Care Home: Moorend Place

What the care home does well Arrangements for administrating medication to people who use the service was well managed, which ensures people receive the medicines safely and as prescribed. Controlled medication records were accurate and the home has introducded additional monitoring systems to ensure safe storage and administration. Mealtimes were well managed and they have recently changed the main meal to teatime which staff say is working well. Staff were seen offering appropriate support and they encourage people to choose the food they ate. What has improved since the last inspection? The providers have made a committment to refurbish the home to make it a homely, safe environment for people to live in. Activity programmes are being reviewed to ensure they are appropriate to the needs of people who use the service. There was evidence to confirm activities had taken place, like decorated Easter eggs and pictures around the home that people had drawn. Records show people have been involved in quizes, sing-a-longs and watching videos. They have reduced the usage of child safety gates, only one was still in use and this was at the request of the persons family. Risk assessments were in place with agreements from relatives. Staff training has improved since the last inspection and they were able to confirm additional training to address gaps in statutory training with regard to health and safety. What the care home could do better: The home could improve care plans by making sure the information is up to date including signatures of the person completing the care plan. They should make sure there is no gaps in the information. The reviews of care plans could be more detailed as most said `no change to care plan`. Care staff should be fully involved in developing care plans as they currently have very little involveent, although they were able to describe the care needs of individuals. The registered providers must continue to refurbish the environment to ensure it is safe and comfortable for people to spent their time. Accident and incidents should be analysed to ensure risk assessments are developed to reduce risk of further falls. Key inspection report Care homes for older people Name: Address: Moorend Place 34 Commonside Walkley Sheffield South Yorkshire S10 1GE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Valerie Hoyle     Date: 3 0 0 3 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 23 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Moorend Place 34 Commonside Walkley Sheffield South Yorkshire S10 1GE 01142680001 01142684056 mplace2@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southern Cross Healthcare (Focus) Limited Name of registered manager (if applicable) Mrs Joy Denise Hardy Type of registration: Number of places registered: care home 58 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who may be accommodated is 58. 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 category: Dementia Code DE), maximum number of places: 58 places. Date of last inspection Brief description of the care home Moorend Place is a 58-bedded nursing home for adults. It provides care to people who are elderly and affected by mental infirmity. The home is situated in a residential area of Sheffield with good access to public services and amenities. It is built over two floors and separated into three units. There are stairs and a lift to access the different floor areas. The home is surrounded by gardens, which would benefit by landscaping. There Care Homes for Older People Page 4 of 23 Over 65 0 58 Brief description of the care home is a car park to the front of the building for visitors. Information received on 30th March 2010 told us the weekly fees for the service range from £377 to £497. The acting manager explained that the fees are charged according to the dependency levels of the individuals and also according to the source of funding. The people living at the home pay from their pocket money for toiletries hairdressing, chiropody and any personal items. There is up to date information available regarding the service so that the people visiting the home are able to make an informed choice of home. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. This inspection was undertaken following information received from Sheffield City Council (safeguarding adults). The unannounced inspection took place over 7 hours starting at 09:00 finishing at 16.00. The visit included a partial inspection of the home. The acting manager and unit manager, four staff and four relatives were spoken to during this inspection, their views are included within this report. Occupancy at the home on the day of this inspection was 30, as there is currently a voluntary suspension of admissions following a number of safeguarding alerts received by Sheffield City Council. Four peoples care plans were looked at. Policies relating to medication, complaints, Care Homes for Older People Page 6 of 23 protection and handling of peoples money were looked at. Five recruitment and training records were looked at to assess how people were protected from harm. Procedures and risk assessments relating to health and safety were looked at and discussed with the acting manager. The Annual Quality Assurance Assessment (AQAA) was not used at this inspection as it was received on the anniversary of key inspection in August 2009. Care Homes for Older People Page 7 of 23 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 8 of 23 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs can be met following a comprehensive assessment of their needs. Evidence: There is currently a voluntary suspension on admissions at the home following a number of safeguarding investigations. We looked at assessments that had been completed on recent admission and they were comprehensive and provided staff with the information they need to provide care to people who use the service. Care Homes for Older People Page 11 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are met in a dignified way. Medication procedures were well managed ensuring people receive their medication as prescribed. Evidence: A number of care plans were looked at, they contained sufficient information to enable staff to deliver the care people need. Staff interviewed had a good understanding of how to meet the needs of people, however they seemed to have had very little involvement in completing the care care plan. This responsibility was mainly the qualified nurses. Monthly reviews of care plans are undertaken although they could be more detailed as they currently say no change to care plan. The new unit manager told us he hoped to involve care staff in the future when completing care plans. The manager was aware that improvements were needed to ensure gaps in documentation is fully completed. Risk assessments were in place and included action to reduce risk while helping people to maintain their independence. Medication procedures were followed which ensures people receive their medication as Care Homes for Older People Page 12 of 23 Evidence: prescribed. The medication administration records were checked and they were an accurate reflection of the medication administered. The store was tidy and controlled drugs were recorded accurately, although the book used should have details of the up to date page in use, so that medication can be audited quickly. The medication fridge was checked each day and recorded to ensure medication was stored at the correct temperature. The unit manager had introduced a extra monitoring document to ensure controlled drugs are administered safely. The organisation has medication audits to ensure staffs competencies can be checked. The unit manager has recently had refresher training in safe administration of medication and other staff members are to attend the course organised by Boots the chemist. Health and medical records confirm people receive the support they need to maintain their health and wellbeing. The home had good records to demonstrate they use assessment tools to help maintain healthy skin and meet peoples nutritional needs. Throughout the visit staff were seen interacting with people in a kind manner, they spent time talking to people and were observed knocking on peoples bedroom doors before entering. People were referred to by their first name and this was agreed in the care plans looked at. Relatives told us that there had