Inspection on 03/08/06 for The Moorings

This inspection was carried out on 3rd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Moorings 31/07/07

The Moorings 08/12/05

The Moorings 02/03/05

The Moorings 06/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Moorings Church Road Earsham Bungay Norfolk NR35 2TJ Lead Inspector Ruth Hannent Unannounced Inspection 3rd August 2006 9:00 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 The Moorings DS0000027272.V307177.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. The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Moorings Address Church Road Earsham Bungay Norfolk NR35 2TJ 01986 892269 F/P 01986 892269 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) Mr Malcolm Paul Blackham Mr Robert James Blackham, Mrs Sally Crawford Mrs Frances Friday Care Home 39 Category(ies) of Dementia - over 65 years of age (34), Old age, registration, with number not falling within any other category (39) of places The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Thirty-nine (39) Older People may be accommodated of which thirtyfour (34) may have dementia. Total number not to exceed thirty-nine (39). The home shall have one person on shift at all times who has received training in dementia awareness. 8th December 2005 Date of last inspection Brief Description of the Service: The Moorings is an extended property situated in six acres of grounds in the village of Earsham, close to the town of Bungay. The home is registered to accommodate up to thirty-nine older people but due to recent conversion of double bedrooms to single rooms, the home currently accommodates thirtyfour service users in twenty-eight single and three double bedrooms. The three double bedrooms have an en-suite facility. Four single rooms do not but there are plans for en-suite facilities to be provided in two of these. Bedrooms are on the ground and first floor with the first floor accessed by passenger lift. There is car parking to the front and the side of the property. Email – info@chevington.f9.co.uk Fees - £380 - £530 The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced site visit to The Moorings to assist the Inspector in collating all the evidence since the last inspection and compile a report. Information used as part of this report has been taken from comment cards receive from residents and families along with the information sent from the home on quarterly quality checks and incidents that have occurred with in the Home. The manager had also returned a pre inspection questionnaire and information from this has also been used as part of this report. The Home or the Commission has not received any complaints. Throughout the visit it was noted the atmosphere and environment is relaxing and pleasant with lots of smiles and appropriate conversations. During the visit residents, staff and management were spoken to. A tour of the building took place and a meal was taken with the residents. Records were looked at that included care plans, medication, maintenance and personnel and staff training. What the service does well: What has improved since the last inspection? The Home has improved some bedrooms by replacing linen and curtains and adding en-suites where possible. The outside grounds have had some improvement work carried out. The staff, now have regular supervision sessions. The Home has made an improvement on the recording of the care required. The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 6 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 DS0000027272.V307177.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 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 the following standard(s): 3 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents have an assessment prior to moving into The Moorings EVIDENCE: A recently admitted resident had on their care plan comprehensive information that had been obtained and detailed on an assessment format prior to admission (Seen). The Deputy manager explained the full procedure of assessment, which includes families and the resident if able visiting the Home, with as much information taken to assist in the judgement as to if the service at The Moorings can meet the needs of the potential resident. The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 7,8,9 and 10 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident’s health, personal and social care needs are written in a care plan. Residents health care needs are met. The residents are protected by the procedures of dealing with medication within the Home. Residents are treated with respect and their right to privacy is upheld. EVIDENCE: Throughout the visit in observation and by looking at three care plans the Home has begun to improve the way they document the care requirements. The detail is beginning to include the whole picture of need with the Homes management team have been assisting the staff with training on how to write these records. The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 10 The heath carer needs of resident’s are met by the local G.P. practices that support the Home well. (According to the staff team they have an understanding and empathy towards older people). Any changes in medication were noted and the G.P. will change the information on the MAR chart for the staff to follow. The District Nurse visits regularly and it was noted one lady was having regular treatment for a sore heel. Dressings were in place with protective shoes and the person had a pressure-relieving mattress on the bed. The medication procedure was observed during the lunchtime period with all medication administered correctly. Charts are clear, each resident has a photo (except a new resident who will have this in place shortly) the medication was checked for dose and name, placed in the pot and given to the resident with no signature placed on the chart until the medication had been swallowed. Plenty of water was available and no resident was hurried. A concern was shared regarding any medication that may be required at night as none of the night team have received training in the administration of medication. (Requirement See staff training) Throughout the day and through conversations with staff it was evident that residents are treated with respect and each staff member spoken gave examples of the way privacy and dignity is preserved. Doors are locked or knocked upon before entry. Each staff member was noted to bend down and talk to residents at eye level and all conversations within the residents hearing were appropriate. The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 12,13,14 and 15 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents appear happy. Information about the person’s background has been gathered and staff will support the interests of the residents. Residents are encouraged to remain in contact with all who are important to them. Residents are encouraged and helped to have control over their lives. Meals are wholesome and appealing but the environment and the way meals are presented needs to be rethought. EVIDENCE: Many of the residents have problems expressing their wishes through conversation and the staff are beginning to build skills to understand and act appropriately to ways that residents show their needs. The questionnaires received from both residents and families show they are happy with their life at The Moorings. There is still the need to develop further the understanding of when a routine is suitable and when someone with dementia may not be able The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 12 to conform to routine. For example at the meal table two or three residents were not comfortable often rising and moving off as they had nothing in front of them while awaiting the meal to arrive. To offer person centred care the needs at meal times needs to be reviewed to ensure all residents are treated as individuals. Some residents were being assisted by an activities staff member and noted was a variety of events that residents enjoy throughout the week. The previous day had been videos of the Broads, which was recorded as enjoyed. Some were enjoying a stroll around the grounds and some looking at history picture books. A regular visitor explained how she likes being involved and always arrives with treats such as magazines, sweets and fruit for everyone to share. Of the four relatives comment cards received all stated they are welcomed and can talk to anyone at the home if they have concerns. The residents throughout the day were given choices. Overheard were conversations of “would you like to sit here or in the other room”. “ Are you comfortable”. “Would you like something different to drink”. The Home sent copies of the meals offered to residents with the pre inspection questionnaire. The main meal is offered to all but an alternative can be available to anyone who wishes, with a large choice as the alternative. Concern was shared with how the choice was made. To offer the choice the day before for people with memory problems is not suitable which is how the Home operates at this time and at the table no choice was available for the main course. (Requirement). Each person was asked what and how many vegetables they would like with the choice to go with the quiche being cheesy potatoes, peas, broccoli, beetroot and pickled onions. Desert was cheesecake or jelly and ice cream. The Menu’s appeared wholesome and offered more choice at teatime. The tables are not very inviting with people sat, waiting with nothing in front of them but a 2ply harsh paper napkin that is unsuitable and wipes very little if people have food on their mouths. (Recommendation) The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relatives and residents are happy to talk to any staff member and voice their complaints. Residents are protected from abuse. EVIDENCE: The Home has not received any complaints. The pre inspection questionnaire showed no complaints, the home has none recorded and residents on the four comment cards received felt able and knew who to talk to if they were unhappy. The management team are to develop procedures to include comments and concerns to show how the items of concerns are dealt with appropriately. The staff recently (certificates seen) had training on abuse and on talking to a staff member she was able to explain signs to look for. All records including the pre inspection questionnaire and personnel records in the Home show the POVA register has been checked and CRB’s have been received for all staff. The most latest staff member had just had her CRB returned (seen). The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24 and 26 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do live in a safe well-maintained environment. The bathroom facilities are not suitable for all residents. All the bedrooms were personalised and comfortable. The home is clean pleasant and hygienic. EVIDENCE: Records from the Home show that ongoing improvements take place as required. The home has replaced many items of furniture, decorated rooms and added en suites as they have become vacant and new soft furnishings have been supplied. The Home is set in nice outdoor surroundings which is The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 15 well maintained. Communal areas are light and have many windows. The Fire officer visited last year with no concerns (seen) and all extinguishers were dated 06/06. Fire risk assessments were not available at the inspection due to records being held by one of the management team being away, but will be seen at a future visit. Concern was shared over the lack of choice for residents who require hoisting and are unable to access any of the bathrooms due to the size of the bathrooms. At present these residents can only have a bed bath, which is not what everyone requires. (Requirement). It was also noted the temperature of the bath water in one bathroom was too hot when tested by hand. Although verbally the maintenance man stated he does test the water regularly there were no clear records to show this. (Requirement). All bedrooms are unique in size, shape and furnishings. Many personal possessions were in each room, which were clean and fresh. Three residents spoken to by the Inspector said how much they loved their room. One gentleman was pleased to show his room and stated how comfortable he was. The whole home is clean and tidy with no unpleasant odour. There is a laundry assistant who manages the personal clothing items with linen sent to an outside laundry. The Home has a clinical waste contractor who is certified to collect the waste and visits weekly to remove items from the designated bins. The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 The quality of this outcome is adequate. This judgement has been made using available evidence including a visit to this service. Residents are assisted by an adequate in numbers, competent staff team. Residents are protected by the Homes recruitment policies and procedures. The Home needs to look more in depth at the training to ensure the level of knowledge meets the needs of the residents. EVIDENCE: On seeing the rota’s and watching the staff throughout their work there appeared sufficient staff on duty. On the morning of the inspection there were 7 carers, 2 senior staff members, 