Inspection on 02/07/07 for The Moorings

This inspection was carried out on 2nd July 2007.

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 12/02/07

The Moorings 30/06/06

The Moorings 27/01/06

The Moorings 14/09/05

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 Moorings, The 167 Thorney Bay Road Canvey Island Essex SS8 0HN Lead Inspector Carolyn Delaney Unannounced Inspection 07:15 2nd July 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 Moorings, The DS0000015546.V341875.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. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moorings, The Address 167 Thorney Bay Road Canvey Island Essex SS8 0HN 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) 01268 514477 01268 514474 moorings@abc-care-solutions.co.uk Independent Homes Limited Manager post vacant Care Home 39 Category(ies) of Dementia - over 65 years of age (39), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (39) Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Excluding any person who is liable to be detained under the provision of the Mental Health Act 1983 2nd May 2007 Date of last inspection 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 range of fees for accommodation and nursing care at the home is between £560.00 for a shared room and £560.00 for a single room. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced Key inspection carried out on 2nd July 2007. It took place over eleven and a half hours between 07.15 am and 6.45 pm and I was accompanied by inspector Michelle Love. As part of the inspection process the relatives of twenty -three residents living at the home were contacted by post and given the opportunity to make comment about the home. At the time of this inspection eight people had returned completed questionnaires. Each person had been offered the opportunity to speak with the inspector, however all those who responded recorded that they did not wish to do so. The comments and views of residents and those people who responded to questionnaires have been used in conjunction with the findings of the inspection visit so as to make a judgement about the level of services provided by the home and have been included throughout the report. Records including assessments, care plans, daily care notes, and medication records, risk assessment documents and accident records in respect of a number of people living at the home were examined. Members of staff and the home’s manager, and the home’s owner were spoken with and a number of records including duty rotas and staff recruitment files were examined. A tour of the premises was carried out. Key standards as identified in the intended outcomes sections of this report are inspected at each key inspection. Key standards are identified for each section of the report. Where other standards have not been assessed these will have been assessed at previous inspections. Reports in respect of previous inspections may be accessed via the Commissions website www.csci.org.uk. The judgements made in this report are based upon the information collected during the site visit, the information provided by residents relatives and other relevant individuals, and other information received by the Commission from the home and other parties. Below is a brief summary of the findings of the inspection. More detail is contained within the main body of the report. What the service does well: Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 6 People are only offered a place at the home once an assessment of the persons nursing needs has been carried out by a member of nursing staff working in the home. The information about the home and the services and facilities provided is reviewed regularly and amended wherever there are changes. Residents relatives are being encouraged to meet with staff, the manager and home’s owner on a regular basis to discuss how the home is run and how residents are cared for. Some relatives have made suggestions for how residents may be able to take trips outside of the home. It is positive that family involvement is being encouraged. Relatives are aware of the complaints procedure and complaints are dealt with appropriately. The Moorings offers a safe and clean environment for residents to live in. What has improved since the last inspection? Since the last inspection there has been an improvement in the way that staff carry out assessments of a person’s needs before they are offered a place in the home and recording of relevant information in the home’s assessment document has improved. This ensures that there is enough information about the person to show that the home can meet the person’s needs. Following on from meetings with relatives, staff and healthcare professionals where issues around communication were highlighted, one of the senior carers has been identified as a designated ’resident / relative’ coordinator who will liaise with relatives and act as a point of contact to answer any questions. In addition the home’s manager has provided her mobile telephone number, which relatives may use if they wish to speak with her, when she is not available at the home. The home is clean and there has been some redecoration to communal areas, hallways and some resident’s bedrooms. In addition the home’s owner has purchased all new beds for residents. There have been improvements made in the way in which staff are recruited to work at the home and all of the checks as required including references and Criminal Records Bureau (CRB) disclosures had been carried in respect of the one person who has been employed at the home since these records were last inspected. A system for monitoring the quality of the service provided by the home has been implemented. Relatives have been contacted and asked for their opinion about how they receive information from the home, how telephone conversations are managed, if they can spend time privately with their relative, if they are made to feel welcome in the home and whether they feel Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 7 that the resident is happy and content in the home. The responses were available at the time of the inspection and in general relatives were positive in their response. The home is managed better and communication has improved. 