Care Home: Moorlands Care Home

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What the care home does well What has improved since the last inspection? The manager is enthusiastic, and looks for ways in which the service can be improved. She has developed better ways of getting information from people who live at the home, their relatives, and visiting professionals, so that she can make sure that the home is run in people`s best interests. People have care plans which are becoming more person centred. This means that they focus more on the person, what is important to them, and how their individual needs can be met. The environment is being decorated. This is helping to make it more pleasant for the people who live there. What the care home could do better: People`s care plans could always contain information about individuals` personal needs and wishes, so that their personal goals and aspirations are clearly understood and acted upon. The care of the person discussed at the inspection could be reviewed, so that identified discrepancies between the care being provided and the care plan are rectified. This will make sure that the person`s care, and risks associated with it are met, in line with their identified personal, health and psychological needs. To make sure that the chance of avoidable errors are kept to a minimum, the way that the medication system is checked could be reviewed, so that shortfalls in practice are identified and acted upon. To maintain people`s dignity, their care needs must not be discussed publicly, and equipment supplied to them could be kept clean, and maintained to an acceptable standard. Further thought could be given as to how the communal areas can be made more interesting, to further meet people`s social and recreational needs. The means by which people can attract the attention of staff could be improved upon so that they are able to attract the attention of staff at all times, wherever they choose to sit.The meals service could be reviewed, so that everyone gets an enjoyable meal, which meets with their dietary needs, in social surroundings. Staff responsible for checking bed safety rails could be provided with additional training so that people can be assured that the equipment is fitted safely. CARE HOMES FOR OLDER PEOPLE Moorlands Care Home 10/12 Moor Lane Strensall York YO32 5LQ Lead Inspector Anne Prankitt Key Unannounced Inspection 10th October 2007 09:30 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 Moorlands Care Home DS0000070004.V343811.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. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moorlands Care Home Address 10/12 Moor Lane Strensall York YO32 5LQ 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) 01904 491694 None Mimosa Healthcare (No4) Limited Mrs Sharon Ann Gatus Care Home 68 Category(ies) of Dementia (68), Old age, not falling within any registration, with number other category (68) of places Moorlands Care Home DS0000070004.V343811.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 category: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 68 N/A 2. Date of last inspection Brief Description of the Service: Moorlands Nursing Home offers nursing care for up to sixty eight people. It is divided into separate units. One unit provides care specifically for up to twenty two people with dementia. There is parking at the front of the building. The home is situated in a residential area of the village of Strensall which has local shops and pubs nearby. All the accommodation is on the ground floor and both wings have access to small, sheltered gardens. The company has produced a ‘welcome pack’ which is given to people before they are admitted to the home. They are also given a copy of the service users’ guide. A copy of this, the Statement of Purpose and the most recent inspection report are available in the foyer of the home. The registered manager confirmed on 10 October 2007 that the weekly fees currently range from £470 to £530 plus the registered nursing care contribution. Additional charges are made for chiropody, hairdressing, toiletries newspapers and magazines. Since the last inspection of the home there has been a technical change in company arrangements. Therefore the service is classed as a ‘new registration’, following a completed application made to the Commission for Social Care Inspection. However, it is an existing service, and this arrangement has made no detrimental changes to the way that the home is run. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the site visit the registered manager, Sharon Gatus, returned a self assessment called an ‘Annual Quality Assurance Assessment’, which provided information about Moorlands Nursing Home. Surveys were sent to a selection of people who live at the home, some relatives, and some visiting professionals. A record has also been kept about what has been happening at the home since the last key inspection, and since the home re-registered in May 2007. During the visit, time was spent with people who live at the home, and observations made to see how staff interacted with them. One hour was also spent over lunch time on the dementia unit watching the general activity, and looking at how care and support was offered to people. Time was also spent talking with staff and looking at some documents. A general tour of the communal areas was made. Some people’s bedrooms were inspected, after checking that this would be acceptable. The site visit took approximately eight hours to complete. All of the information gathered was used to form a judgement about the service that Moorlands Nursing Home offers to the people who live there. Feedback was provided to the registered manager. What the service does well: Staff make sure that people’s needs are assessed properly before they are offered a place at the home. This helps to check that their needs can be met with the resources available. People appreciate the contribution that staff make towards their care. They commented ‘All staff are most helpful at all times’, ‘It’s not home, but it’s fine. I feel they do as much as they can’, ‘It’s nice here – the girls are good. They ask me if I want to go somewhere else but I want to stay here’. People are offered a range of social activities, and staff think about how they can meet the needs of people who are not well enough to leave their room. One visitor commented that their relative is offered ‘one to one massage and communication therapy twice each week’. People can maintain important links with their family and friends, because the home places no restrictions upon visiting arrangements. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 6 People are properly protected from unsuitable workers, because the registered manager takes all concerns which are brought to her attention seriously, and refers any problems on to the appropriate people for investigation. She also makes sure that staff are properly recruited. This reduces the risk of people being cared for by unsuitable workers. Staff training is monitored to make sure that it does not fall behind. This helps to make sure that people are supported by staff who know how to look after them safely and with due care. What has improved since the last inspection? What they could do better: People’s care plans could always contain information about individuals’ personal needs and wishes, so that their personal goals and aspirations are clearly understood and acted upon. The care of the person discussed at the inspection could be reviewed, so that identified discrepancies between the care being provided and the care plan are rectified. This will make sure that the person’s care, and risks associated with it are met, in line with their identified personal, health and psychological needs. To make sure that the chance of avoidable errors are kept to a minimum, the way that the medication system is checked could be reviewed, so that shortfalls in practice are identified and acted upon. To maintain people’s dignity, their care needs must not be discussed publicly, and equipment supplied to them could be kept clean, and maintained to an acceptable standard. Further thought could be given as to how the communal areas can be made more interesting, to further meet people’s social and recreational needs. The means by which people can attract the attention of staff could be improved upon so that they are able to attract the attention of staff at all times, wherever they choose to sit. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 7 The meals service could be reviewed, so that everyone gets an enjoyable meal, which meets with their dietary needs, in social surroundings. Staff responsible for checking bed safety rails could be provided with additional training so that people can be assured that the equipment is fitted safely. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience good quality outcomes in this area. They can be confident that their needs will be assessed before they are admitted, to check that they can be met. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Staff try to meet people before they are admitted to the home, when they collect information and carry out an assessment about their needs. Information is also collected from other professionals, such as hospital staff and care managers. This helps staff to check that the home will be able to meet these needs properly. It also helps staff to write a care plan about the person, which looks at how their needs will be met once they are admitted. People and their relatives are offered the opportunity to look round the home if they wish, so that they can see what it is like. This helps them to decide whether they want to live there. The registered manager has looked into a complaint made by a person who said they were not given any literature or clear information when they came to view the home. She has taken action to stop this from happening again. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 10 Many of the people who live at the home are very dependent upon staff because of their physical and mental frailty. The registered manager said that they always take this into account when deciding whether they will be able to meet the needs of prospective residents. This should help to make sure that they are met. The registered manager confirmed that the home does not provide intermediate care. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience good quality outcomes in this area. People’s care is generally well planned and recorded. But attention to detail by staff will help to make sure that avoidable shortfalls in care delivery and medication do not happen. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Following admission, staff carry out a further assessment of people’s needs. They also look at any risks associated with that person’s care. Where a problem is highlighted, a care plan is usually completed, and action taken to reduce any risk to that person’s health and social wellbeing. Shortfalls in people’s health needs are discussed with the appropriate professional where these are identified. This helps to make sure that care is provided in a consistent and safe way. The registered manager and the staff have worked hard to make people’s plans more person centred, by looking more at people’s social needs, family involvement and personal interests. For instance, staff had completed a care plan to identify when a person was in pain, and what action should be taken to give them some comfort. The plan was based on observations of that person’s Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 12 behaviour. Another explained how the person’s family is involved in their daily life to help reduce the risk of social isolation. This sort of information gives a good sense of the person, and their needs and wishes. However, other plans were sometimes task orientated, and important information about personal wishes about dying and death, or choice about whether the person preferred a male or a female carer, were not recorded. This information would help to make sure that people are always cared for according to their wishes. The registered manager has agreed to look at one person’s care straight away. This is to check that they are getting the right care to reflect their physical, emotional and health care needs. This will help to make sure that the care that the person receives is safe and appropriate. Many people who live at the home are frail, and need a lot of care from staff. Staff generally assist them with their care and hygiene needs so that their dignity is maintained. However, some matters which affect people’s dignity were seen and were discussed with the registered manager, who must make sure that these are addressed. For instance: • • • Staff were overheard discussing people’s continence needs in a public area. To maintain people’s privacy and dignity, this information must only be discussed privately. One person’s hearing appliance was badly marked with a build up of old food matter. Many of the towels were of poor quality, being worn and frayed into holes. One person commented upon the poor state of the ones they had been given. However, people made very positive comments about the care. One relative said that they were ‘very impressed’ with the care at the home. They were pleased that they were always kept up to date with important issues affecting their relative. Another said about the care ‘I’ve been more than pleased. I couldn’t thank them (the staff) enough’. Another commented ‘High standards of care, conscientious staff, good communication. Some of the younger staff are extremely motivated and friendly’. One person living at the home said ‘It’s not home, but it’s fine. I feel they do as much as they can’. Another stated ‘It’s nice here – the girls are good. They ask me if I want to go somewhere else but I want to stay here’. Another commented ‘All staff are most helpful at all times’. The registered manager said that the medication is audited on a monthly basis. The medication is separated into separate wings. This makes it more manageable. The systems were generally well