Care Home: Moor-haven (Nh) Limited

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What the care home does well The accommodation at Moor-Haven is comfortable and spacious. The environment is homely, pleasant, adaptable and accessible for the people who live there.Moor-haven (Nh) LimitedDS0000025444.V376248.R01.S.docVersion 5.2People at Moor Haven have their health care needs met effectively so that they stay healthy and comfortable for as long as possible during their time at the home. People at Moor Haven are supported in maintaining a high standard of personal grooming and cleanliness. The meals, snacks and drinks are well prepared and fully satisfy the expectations and preferences of people at Moor-Haven. The registered person has made sure that there is enough staff on duty to look after all the residents. The recruitment and selection process, including vetting, is robust and promotes the employment of suitable people. The registered person has ensured that where possible the routines at MoorHaven are flexible so that people are able to make choices about their lifestyle. People living at Moor haven and their families and friends felt that staff were kind and helpful, and said: `They are very approachable and friendly people.` The home maintains clear and precise records and so staff have clear instruction and information about peoples health and care preferences and needs. The care-plans and daily records are tamper proof. And it is possible to audit and monitor which staff have has taken responsibility for each area of care. The general atmosphere and conduct in the home fosters a feeling of wellbeing and satisfaction amongst the residents and staff. Comments form the residents included: `It`s great! I like being here.` Members of staff told us that what the home did well was to `Make sure individual care requirments are met, provide a friendly yet professional environemnt. And provide supportive staff and an approachable manager.` What has improved since the last inspection? Since the previous inspection the registered person has ensured that staff always record when they have administered medication and so makes sure that people receive the correct medication. Since the previous inspection a variety of activities has been introduced and made available for people to participate in. and so now they can continue to enjoy established hobbies or learn new skills.Moor-haven (Nh) LimitedDS0000025444.V376248.R01.S.docVersion 5.2Since the previous inspection people feel more able to comment and make complaints and they feel that they are listened to they said `If I had a complaint I would talk to Dawn.` Since the previous inspection a formal quality assurance system has been introduced this gives residents and their relatives the opportunity to comment on all aspects of the service. And so areas of strengths and weaknesses from a resident`s perspective have been identified, analysed and can be incorporated into future development plans. Since the previous inspection staff have received training and information to make sure that they understand fully the behaviours and actions that must be investigated as a protection of vulnerable adults concern. Since the previous inspection the Acting Manager has completed all the paperwork required to become the registered manager with CQC, and is now awaiting a date for her interview. What the care home could do better: Although there was evidence that people feel more listened to by staff at Moor Haven it was still apparent through the result of the home`s own quality monitoring question that a significant number of people did not know about the home`s official complaints policy. This needs to be addressed so that people are clear who they need to speak to in order for their complaint to be listened to and sorted out. We found that there had been an outbreak of diarrhoea and vomiting in the home to which we were not alerted. The registered person must make sure CQC receives notifications of all incidences as outlined in the Care Standard Act 2000 Regulation 37. The registered person should ensure that medication that needs to be carefully audited is in a separate cabinet that meets with pharmaceutical guidelines and is not stored with other medication. This will help with auditing and tracking errors should they occur. The registered person should ensure that risk assessment is conducted in relation to access to the laundry to prevent accidents and ensure that only people who can manage the stairs into the area have easy access. The registered person should arrange for all parts of the home to be clean and pleasant to use including the laundry.Moor-haven (Nh) LimitedDS0000025444.V376248.R01.S.doc Version 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Moor-haven (Nh) Limited 193 Ripponden Road Oldham Lancashire OL1 4HR Lead Inspector Michelle Haller Key Unannounced Inspection 11th June 2009 09:00 DS0000025444.V376248.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moor-haven (Nh) Limited Address 193 Ripponden Road Oldham Lancashire OL1 4HR 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) 0161 628 2064 0161 628 9801 moorhavench@btconnect.com Moor-Haven (NH) Limited Dawn Macdonald Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (33) of places Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD The maximum number of service users who can be accommodated is: 33 Date of last inspection 25th June 2008 Brief Description of the Service: Moor-Haven is a 33 bedded care home providing nursing care for up to 24 service users and personal care only for a further nine service users. Accommodation is provided over two floors, accessible by passenger lift. Eleven bedrooms are single with en-suite facilities. A further 20 single rooms are provided with hand washbasins. One double en-suite room is available for service users wishing to share. There is a lounge/dining room on the ground floor, with two further lounges. On the first floor there is one lounge area. The home is situated in the Watershedding district of Oldham, close to local shops and on a main bus route. Fees for accommodation and care at the home range from £370 to £599.39 per week. Additional charges are also made for hairdressing, newspapers and personal toiletries. A copy of the previous Commission for Social care Inspection (CSCI) report is on display in the reception area of the home. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 5 Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. This was a key inspection that included an unannounced visit to the service. This means the manager did not know in advance that we were coming to do an inspection. During the visits we looked around the building, talked to residents, relatives and staff including the operations manager. We observed the interactions between people living at Moor Haven and examined care plans, files and other records concerned with the care and support provided to people in the home. We also looked at all the information that we have received or asked for since the last inspection. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • Information we have about how Moor Haven has managed any complaints and any adult protection issues that may have arisen. • What the manager has told us about things that have happened in the home through ‘notifications.’ We also received 6 Care Quality Commission (CQC) that were returned to us by staff. Since the last inspection there has been two investigations carried out in the home relating to safeguarding vulnerable adults. These were fully investigated by the local authority social services and were found to be unsubstantiated. What the service does well: The accommodation at Moor-Haven is comfortable and spacious. The environment is homely, pleasant, adaptable and accessible for the people who live there. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 7 People at Moor Haven have their health care needs met effectively so that they stay healthy and comfortable for as long as possible during their time at the home. People at Moor Haven are supported in maintaining a high standard of personal grooming and cleanliness. The meals, snacks and drinks are well prepared and fully satisfy the expectations and preferences of people at Moor-Haven. The registered person has made sure that there is enough staff on duty to look after all the residents. The recruitment and selection process, including vetting, is robust and promotes the employment of suitable people. The registered person has ensured that where possible the routines at MoorHaven are flexible so that people are able to make choices about their lifestyle. People living at Moor haven and their families and friends felt that staff were kind and helpful, and said: ‘They are very approachable and friendly people.’ The home maintains clear and precise records and so staff have clear instruction and information about peoples health and care preferences and needs. The care-plans and daily records are tamper proof. And it is possible to audit and monitor which staff have has taken responsibility for each area of care. The general atmosphere and conduct in the home fosters a feeling of wellbeing and satisfaction amongst the residents and staff. Comments form the residents included: ‘It’s great! I like being here.’ Members of staff told us that what the home did well was to ‘Make sure individual care requirments are met, provide a friendly yet professional environemnt. And provide supportive staff and an approachable manager.’ What has improved since the last inspection? Since the previous inspection the registered person has ensured that staff always record when they have administered medication and so makes sure that people receive the correct medication. Since the previous inspection a variety of activities has been introduced and made available for people to participate in. and so now they can continue to enjoy established hobbies or learn new skills. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 8 Since the previous inspection people feel more able to comment and make complaints and they feel that they are listened to they said ‘If I had a complaint I would talk to Dawn.’ Since the previous inspection a formal quality assurance system has been introduced this gives residents and their relatives the opportunity to comment on all aspects of the service. And so areas of strengths and weaknesses from a resident’s perspective have been identified, analysed and can be incorporated into future development plans. Since the previous inspection staff have received training and information to make sure that they understand fully the behaviours and actions that must be investigated as a protection of vulnerable adults concern. Since the previous inspection the Acting Manager has completed all the paperwork required to become the registered manager with CQC, and is now awaiting a date for her interview. What they could do better: Although there was evidence that people feel more listened to by staff at Moor Haven it was still apparent through the result of the home’s own quality monitoring question that a significant number of people did not know about the home’s official complaints policy. This needs to be addressed so that people are clear who they need to speak to in order for their complaint to be listened to and sorted out. We found that there had been an outbreak of diarrhoea and vomiting in the home to which we were not alerted. The registered person must make sure CQC receives notifications of all incidences as outlined in the Care Standard Act 2000 Regulation 37. The registered person should ensure that medication that needs to be carefully audited is in a separate cabinet that meets with pharmaceutical guidelines and is not stored with other medication. This will help with auditing and tracking errors should they occur. The registered person should ensure that risk assessment is conducted in relation to access to the laundry to prevent accidents and ensure that only people who can manage the stairs into the area have easy access. The registered person should arrange for all parts of the home to be clean and pleasant to use including the laundry. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 9 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 10 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 Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): £ (standard 6 is not applicable) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s wellbeing is promoted because they have their needs fully assessed before they move into Moor Haven so that staff can begin to provide effective support right away. EVIDENCE: We looked at the files of the most recent admissions and each held a copy of a pre admission assessment completed a qualified member of staff and dated before the person admitted to Moor Haven. These assessments provided very detailed information about peoples care needs, including medication, moving and handling, nutritional and social needs. We found detailed information about how people communicated and about the emotional support they required. This information was expanded on and developed into care plans. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 12 We talked to people about the process of them moving into the home. They said ‘We visited a number of homes between us and felt this was the best. She was visited and when she came she settled in right away.’ Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Moor-Haven benefit from very effective health care and personal care, and this is provided with dignity and respect. EVIDENCE: We looked at the care files and other correspondence, charts and information about four people. We found that the manager has completed the process of transferring care plans and daily records from being held electronically to being hand written. We looked closely at the information in the care plans and assessment which are combined. These were very effective at providing up-to-date information to staff because when care plans are reviewed a reassessment of needs also occurs. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 14 We found that the information in the care plans fully reflected the information in the assessments and so would meet the needs of the resident. We saw that additional risk assessments had been completed and the information made clear in the care plan. These included moving and handling, pressure area risk, falls, using bed rails, oral hygiene and nutritional status. We found that all care plans were hand written, dated and signed and it was easy for the manager to confirm that care needs are reviewed monthly or when necessary. We looked at the daily records. We noted that these were written using more respectfully and indicated that staff thought of people as individuals. The information written also showed that staffs continue to deal with difficult situations calmly and in a manner that maintained people’s dignity. We noted that all instructions to staff identified peoples’ needs and was detailed and clear. This included excellent risk assessments and care plans about how to support people who are anxious or who may at times become aggressive. We found that specialist risk assessments and risk reduction strategies were in place. Those seen included pressure area care, falls, nutrition and moving and handling. We found, through daily records, computer held information, what people told us and observations throughout the day that, routine and specialist health care including, podiatry, general practitioners, dietician, physiotherapist, speech and language therapist and specialist nursing input such as mental health team and the continence service was provided when needed. We observed the medication round and this was conducted safely. The medication administration records sheets (MARS) were examined and a no gaps were noted. We checked the way in which the home managed medication that needed to stored more securely and monitored more strictly than ordinary medicines. We found that the storage was secure and that an accurate record was kept of what was on the premises. This medication was also administered by two members of staff. We also found, however, that the medication cabinet is used to store a large amount of other medication. This is not best practice because it means that staff are entering this cupboard more frequently than needed, and that staff are not always chaperoned when they access this cupboard. This means that it could be difficult to track who may have been in the cupboard if a quantity of these drugs were mislaid. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 15 This area could also be improved if sample signatures of staff who administered medication was provided in each medication file. These matters were discussed at the time of the inspection. We observed staff throughout the day and saw that people were treated with dignity and respect. People were approached gently and they were given a choice about what they did. Staff was also discreet when offering to support people with personal care and hygiene. We observed staff as they completed moving and handling procedures. This appeared safe and in keeping with peoples care plans. We looked at the training calendar and talked to staff we found that since the previous inspection all staff have had their moving and handling training updated. We observed that personal care in at Moor Haven is always to a high standard. People who were seen were well groomed and clean. The ladies and gentlemen were fully dressed wearing tights or stockings, socks and shoes or slippers. Hair was neat and clothes were well laundered and ironed. People looked smart and tidy, their fingernails were clean and neatly trimmed and staff had made sure that people were given their glasses and fitted with hearing aids as prescribed. People living at Moor Haven, and their relatives, told us that health care and personal care in the home was effective always met their needs. They said: ‘I have a bath twice a week and that’s what I want.’ ‘The GP was called because her dementia seemed to get worse and he looked at her medication.’ And: ‘Mum looks very well, her skin and everything looks well- she came out of hospital and couldn’t walk but has now began to improve, she has put on weight and looks better. Mum is always clean, always well dressed, clean clothes on every day. And if she’s poorly they get the doctor out at any sign of anything’ Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Moor Haven are able to make choices about their lifestyle, and are offered interesting and varied meals and activities. EVIDENCE: We looked at assessments and care plans for four people. We found that although a document called a ‘profile’ was in each file this was not always completed in sufficient detail. However it was evident from those that had been completed in full that the manager places an importance in finding out about people’s social histories and interests. This is an improvement since the previous inspection and needs to continue to be developed until all profiles provide detailed information about peoples social histories, hobbies, interests and aspirations. We found that the training calendar confirmed that staff now receive training about how to support people in respect of their social needs and making Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 17 lifestyle choices. The courses attended included the Alzheimer’s Society course ‘Yesterday, Today and Tomorrow’. This course specifically teaches about the person centred or individualised care planning, and the importance of peoples histories and past experience in this process. We discussed the activities program with the activities coordinator and the manager. Both seemed knowledgeable about the interests and personal histories of the people discussed. We found through what people told us, written records and photographic evidence that people were now offered a varied program of activities in the home and the community. We read through the records which indicated that each person is offered the opportunity to join in with group or one to one activities. These activities included: soft stuff modelling; art and crafts; playing cards large and small; draughts; scrabble; Connect Four; beanbag target games and musical quizzes; baking, Pat-a-dog; indoor bowls and trips out to the theatre or local beauty spots. We found that activities on the day of inspection included the activity coordinator offering hand massages to residents. We found through what we were told and written instructions provided to staff, that all care staff have a responsibility to ensure that people are provided with activities so that they remain mentally alert and interested in what is happening around them. The activities coordinator has provided staff with a list of activities they can do and information about where the equipment is kept. The activities coordinator also said that she was in close liaison with Age Concern and that the home were going to be involved in an eight week project called Fit as a Fiddle. This involves a physiotherapist visiting the home and conduction a programme of exercises with the residents. This exercise class was taught to staff who can continue with the plan. We observed that visitors came to the home throughout the day and people stated that there were no restrictions – ‘My friends can come and visit when it’s convenient to us both’ People told us that the routines in Moor Haven were flexible and that people were able to make choices about what they did and when. We observed throughout the day that this was the case. We found on the day of inspection that people were encouraged to socialise even more than at previous inspections. We found that if they chose to remain in their rooms this was an informed choice. On the day of inspection however we found that no one chose to spend a significant amount of time in their room during the day. And relatives commented that a good thing about the home was the way in which staff encouraged people to socialise so that new friendships could be made. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 18 We found that the menu has been changed to include items that have been requested by the residents, for example curries. We were informed that the menu also changes from season to season. We saw that the current menu for meals and snacks included Lancashire hotpot, chicken soup, curry, sandwiches, Finny Haddock, chicken and vegetable casserole, sausages, steak pie, fish and chips, beef cobbler, turkey roast, Cauliflower cheese, spaghetti on toast and beef muffins. Desserts and pudding were also offered following every meal. We noted that people mostly gained weight following admission to the home. We looked at the lunchtime meal which was home made steak pie, mashed potatoes, broccoli and carrots. The meal looked delicious and as they ate people said that it tasted good. Comments about the meals included ‘I enjoyed that meal – very nice today.’ We saw that those requiring support were treated with courtesy and respect and adapted plates and cutlery was provided to help with maintaining independence. We noted that staff supported people to eat by sitting with them and taking time. We saw that hot and cold drinks were offered to people throughout the day and jugs of cold drinks were available and refilled. We found that people who were at nutritional risk had a record of their food and drink kept in sufficient detail to assist with monitoring their diet so that extra steps such as referral to the dietician for advice about fortified foods and food supplements could be occur as soon as possible. We found that people were more satisfied with the activities and events that took place at Moor Haven that at previous inspections, and felt that the home met their lifestyle needs. People told us ‘We go out we go to Hollingworth Lake which is ok- it’s enough for me.’ ‘We made buns yesterday, we play bingo and cards and we have quizzes. It can be quiet at the weekends but we watch television and videos. Visitors come when they want. I feel calm and safer here.’ And ‘They think about compatibility to that people sit with those they’ll get on with.’ Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Moor-Haven are given support to express their concerns and staff understand the local protection of vulnerable adult protocol EVIDENCE: We read through the training calendar and records. These confirmed that the majority of staff have now completed Protection of vulnerable adult training with the Oldham Metropolitan Borough Council (OMBC) training partnership. We received information from six members of staff and each person confirmed that they understood about how complaint and advocacy. We talked to two members of staff and both were confident about the actions that could be considered abuse and the action that was needed to protect vulnerable people. Comments from staff included: ‘I would also ask them to speak to the manager regarding any concerns they may have.’ We looked at the incident records and the entries indicated that accidents and incidents had been investigated fully and the appropriate action taken. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 20 We found that the complaints procedure is in place and on display, and people we spoke to said that they would speak to the matron or care staff if they had a complaint. We also found through looking at the results of the Relatives Satisfaction survey which was conducted in May 2009 that a significant number of respondents did not know about the home’s complaints procedure. However the majority of respondents also noted that comments and concerns were listened to and taken seriously. We assess that an improvement in this outcome would be achieved if the registered person made it a priority to make sure that all who are involved in the home understand and have a copy of the complaints procedure used at Moor Haven. We have been made aware of two incidents in the home that have been investigated under the safeguarding protocol, and this was confirmed in the information provided by the manager. The outcome for both of these was that the allegations were unsubstantiated. Although this was the case the manager took steps to try and prevent similar allegations. People we talked to about complaints and concerns said, ‘There’s nothing to complain about but I’m aware that all the nursing staff can be spoken to- they are very approachable and friendly people.’ Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensures that environment at Moor Haven provides a well maintained environment that is pleasant use, comfortable and accessible for the people who live in or visit the home. EVIDENCE: We found that adapted equipment such as handrails, hoists and other moving and handling equipment were readily available. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 22 We found that the lounge areas were of a comfortable temperature. All fixtures and fittings such as the carpets and furniture were clean and free from stains. There were no bad odours. We were told that a refurbishment program has commenced and some areas of the home including a lounge, bathroom and a number of bedroom areas have been re-decorated. On the day of inspection we found that some areas of the home would benefit from been redecorated. For example one of the hallways looked shabby and the walls in the laundry were very dirty and looked unpleasant. The manager needs to risk assess the safety of access to the cellar. Currently the door is locked by a key but this could turned and used by people who are not able to negotiate steep stairs safely and so they should consider a code lock to this area. These matters were discussed with the manager. We noted that wheelchairs continue to be stored in the main corridors. We examined accident records and this did not seem to cause any accidents. We observed throughout the day that people mobilised around the home independently. People used walking sticks; frames and staff support in keeping with their care plans. People we talked to about the environment said ‘It’s clean- no urine smell, it smells like my home-clean.’ Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Moor Haven residential and nursing home benefit from having staff that are well trained to do their jobs, are deployed in sufficient numbers to meet needs and recruited using a robust employment process which promotes the selection of people who are suitable to work with vulnerable adults. EVIDENCE: We found on the day of inspection that staff were available in sufficient numbers and skill mix to meet the needs of people living at Moor Haven. On that day the manager reported that there were 29 people living at Moor Haven. The roster indicated that the staff for the early shift was 2 qualified nurses including the manager, 3 carers (this should have been 4 but one person was not able to work at short notice), the activities coordinator (10:00-12:00), the administrator, 1 laundry worker, 1 cleaner, 1 housekeeper, the cook and a kitchen assistant. Furthermore a handyman also came in to complete jobs around the home. We found that staff who returned surveys mostly felt that there was usually enough of them do the jobs required, and observation throughout the Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 24 confirmed that staff were deployed in numbers that met needs. We noted that people were not hurried and that call bells were answered quickly. We saw that at lunch time carers were able to sit with people and support them whilst they ate. And in the afternoon staff were able to organise games and sit and talk to the residents. We examined the training record and also discussed this with the manager. We found that the training provided was varied and met the training needs of staff. Training provided since the previous inspection was included health and safety training such as moving and handling; fire safety trianing; handwashing and infection control; Induction; Protection of Vulnerable Adults and food hygeine. We also found that staff received training to develop their knowledeg about issues related specifically related to older people or the care sector for example nutrition; medication; Chronic Obstructive Pulmonary Disease (COPD); life story work; dementia care; Yesterday, Today and Tomorrow; Psychology of conflict and agression; Perception, attention, learming and memory; dysphagia and pressure area care awarness. We found that professional training was also provided for example National Vocational Qualifiaction (NVQ) level 2 in catering and the (NVQ) level 2 and 3 in care award. We found that 14 out 19 care staff had achieved NVQ in Care level 3 or above. Staff who returned Care Quality Commission surveys all stated that the training received prepared them for their jobs and kept them up dated with new ways of working. They told us: ‘We are always encouraged to attend training courses etc. in order to keep uptodate.’ We looked at the recruitment records for the recently recruited staff. We found that files contained confirmation that Protection of Vulnerable Adults checks or POVA firsts had been done. There was also evidence that Criminal Record Bureaux checks had been completed. We saw that people had two and sometimes three references in place prior to them starting work. We were told by a recently employed member of staff that she had completed an induction programme and this was highlighted on the training calendar. We saw that pictures identifying the staff were on display in the home. We found that people liked the staff working at Moor Haven. Comments included: The staff are alright- I get on alright with them.’ And Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 25 ‘The staff are really friendly.’ We found that the staff who returned surveys were proud of the staff team and said that this was strength. They commented that: ‘We meet the individuals care requirments. We are a friendly yet professional and supportive staff group. We have an approachable manager. Staff are treated well as we have a fair break allowance and receive enhancments for doing overtime.’ Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider continues to ensure, in the absence of a Registered Manager, that Moor Haven is managed in a way that will promote the general well being and safety of people involved with the home. EVIDENCE: We found that the acting manager was well qualified and experienced in working at Moor Haven She is a qualified nurse and has worked at Moor Haven for a number of years. We were told that she has applied to the Care Quality Commission to become the registered manager for Moor Haven. And it is envisaged that by the publication of this report she will have successfully completed the process. We were told by the manager that the registered Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 27 individual is experienced in running care homes and takes an active interest in the day to day progress of Moor Haven. We noted that the home continues to be awarded accolades from other organisations concerned with quality of people management and the development of services. This includes receiving a Certificate of Recognition from Investors in People in January 2009. We found that the company provides an operations manager who the acting, manager can refer to for advice and guidance, this person was on hand during the course of the key inspection. We found that the acting manger has worked hard to improve aspects of care and management in the, and has ensured that all the requirements and recommendations made at the previous inspection have been addressed almost in full. We note that communication between staff and residents and their representatives have improved and record keeping is more safe accurate. We found through reading through the notes that residents meetings are organised and that people feel able to make their view known. We noted that a news letter is produced, this document included information about the changes that had occurred in the home and also encouraged people to take part in the quality assurance procedure. The quality assurance process was conducted through use of questionnaires which were given to the residents and the relatives. People were asked about their level of satisfaction with different aspects of living at Moor Haven including, food, activities, and response of staff to any issues and knowledge of the certain procedures such as the complaints procedure. We found the result of the quality monitoring exercise had been analysed and people were very satisfied in all of the areas discussed. It was noted however that even though people felt that they could make their needs known and that staff responded to complaints and concerns, only half of the respondents said that they know how to make an official complaint. This issue needs to be addressed. We found, at the time of the inspection, that the service had not informed people about what action was to be taken in response to the information that had been gathered. We discussed the management of people’s money and asses that people are safeguarded from financial misconduct as money is held by the person or their representative. The home sends an invoice for money that is spent on the person’s behalf and receipts are maintained for auditing purposes. We found that the manager reported in the AQAA the dates on which the appliances, lifts and utility services in the home where last maintained and inspected by an appropriately registered person. These dates were within the expected time spans. Fire safety equipment was checked and this had been serviced within the last 12 months. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 28 We noted that food hygiene continues to be managed through the Safer Food Better Business protocol and the home received a four star certificate from Oldham Metropolitan Borough Council for its food safety management. We found that Control of Substances Hazardous to Health (Coshh) training had been completed. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 30 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 31 Regulation 37 Requirement The registered person must ensure that CQC are informed of deaths, illness or other events in the home that have affected the residents. This is so that we can monitor that appropriate steps have been taken to deal with any issues. Timescale for action 01/09/09 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 OP16 OP9 Good Practice Recommendations The registered person should ensure that the homes official complaints policy is made known to residents and their representatives. The registered person should ensure that controlled medication is stored separately from other medication so that it is possible monitor and audit those who can access it. The registered person should risk assess the lock to the cellar to make sure only people who can navigate steep DS0000025444.V376248.R01.S.doc Version 5.2 Page 31 3. OP19 Moor-haven (Nh) Limited 4. OP26 steps can gain entry so that accidents are prevented. The registered person should whitewash the laundry so that it is pleasant and clean working environment. Moor-haven (Nh) Limited DS0000025444.V376248.R01.S.doc Version 5.2 Page 32 Care Quality Commission North West Region Citygate Gallowgate Newcastle upon Tyne NE! 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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