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 summary of this inspection report can be made available in other formats on request. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are only offered a place at the home once a registered nurse has carried out a detailed assessment of the person’s nursing needs. Detailed information about the home and the services provided is readily available. EVIDENCE: The home has a statement of purpose which sets out the aims and objectives of the home and the services provided. The home’s service users guide is not in a format that residents in the home can fully understand and it is accepted that it would be difficult to produce a document which would suit all of the people’s individual level of understanding. This information is made readily available to residents’ relatives and other representatives. People living at the home generally rely upon the assistance of staff for information about living at the home. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 10 There are a number of elements as required by regulation, which were omitted from the service users guide. For example the service users guide does not include details of the home’s complaints procedure, the terms and conditions in respect of the accommodation to be provided. The home’s statement of purpose was detailed and in line with current regulations. There has only been one person admitted to the home since the last key inspection. There was evidence that an assessment of this person’s nursing and care needs had been carried out and documented by the home’s manager prior to the person being offered a place at the home. Some elements of the assessment could be more detailed such as information about the individual’s abilities in respect of daily activities such as washing and dressing and information about communication, sight and hearing. However the assessment was detailed sufficiently so as to determine that the home could meet the person’s needs. The Moorings does not provide intermediate or rehabilitative care. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home do not always receive the care and support they need for they’re mental and physical health needs. EVIDENCE: The people living in the Moorings have a number of complex mental health and physical healthcare needs. The majority of people living at the home are incapable of effectively expressing their needs or seeking assistance from staff. People living in the home rely and depend on staff to ensure that they receive the care, treatment and support that they need. The care plans for six people were assessed. While there were some improvements noted in the way which information about residents’ nursing and care needs was recorded, for some residents there were still areas where information was poorly recorded and information was not reviewed or amended when there have been changes to the needs of the person. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 12 The care plan for one person who had leg ulcers was examined. The dressings were observed by both inspectors to be poorly bandaged in that the bandages had come loose and were positioned around the person’s ankles and not secure to the leg. There was a wound management plan, which had been written with information as to the type of dressing to be used, and the frequency at which dressings should be changed. This plan had not been reviewed or updated since January 2007. There was a care plan, which referred to the wounds. However the information recorded was unclear. There was no information as to how often the dressings were being re-dressed or whether the treatment was effective and whether there had been any improvement in the condition of the wounds. The care plan for one person who has epilepsy indicated that if the person should have a seizure that staff should ‘put in airway if possible’. This practice is not in line with guidance and good practice for managing a person who is suffering an epileptic seizure and may even be potentially dangerous. Some care plans had not been reviewed in light of changes to the person’s condition. For example it was recorded in one person’s care plan that they were to have ‘soft’ food and a ‘low cholesterol diet’. During the inspection it was evident on observing the resident that they could eat normal food and the person was observed to have egg and chips for their lunch meal. However the care plan had not been updated and did not accurately describe the person’s needs. One of the residents had sustained an injury following a fall. When one of the inspectors asked a member of staff working in the home what had happened the member of staff said that they ‘did not know’. The injury had been sustained one month prior to the date of the inspection. The care plans and assessment in respect of the risk to the person of falling were examined. The care plan in respect of washing and dressing had not been amended in light of the person’s injury and the risk assessment plan for falls had not been reviewed or amended. A care plan had been developed for the person in which it was recorded that the resident’s injured limb should be elevated and the person should be offered analgesia for pain relief. The plan had not been reviewed and updated in respect as to whether the pain relief had been effective etc. Bedrails are used for a number of