3 domestic staff, 1 cook and 1 kitchen assistant for 33 residents. Some of the staff have been at The Moorings for many years and the skill mix within the Home was noted. No resident was rushed and allowed whatever task to be carried out at the person own pace. Two personnel files were looked at with all relevant paperwork in place that included two references and POVA/CRB checks. All files are kept in order in the office. Each staff member is issued with a Code of Practice and signs a document to state they have read and understand the information. (Seen). The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 17 Two staff members along with the Deputy manager were spoken to. The Home has worked hard to get the staff trained in many areas relevant to the care the staff need to provide, including support and training on dementia care and the person centred approach. These training sessions were discussed with the staff members who found them very helpful and felt their skills had improved with this learning. Although all statutory training has occurred and certificates are held in each staff members training file concerns regarding moving and handling were shared with the Home on some equipment used (blue back strap) which is no longer recommended as suitable. It was also noted through observation that many of the frail residents should be reassessed to what is the right equipment for them to be assisted with when being transferred. (Requirement) (The Home does not have an internal trained moving and handling assessor to be able to keep staff updated). (Recommendation) The home also needs to ensure the night staff team have medication training as they are accountable when administering any medication during the night as mentioned in standard 9. (Requirement) The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home is run in the best interests of the resident’s. From past records the resident’s financial interests are safeguarded. The Home has worked hard to get supervision up and running appropriately. The Home needs to improve this area of the Management responsibility to ensure health, safety and welfare are promoted and protected. EVIDENCE: The manager has worked at the Home for many years and been the manager for approximately the last two years. Unfortunately she was unavailable for the The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 19 inspection so the Inspector was, accompanied by the Deputy Manager and the R.I. for this site visit. The R.I. was able to show, and the Commission had received regular quality assurance information on how the Home is checking the standards as required by Regulation 26. The action points made and the completion of required task showed dates and how tasks were completed. The Home need to carry on developing the audits to ask all people involved with the home to contribute such as GP’s DN’S, social workers, hairdresser and the vicar etc. This will aid the Homes annual development plan as written in standard 33.2. (Recommendation) The resident’s personal allowance is managed by the home and was checked thoroughly on the last inspection and the standard was met. Although records were not seen on this occasion the R.I. stated the system had not changed and there had been no concerns. The Home has improved greatly the one to one supervision sessions taken with all staff. The list of all dates for staff, were posted on the office wall with staff stating on being asked how valuable the sessions are. The Deputy manager was able to explain the process and how records of the sessions are stored. A discussion was held with management about the need to be more comprehensive in the reporting of incidents and deaths. Full details and cause of incident or death need to be written. (Latest information just stated died of old age). No information of when how or who with and if any action was taken or how the person was cared for towards the end of their life. The Home does need to look more closely at safe working practices. The Moving and handling training needs to be refreshed and records of maintenance need to be available. No records of regular alarm checks call bell checks, electric lighting or water temps and legionella tests could be found. The staff have a book they record any faults in and these are rectified straight away but records showing action before an error or accident occurs was not evident. (Requirement). The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 20 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 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 3 X 2 The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO 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 OP14 OP15 Regulation 16.2(i) Requirement The Registered Person must ensure choice and suitability of food, including sitting arrangements and tools required for eating the food are in place for each, individual person’s needs. The Registered Person must find a way of allowing residents who need hoisting to have a bath or a shower in a room that is suitable for the equipment to allow this to happen. The Registered Person must ensure that water temperatures are checked and records are held for evidence and inspection. The Registered Person must ensure that the staff are up to date with moving and handling to ensure all residents are transferred appropriately. The Registered person must ensure that night staff who are responsible for assisting residents with medication through the night are appropriately trained. Timescale for action 01/10/06 2 OP21 23.2(j) 01/12/06 3 OP25 13.4 (a.b.c.) 13.4(b) 18.1(c) 01/09/06 4 OP30 01/10/06 5 OP9 18.1(c) 01/10/06 The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 22 6 OP38 23.2 (c) Schedule 4 The Registered Person must ensure that all records of maintenance of equipment and fire records are available and up to date. 01/10/06 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 2 Refer to Standard OP15 OP30 Good Practice Recommendations It is recommended that the tables are laid appropriately and that more suitable napkins/serviettes are used. It is recommended that the Home allocates a staff member to be trained as an assessor and trainer to cascade the most current practice in moving and handling to the staff team. It is recommended that all interested parties to include people like the hairdresser, vicar, district nurses etc who are actively involved within The Moorings are encouraged to be part of the annual quality audit. 3 OP33 The Moorings DS0000027272.V307177.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 DS0000027272.V307177.R01.S.doc Version 5.2 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!