on 14th September 2005.

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

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

Other inspections for this house

The Moorings 02/07/07

The Moorings 12/02/07

The Moorings 30/06/06

The Moorings 27/01/06

The Moorings 18/01/05

The Moorings 13/07/04

The Moorings 30/12/03

The Moorings 23/10/03

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Moorings 167 Thorney Bay Road Canvey Island Essex SS8 0HN Lead Inspector Carolyn Delaney 14 th Un-announced September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Moorings Address 167 Thorney Bay Road Canvey Island Essex SS8 0HN 01268 514474 01268 514477 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Independent Homes Ltd Vacant CRH 39 Category(ies) of Dementia over 65 (DE) (E) - 39 registration, with number Mental disorder over 65 (MD) (E) - 39 of places The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2005. Brief Description of the Service: The Moorings provides purpose built accommodation for thirty-nine older people with dementia and mental disorders. The home is situated in a quiet residential area of Canvey Island within close proximity of the sea front.The Moorings offers 35 single occupancy bedrooms and 2 shared bedrooms. Residents at the home are accommodated on two floors, which are accessed by a passenger lift.Residents have access to the rear garden.There is parking facilities for approximately twelve cars adjacent to the home. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection of the service carried out between the hours of 11.00 and 16.30. Lead Regulation Inspector Carolyn Delaney and John Hawkins Regulation Manager carried out the inspection. Records such as pre- admission assessments care plans, assessments in respect risks to residents of sustaining injuries from falls etc were examined for eleven residents living at the home. Records in respect of the receipt and administration of medicines within the home were also assessed. Three residents and two relatives were spoken with during the inspection. Records in respect of the recruitment and training of staff were assessed, as were staff duty rotas. Staff were observed generally in their delivery of care and treatment of residents living at the home and five members of staff including the cook and acting manager were spoken with. A brief tour of the premises was carried out. The standards in respect of the management of the home were not assessed during this inspection. The home is due to be sold soon, so these standards will be assessed following the change of ownership. What the service does well: What has improved since the last inspection? It was positive to note that the care provided by staff appeared to have improved since the previous inspection. The majority of residents looked well cared for and clean. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 6 The number of complaints about the service had decreased in the past six months. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 & 5 Detailed assessments are carried out for each person prior to them being offered a place at the home and prospective residents and /or their relatives may visit the home to assess its suitability. The Moorings does not consistently meet the needs of residents in respect of safety and injury prevention. EVIDENCE: Two residents had recently moved into the home. The acting manager had visited both these people prior to their admission and a detailed assessment of their health; safety and welfare needs had been carried out and recorded. It was positive to note that these assessments had been reviewed upon the admission of each person to the home. There was also evidence that these resident’s relatives had been involved in the assessment process and that they had been invited to visit the home before making a decision about the admission. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 9 While the level of care provided did appear to have improved since the previous inspection, resident’s needs in respect of safety and the prevention of physical injuries were not always regularly assessed following admission and appropriate actions taken to ensure that these were met. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8, & 9 Care plans do not always include accurate and up to date information in respect of the needs of the people living at the home. Staff do not always act so as to minimise the risks of injuries to the people who live at the home. Staff working at the home ensure that residents receive the medication for which they have been prescribed. However staff do not always maintain records in respect of the administration of medication so as to minimise the risks of errors, and mishandling of medicines received into the home. EVIDENCE: The recording of information in residents care plans had improved since the previous inspection and care plans and other documents were reviewed each month. However these reviews did not always evidence that an evaluation of care and treatment had been carried out and the plan of care amended according to changes in residents care needs. For example, one resident who had previously been nursed in bed was now spending time during the day in a recliner chair in the lounge, although all of the care planning and assessment documentation still indicated that this person was being nursed in bed. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 11 A new assessment in respect of determining the risks of falls to residents had been introduced and where it had been completed it was detailed, however it had not been completed for all residents and the old style assessments did not clearly identify the risks to residents of falls. Records did not clearly indicate how these risks were to be managed so as to minimise injuries to people living at the home. Records maintained in respect of accidents and injuries evidenced that some residents sustained a large number of injuries, the majority minor but some serious. Assessments and management plans for determining risks to residents such as risks of sustaining injuries through aggression related altercations with other residents were not clearly written so as to minimise the risks to residents. Resident’s relatives have not always been informed of injuries and the Commission for Social Care Inspection have not always been informed as required by Regulation, when residents have sustained serious injuries. It was positive to note that residents received medication at appropriate times as prescribed. However Medication Administration Records (MAR) and records in respect of Controlled Drugs were not always signed by staff to evidence that medication was given. Where nursing staff handwrote MAR they were not checked and signed so as to minimise the risks of recording errors. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, & 15 The home does not provide suitable meaningful social and occupational activities for the people who live there. Residents on the day of the inspection received a well-presented and balanced lunchtime meal. EVIDENCE: There appeared to be very little in the way of meaningful occupational activities provided for people living at the home and staff were noted to very busy with little time to spend interacting with residents. The deployment of staff across the three lounge areas meant that on a number of occasions one member of staff was left supervising two adjacent lounge areas. In order to do this the person would stand outside both of these lounge areas making any interaction very difficult. The serving of the lunchtime meal on the day of the inspection was observed. It was noted that residents were served good-sized portions of food, which was well presented and residents appeared to enjoy their meal. Staff were available to assist residents to the dining area and to assist with the meal according to each individuals requirements. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 13 Records in respect of resident’s dietary intake were well maintained for those residents whose records were examined. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Relatives are not always assured that complaints will be dealt with in a satisfactory manner. The manner in which complaints received and investigated by the Commission are responded to by the homes management has improved. The management of the home does not consistently act so as to ensure the protection of the vulnerable people who live in the home. EVIDENCE: The Commission for Social Care Inspection had received one complaint shortly prior to this inspection. This complaint was made regarding the suitability of locks on bathroom doors following an incident where a resident locked themselves in a bathroom and staff had to force the lock and break into the room. This complaint was investigated during the inspection and was upheld. Another element of the complaint, which referred to the appropriateness of seating at the home, was unresolved. A prompt and satisfactory response to the investigation report was received by the Commission in respect of this complaint. However the person making the complaint did not feel confident that the issues would be addressed in a satisfactory manner if they were raised solely with homes acting manager or registered provider. The number of complaints received in respect of the service had decreased during the past six months. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 15 Not all staff working at the home have received training in respect of protecting vulnerable people living at the home from abuse. Some staff files indicated that staff had been employed without the necessary checks such as PoVA First and Criminal Records Bureau (CRB) disclosures having been first undertaken. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21, 22 & 26 The locks on door to bathroom and shower rooms are not suited to the needs of the people living at the home. Wheelchairs used by residents at the home were not maintained in safe working order so as to minimise the risks to residents of sustaining injury. The home was noted to be clean and hygienic on the day of this inspection. EVIDENCE: The locks on bathroom and shower room doors are not of the type which may be overridden by staff in the event that they needs to access thee rooms for example in an emergency. This could potentially put residents at risk of harm. Some resident’s bedrooms were noted to be bare with little in the way of personal possessions and effects. On the day of the inspection staff were noted to use wheelchairs, which did not have the appropriate footplates in place and could cause injury to residents. A The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 17 box of footplates was observed in the wheelchair storage area, however it was not clear that these belonged to the wheelchairs, which were in use on the day. This was discussed with the acting manager who said that he would ensure that all wheelchairs had appropriate footplates. The home was noted to be clean and generally odour free on the day of the inspection. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Staff are not consistently employed in sufficient numbers so as to meet the needs, particularly the needs in respect of safety of the people living at the home. Staff are not consistently employed in an effective manner so as to protect the safety and welfare of the people living at the home All staff working at the home have not received training in respect of meeting the needs of the people living at the home. EVIDENCE: There were insufficient numbers of staff employed on the day of this inspection to provide supervision to all people living at the home. Many residents wander about the home and can become verbally and / or physically aggressive towards staff and other residents. Some people living at the home sustain injuries on a regular basis and records indicate that a number of residents are ‘found by staff on the floor’. Staff rotas indicated that a number of staff work excessive duties without appropriate off duty days. Some staff worked day duties after working night duties. The acting manager was advised that this continued practice could put residents at risk. It was noted that some staff had been employed without appropriate checks such as PoVA First and Criminal Records Bureau (CRB) disclosure and The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 19 references having first been obtained. The home employs a recruitment agency to recruit staff from overseas and for these staff there were no references on file. This was discussed with the acting manager on the day of the inspection. The records maintained in respect staff training did not evidence that all staff had received training in respect of meeting the needs of the people living at the home. Particularly files did not evidence that staff had received training in respect of the needs of people with mental disorders, dementia and the management of aggressive behaviour, managing risks and the protection of vulnerable people. The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 Not inspected. EVIDENCE: The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x 2 2 x x x 3 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x x x x x x x The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 OP4 Regulation 12(1) (a) 14(2) Requirement The registered peson must ensure that residents needs are assesssed acccording to any changes in the persons condition and that safety needs are fully assessed and kept under regular review. ELEMENTS OF THIS ARE OUTSTANDING FROM THE PREVIOUS TWO INSPECTIONS. The registered person must ensure that care plans contain up to date and accurate information in respect of each persons needs so as to ensure that staff are aware of and can meet these needs. THIS IS A REPEAT REQUIREMENT OUTSANDING FROM THE PREVIOUS TWO INSPECTIONS. 3. OP8 13(4) (a) (b) & (c) The registered person must ensure that so far as it is practicable that people living in the home are protected from harm and injury, through assessment of risks to people and planning care to minimise 15/11/05 Timescale for action 30/11/05 2. OP7 15(1) (2) 30/11/05 The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 23 these risks. ELEMENTS OF THIS ARE OUTSTANDING FROM THE PREVIOUS TWO INSPECTIONS. 4. OP9 13(2) The registered person must ensure that staff act in accordance with the homes policies and procedures, the Nursing & Midwifery guidelines and any other relevant legislation and so as to prevent the mishandling of medicines received into the home. THIS IS A REPEAT REQUIREMENT OUTSANDING FROM THE PREVIOUS TWO INSPECTIONS. The registered person must ensure that people living at the home are offered a range of suitable activities which meet their needs and so far as it is practicable their wishes. ELEMENTS OF THIS ARE OUTSTANDING FROM THE PREVIOUS TWO INSPECTIONS. The registered person must ensure that staff act in a manner according to the homes policies and procedures so as to ensure that any complaints received are dealt with appropriately. The registered person must ensure that people living at the home are so far as it is practicable protected from abuse. 15/11/05 5. OP12 16(2) (m) & (n) 30/11/05 6. OP16 22 (3) 15/11/05 7. OP18 13(6) Immediate & ongoing 8. OP21 OP22 13(2) (b) 23(1) (c) & (n) The registered person must Immediate ensure that facilities and & ongoing equipment provided by the home are adapted where necessary and suited to the needs of the people living at the home. Version 1.30 Page 24 The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc 9. OP27 18(1) The registered person must 30/11/05 ensure that staff are employed in suitable numbers so as to meet the needs and ensure the protection of people living and working at the home. The registered person must ensure that staff are employed at the home only after all appropriate checks including references, checks on past employment and Criminal Records Bureau disclosures have been obtained. The registered person must ensure that staff working at the home receive training in respect of the work they are to perform, the needs, welfare and safety of the people living at the home. Immediate & ongoing 10. OP29 19 & Schedule 2 11. OP30 18(1) (c) 30/12/05 12. 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 Good Practice Recommendations The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on sea, Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Moorings I06-I56 S15546 The Moorings V228844 140905 Stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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