residents as a preventive measure to minimise the risk of persons falling from bed. However while in some instance the consent of relatives had been sought there was no assessment of risk carried out regarding the risks associated with the use of bedrails such as injury or entrapment for the three people who had bedrails fitted to their beds. Where it had been identified in the care plans that a person was at risk of developing pressure sores due to immobility these risks had been identified using a recognised assessment tool (Waterlow). However, where pressure Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 13 relieving equipment such as mattresses and cushions were to be used so as to minimise the risk, there was nothing recorded to evidence the rationale for deciding which pressure relieving device was more appropriate and suited to the needs of the individual. A list of equipment is available which shows the location of the equipment in the home. During the day of the inspection some staff were observed to interact with residents in a way, which aggravated them. Two such incidents were observed during the inspection - a member of staff when attending to a resident who was being verbally aggressive and shouting put her finger on the person’s face and said ‘shush’. The other incident was where a nurse leaned over the table to a resident and put the medicine pot to the person’s mouth without explaining beforehand what they were about to do. None of the people living at the home are capable of safely retaining control of their medication and rely upon nursing staff working at the home to ensure that they receive appropriate medical treatment. During the inspection nursing staff were observed to administer medicines at the appropriate times. The Medication Administration Records (MAR) for each of the people who were living at the home at the time of this inspection were assessed. These were well maintained and staff completed records when they administered medicines. It was positive to note that resident’s medicines had been reviewed and that analgesic (such as Paracetamol) and sedatives (such as Temazepam) had been reviewed and were now being administered only as required. Medicines such as antibiotics were provided in liquid form for some residents where they had difficulty in swallowing tablets. There was evidence that generally all residents received the medicines prescribed for them including topical creams and ointments as part of their treatment. It was noted in the minutes of a staff meeting held since the last key inspection that nursing staff had not administered a medicine patch to a resident for a number of days, as they were unsure as to whether it was a medicines ‘controlled’ under the Medicines Act which requires specific storage and handling procedures. Nursing staff had not sought advice in respect of this and it is unacceptable for residents not to be administered medicines, which have been prescribed for them due to staffs’ lack of knowledge. However it is noted that when these issues were raised, at the staff meeting, they were dealt with immediately and appropriately. Following on from this it has been established that the nurse practitioner who regularly visits the home will be available to offer support and advice to nursing staff. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are not supported at mealtimes in a manner, which ensures that they receive the care, and assistance they need. Opportunities are not provided for activities, which are suited to the person’s needs and wishes. EVIDENCE: On the morning of the inspection one of the inspectors asked about the arrangements for providing activities and opportunities for stimulation for people living in the home. The home’s manager said that there were no planned activities as it was difficult to plan group activities due to differing needs of residents and their short attention span. The home’s manager also said that there is ‘ a lot of one to one’ interaction with residents. Staff had recorded in resident’s care plans some of the activities, which residents would like to participate in. It was recorded for one resident that they enjoy watching films, it was recorded for one other person that they enjoyed football. The records which are maintained by staff regarding the activities Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 15 provided were sampled. In general there were entries made each day. However these records on the whole did not evidence that the activities, which the individual enjoys as, recorded in the person’s care plan were provided. Records contained numerous entries made regarding ‘having a chat’ with residents, ‘drawing and colouring’ or ‘listening to music’. In the home’s Annual Quality Assurance Assessment (AQAA) it is recorded that the home acknowledge that more improvement could be done in the way in which staff record information about resident’s activities. One resident’s relative who completed a survey said that they felt ‘that residents are left unattended in lounges quite often’. There were copies of letters in resident’s care files indicating that relatives have been contacted so that they can meet with the home’s manager and staff to discuss care so as to provide care and support which is person centred and specific to the needs and wishes of the individual. This is seen to be a good approach and the Commission looks forward to seeing it fully implemented The minutes from a recent relatives meeting held in May and June 2007 provided evidence that some relatives wish for more activities to be provided by the home including more opportunities for residents to take ‘trips outside of the home’. One relative who completed a survey commented that there was ‘good interaction with residents’. As part of the inspection process, one and a half hours were