been recent concerns about the delivery of care at the home, but they were confident that the new manager would continue to make improvements. They told us that there had been concerns about the staffing levels, which had affected the quality of care provided, although this had improved over recent weeks. Care Homes for Older People Page 13 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 are able to socialise with family and friends and mealtimes were well managed so that it encouraged people to make choices. Evidence: There was a warm and friendly atmosphere on entering the home and people appeared comfortable sitting in the various lounges and bedrooms. The home has activity coordinator who takes the lead in arranging activities although the acting manager told us that they are currently reviewing her roles and responsibilities. There was evidence that people can access activities and there were posters around the home showing peoples art work. People are able to have visitors at any time and visitors to the home told us they were made to feel welcome. They did express concerns about the changes to the manager over the last few months which has led to unrest at the home. Mealtimes were well managed and staff were seen offering support appropriately. The acting manager told us they had changed the time of the main meal of the day to teatime which seemed to be working well. The meals were served from heated trolleys to the two units. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 home has robust complaints and safeguarding procedures which keeps people safe from harm. Evidence: The home has a complaints procedure that is available to people and visitors to the home. The procedure is also referred to in the information given to new people, identifying the steps to follow, including the timescales for responding to complaints. We looked at the complaints folder and we noted that there has been one complaint received in the last twelve months. The complaint record was looked and discussed with the acting manager who confirmed procedures were followed. Two relatives told us they had made complaints recently in relation to staffing levels and the poor environment. They went on to say that they hoped that things would settle once they got a new manager in post. The home has a robust safeguarding adults procedure which had been followed when they received two allegations. We have received information from Sheffield City Council who had received the safeguarding referrals. The acting manager told us that investigations were ongoing and they had attended meeting to discuss the allegations. Training plans confirmed that staff attended a safeguarding adults course to ensure they are aware of the signs of abuse and the action they must take if they suspect and incident of abuse has taken place. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home is suitable for people who use the service, however it requires significant refurbishment to make it homely and welcoming. Evidence: The registered providers have agreed substantive refurbishment to ensure the home is fit for purpose and comfortable for people to live in. We were given a refurbishment plan which includes new bathroom facilities, carpets, beds, lounge and bedroom furniture. The handyman is decorating bedrooms and there is a major plan to replace windows that are in poor repair. Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the skills and competencies to meet the needs of people who use the service, and recruitment procedures are robust which helps to keep people safe from harm. Evidence: The home has robust recruitment and selection procedures that ensures people who use the service are safe and protected. A number of staff recruitment files were looked at and they included all the required employment checks including two references, application form, and Criminal Record Bureau (CRB) check. The files were organised and could be easily audited. Staff rotas and observation during this inspection confirmed there was sufficient numbers of staff to meet the needs of people who use the service. Information received from relatives, and Sheffield City Council (safeguarding) told us that there have been significant problems with staffing during the period following the resignation of the manager. The acting manager told us that a number of qualified nurses have also left the home which means there is currently only 3 remaining nurses. The acting manager told us that agency and bank staff are being used to ensure sufficient levels. The organisation has begun to address staffing issues and we were told that staff morale is getting better. There is a comprehensive induction programme which meets the Skills for Care standards. Staff are only confirmed in Care Homes for Older People Page 17 of 23 Evidence: post when they have completed their induction. Staff have the required skills and competencies to meet the needs of people, and they have sufficient numbers of staff (12 completed NVQ level2/3 out of 21 permanent members of care staff) that have been awarded a National Vocational Qualification (NVQ) to Level 2/3 standard. Care Homes for Older People Page 18 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 were protected by sound management practices, which ensures people are safe and protected from harm. Evidence: There is currently a acting manager who has worked at the home for three weeks. She told us that a permanent manager has been appointed and is due to take up position in April. The acting manager will remain at the home for a short period of time to support the new manager. People who use the service were able to make decisions about how they want to manage their personal money, although some choose to let the home manage their money due to their limited capacity. Records were looked at and they were a true reflection of the money kept in their savings. The administrator told us that people do not receive individual bank statements and was unsure if the account was interest baring. Where people have savings the home should ensure they have the opportunity to gain interest on their capital. Care Homes for Older People Page 19 of 23 Evidence: The organisation have good quality audits which the manager has to complete. They also actively seek the views of people and other stakeholders, and surveys are sent out to people yearly. The acting manager told us surveys were last sent out in February 2010, a small amount of surveys were available for us to look at. Accident and incident reports were looked, it showed that a large number of accidents occurred in January 2010. There was no evidence to confirm how the information was analysed or if any action had been undertaken to reduce the risk of further falls. Maintenance and service records were looked at and they were up to date and current to the service provided. There is the required health and safety policies and procedures and displays the relevant notices. Fire safety procedures were in place and service records were looked at and were up to date. The acting manager told us that most staff have received training in all areas relating to health and safety to ensure they can keep themselves and people who use the service safe from harm. We looked at the training plans which confirmed a number of courses have been arranged for staff to receive refresher training where required. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The registered providers must continue with the refurbishment programme. To ensure it is homely and welcoming for people who use the service. 30/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans should be fully completed including signatures of who has completed the care plan and dates when completed. Monthly reviews should be more detailed so that the plans can be evaluted and updated. Where people have savings the home should ensure they have the opportunity to gain interest on their capital. Advocacy or The Independent Mental Capacity Advocate (IMCA) should be involved where people have limited capacity. Systems should be in place to ensure accidents are analysed monthly, so that risk assessments and action can be taken to reduce the risk of further falls. 2 33 3 38 Care Homes for Older People Page 22 of 23 Helpline: 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. 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. 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