spent observing the care being given to a group of four people, using a Short Observational Framework for Inspection assessment tool. This is a tool used to observe resident mood and how staff interact with residents and the affect this the interaction has on the mood of the resident. This tool is primarily used to observe people who have difficulty in communicating verbally and has been developed for observing people who have Alzheimer’s disease / dementia. This is a summary of what the inspector observed: The time spent observing resident’s daily life and staff care practices found two residents spending most of their time asleep and intermittently two other residents appeared agitated when some members of staff attempted to engage with residents on an individual level. This refers specifically to some staff trying to engage residents with an activity and not picking up on cues whereby they became agitated and verbally challenging. Staff were observed to deal with these matters by withdrawing from the residents without ensuring that they were calm. One senior member of staff was observed to interact appropriately and positively with two residents on two separate occasions. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 16 Some residents’ relatives who attended a recent residents’ meeting and the nurse practitioner who attended a staff meeting commented that when they ring the home and request information about their relatives that some staff have difficulties in understanding them and communicating information effectively. In order to rectify this and to improve communication one senior member of staff has been promoted to resident / relative coordinator and is available to answer queries. In addition the relatives have been given the acting manager’s mobile telephone number for contact when the manager is not in the home. Of the eight resident’s relatives who completed ‘ Have your say about’ surveys, four people said that they always get enough information about the care home to help them make decisions, three said that they usually did and one said that they sometimes did. One person who completed a survey said that there has been a ‘big improvement recently’ in respect of the way information is provided by the home. Menus are displayed in the home and there are alternative meals available should a resident not like the planned meal. The lunchtime meal for the day of the inspection was sliced ham, fried eggs, chips and beans for those people who can eat a normal diet and pureed sausage rolls, mashed potatoes with pea gravy for the people who need a soft diet. Both inspectors observed the serving of the lunchtime meal, one in the main dining room and the other in the lounge area where some tables had been set up since the last inspection so that some of the more capable residents had their lunch there together. Tables were laid with tablecloths however the tablecloths were creased and unironed. Serviettes were not provided for residents in all the dining areas in line with the planned actions from a recent staff meeting. Residents were offered a cold drink with their meal. Sixteen people were taken to the home’s dining room for lunch. These people were more dependent upon staff for assistance and support and there were four members of staff available to serve the meal and assist residents with feeding. Other residents were unsupervised and at one table a resident was attempting to eat their meal while the resident sitting opposite was shaking the table and trying to pour her drink into the other persons meal. Some residents pushed their plates away without eating their meal and staff were not available to sit with them to prompt and encourage residents to eat. There were clearly insufficient staff available to support the needs of these people at this time so as to ensure that residents ate their meal. Inspectors have suggested on two previous occasions that the provision of two sittings at meal times may be a better way to support residents take their meals. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 17 It was noted in the minutes from a staff meeting which was held April that staff were to offer milky drinks / milk shakes to residents who do not eat their meals. A number of people were observed not to eat their meal at lunchtime. However when staff were observed to provide drinks in the afternoon there were no milky drinks available and the member of staff serving the drinks confirmed that these milky drinks are not offered. Moorings, The DS0000015546.V341875.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s relatives generally feel that their complaints and concerns will be dealt with in an appropriate way. EVIDENCE: The home has a detailed complaints policy and procedure, which the manager said, has been made available to resident’s relatives. At a recent residents meeting the home’s manager informed those present that CSCI do not inform the home when complaints have been received. She was advised that this inaccurate and that if the Commission receive complaints about a service that the service is notified and advised to investigate such complaints in accordance with their policy and procedure. Five of the eight residents relative’s who completed ‘Have your say about.’ surveys six said that they knew how to make a complaint about the home if they need to. Of the eight, one said that they have never had to a make a complaint; three said that the home always responded appropriately if concerns were raised and the remaining four said that the home usually does. The home’s manager said that there has been one formal complaint and no others made since the previous inspection. The complainant was unhappy that their relative who is confused and at times both verbally and physically aggressive was sent to hospital during the night without a member of staff to Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 19 escort them. It is the home’s policy that residents will not be escorted by staff should they need to attend hospital as an emergency visit during the night as there are insufficient staff on duty to facilitate this. This complaint was investigated and responded to appropriately. There has been a reduction in the number of complaints made about the home over the past eighteen months. Moorings, The DS0000015546.V341875.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Moorings provides a safe clean environment for residents who live there. EVIDENCE: There have been a number of improvements made to the home’s environment since the new owners bought the home. Carpets have been removed which has improved the problem with odours. There has been some redecoration to the hallways, communal areas and bedrooms, which makes the home look and brighter. Dedicated cleaning staff are employed at the home and the home was observed to be clean and free from odours. New specialist beds have been purchased for all residents. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 21 Some dining tables have been set up one of the lounge areas so that the more independent residents can take their meals together. It was recorded in one resident’s care plan that they tend to wander into others resident’s bedrooms. It was recorded that as a result of this that some resident’s bedrooms are locked during the day. The home’s manager said resident’s relatives had agreed to this action. It was not clear that other options had been considered so that resident’s access to their bedrooms was not restricted. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 22 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, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff recruitment practices are robust, however the arrangements for deploying and training staff does not ensure that the needs of people living at the home are met. EVIDENCE: The staffing levels at the home at the time of the inspection were two nurses and six care staff between 7.45am and 2.30pm, two nurses and five care staff from 2.15pm to 9pm and one nurse and two care staff form 8.45pm to 8am. Rotas, which were sampled, indicated that these staffing levels are maintained and that staff have appropriate off duty time and do not work excessive hours without a break. One relative who completed a survey said that they ‘cannot fault the staff and manager, always approachable, caring and considerate’. The home’s manager said that they use the Residential Forum tool for determining the number of staff hours needed based upon the dependency levels of residents living in the home. Copies of this tool were provided by the manager at the time of the inspection and were examined after the inspection visit. It is noted that the staffing hours were based upon the dependency levels Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 23 of residents as being 2 people who have high dependency, 20 people who have medium dependency and 5 people who have low dependency. This tool is primarily suited to care home where nursing care is not provided, as it does not take into account the persons nursing needs. It was observed during this inspection that staff deployment at mealtimes was poor and that staff struggled to support residents according to their needs. The home’s manager said that one person had been employed to work at the home since the last inspection. The recruitment file for this person was examined and there was evidence that the checks as required by regulation such as references, Criminal Records Bureau (CRB) disclosure and PoVA First check had been obtained before the person started work at the home. The homes manager had also interviewed the person and there was evidence of the persons experience and skills in respect of the job they were to perform. At the time of this inspection a total of thirty-three staff including the home’s manager, seven nurses, two senior care staff, twelve care staff & one bank care staff, three kitchen staff, four housekeeping staff and one laundry staff were employed. A copy of the staff-training matrix was requested and provided by the home’s manager. From this it was noted that three members of staff have not received up to date moving and handling training since 2004 and one had not received this training since 2005. Eleven members of staff had no dates indicated as to when they have completed fire safety training. Five members of staff have had recent infection control training. Eight people working at the home had not received training for protecting vulnerable people from abuse. Four members of staff had undertaken recent training regarding ‘Abuse in the Elderly’. During this inspection and at the last inspection visit carried out in May 2007 inspectors raised concerns about the way in which some staff deal with and interact with people who have difficulty in communicating their needs and who may become verbally and physically aggressive. During this inspection both inspectors observed some staff to deal with residents who are verbally and physically aggressive in a manner which aggravated this behaviour, such as carrying out tasks without first explaining to the person what they were about to do, speaking to residents in an inappropriate manner (a member of staff who put their finger on a residents face and said ‘shush’ to stop the person from shouting). From the information provided by the home’s manager it is noted that twenty staff have undertaken training in ‘Dementia Awareness’ and in addition three of the twenty have undertaken training in ‘Aggression in Dementia’ and ‘Challenging Behaviour’. It was noted that the recent ‘Dementia Care’ training had been carried out in the home on one day over 3 sessions and that twenty staff had undertaken the training on this day. Staff who attended the training on the day of the inspection were rostered to work. It is not clear how care was delivered to residents while staff received this training. For example for Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 24 the morning session three carers who were identified on the rota as working attended the training. The home’s manager said that the internal training consisted of video training and staff complete a workbook. A number of completed workbooks were in the manager’s office on the day of the inspection. These had not been assessed so as to determine if the staff had understood the principles of the training or if further training and learning was needed. It was noted in one member of staff’s file that in February there was an issue in respect of the persons ‘limited English’ and the need for improvement in care practices. It was recorded that this was to be followed up in April however there were no records to indicate that this review has taken place. A resident’s relative who completed a survey said that there could be ‘better communication’ and that ‘sometimes it was difficult to understand foreign staff’. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The way in which the home is managed has improved and resident’s relatives are encouraged to become more involved and their views are obtained so as to monitor and improve services provided at the home. However more must be done so as to ensure that where plans for improvement are made that these are implemented in practice. EVIDENCE: The home’s manager has previously provided management support to one of the owner’s other homes. The manager said that they were now at The Moorings ‘all of the time’. The staff rota did not include the hours worked at the home by the manager and this was discussed with the manager and home’s owner during the inspection and both were advised that the staff rota must include the hours worked at the home by the manager. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 26 Since the last inspection some work has been done so as to obtain the views of residents’ relatives about how the home is managed and to encourage relatives to make suggestions as to how things can be improved. There have been two relatives meetings held since the last key inspection. One person who completed a survey commented that ‘there have been big improvements recently’ and another commented that ‘prior to the current nursing staff taking over the standard of care and support was varied’. Since the last inspection a quality audit has been carried out and the results were available during the inspection. The results were positive and the majority of residents indicated that they were satisfied with how they receive information from the home, how telephone conversations are managed, if they can spend time privately with their relative, if they are made to feel welcome in the home and whether they feel that the resident is happy and content in the home Where results indicated that some relatives were not totally satisfied there was no information as to what they were unhappy about and what actions were being implemented so as to address areas where improvements could be made. Following the inspection visit information was provided which showed that appropriate action was being taken. There was evidence that the majority of staff working at the home have received supervision so as to monitor and improve care practices. However where one member of staff had been suspended as a result of poor practice there was no evidence that the member of staff had received supervision. There was evidence that staff meetings had taken place where staff were advised of areas where care and support of residents and communication could be improved. However during the inspection it was noted that staff had failed to act accordingly, such as failure of staff to provide ‘milky drinks’ for residents who do not eat meals. Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 27 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 3 X 3 X X Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) (2) Requirement The plan of care for each individual must be accurate, kept under review and revised at any time where there is a change to the care and treatment to be provided This requirement has not been met and is outstanding from the previous two inspections. 2. OP8 13(4) (a) (b) & (c) Risks to the health, safety and welfare of people living at the home must be assessed and managed. This requirement has not been met and is outstanding from the previous two inspections. 3. OP12 16(2) (m) & (n) Activities must be arranged and provided which meets the wishes and needs of the people living at the home. This requirement has not been met and is outstanding from the previous two inspections. Meals must be provided in a DS0000015546.V341875.R01.S.doc Timescale for action 30/09/07 30/08/07 30/09/07 4. OP15 16(2)(i) 30/08/07 Page 29 Moorings, The Version 5.2 6. OP27 18 7. OP30 18(1) (c) setting whereby staff can assist and support residents according to their needs. Staff must be deployed in the home in sufficient numbers so as to meet the needs of the people who live in the home at mealtimes. Staff working at the home must staff receive training appropriate to the work they are to carry out. This is in particular relation to the training provided in respect of caring for people who have dementia. This requirement is outstanding from the previous two inspections. 30/09/09 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 © 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 Moorings, The DS0000015546.V341875.R01.S.doc Version 5.2 Page 31 - 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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