managed. Areas for improvement related mainly to the way that medication is kept track of. For instance: Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 13 • • • • • Tablets had been removed from a person’s blister pack, but their medication record had been signed to say that they had not been given them because they were asleep. This does not provide a true record about what medication they have had. The way that hospital details about variable doses were transferred to the records could have been improved upon to reduce the risk of error. People were having their pulse taken before being given one medication, but there was nothing written in the care plan to explain why. Staff should check with the General Practitioner whether he/she wants this doing, so that people can be assured that they will always get the medication prescribed for them. Some dressings were unnamed. This could lead to dressings belonging to one person being used for another. Where doses of medication could be varied, the actual amount given was not always recorded. Further attention to these matters as part of the regular audit of the medication will reduce the risk of errors. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use the service experience good quality outcomes in this area. Important links between people and their families are respected. Further attention to the meals service could make people’s mealtimes more individualised and satisfying. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The activities programme has been developed so that individual as well as group activities are incorporated into it. This was confirmed by one visitor, who explained that their relative, who is too frail to take part in group activities, has one-to-one massage and communication therapy twice each week. Another visitor was pleased with the activities provided for their relative, which included raffles, outside entertainers, sing songs and ‘pat the dog’ sessions. Staff were seen chatting with people when time permitted. One staff member said that this had become more possible since the staffing arrangements had changed. The programme includes regular visits from religious denominations. One person explained that a representative from the church visits them each week. This helps to meet people’s spiritual needs. The home is split into smaller units. The unit providing care for people with dementia keeps pets, including budgies and a fish tank. The walls have been decorated with pictures and stencil drawings. Some people living there enjoyed Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 15 a game of dominoes, and the activities programme was displayed on the wall. This helps to make the environment more interesting for people. The main part of the home however was less enriched. There were no magazines, papers or items of interest for people to look at in the lounges. More thought could have been given to the layout of the rooms, so that occasional tables were within reach. This would have allowed drinks or personal effects to be kept close at hand. People agreed that their family could visit at any time, and they appreciated this. A visitor said that they were always made to feel welcome at the home. People thought that they were afforded choice about how they wanted to spend their time. Staff explained how they try to make the routine as flexible as possible so that people can get up and go to bed when they wish, and so that they can bathe when they choose to. Again, one member of staff said that the new staffing arrangements had made this more possible. They said that the routine was ‘much better now’ for people. There is a four weekly menu which provides choice at each mealtime. On one wing in particular it was noted how the staff turned the meal into a social event which made the meal more pleasurable for people. People’s comments about the meals differed. One person said that the food was ‘alright’ and that it is ‘hot’ and that they ‘get enough’. They said ‘They’ll make you something else if you don’t want it’. Another thought that the menu was ‘boring and monotonous’, and were disappointed that they did not get fresh fruit provided regularly. (The supply available in the kitchen on the day was very limited). They also thought that they should have more opportunity to discuss the menu. From the surveys returned, one person said that they always like the food, two usually and one sometimes. The cook doesn’t ask people what they think about the meals, but the registered manager is discussing the menu with people and their relatives as part of the ‘quality circle’, which looks at the quality of the service that people get. She is looking where adjustments to the menu are needed from the feedback that she receives. The following matters which should also be considered, were discussed with her: • The chef has attended food hygiene training, but could be given more information and training about how to prepare special meals, such as fortified diets for people who have poor dietary intake. Currently, foods are not enriched, but instead supplement drinks are provided to help maintain people’s nutrition. The chef presented pureed meals in separate portions, which makes the meal look more appetising for people. It was unfortunate therefore that one member of staff then mixed the meal together. This made it unrecognisable to the person eating it. To improve choice for people, it would be good practice to provide people with a choice of seasonings and accompaniments for their meal, such as sauces and condiments. • • Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 16 • To help staff understand who is nutritionally at risk, the trays allocated to people are colour coded. However, not all of the staff understood the system, and were not using the trays as were intended. This good system will only work if care and catering staff work in the same way. Some people living in the dementia unit eat their meals whilst staying in their lounge chair with their meal tray on a bedside table. Others sit at dining tables, which face the wall. This arrangement does not encourage a relaxed atmosphere. Nor does it encourage people to face each other and socialise. In addition, it was not possible for staff to easily help people who needed assistance. Provision of a proper dining area would greatly improve the dining experience of people who live on this unit, and should be considered. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. People are protected by a manager who will not hesitate in passing on concerns brought to her attention to the right people, so that action can be taken quickly to protect people. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People spoken to, and who were able to comment, said that they would be happy to speak to someone if they needed to raise a concern about their care. There was evidence on the day that concerns brought to the registered manager’s attention are acted upon. There have been three complaints made direct to the home in the last year. These involved concerns about poor laundry service, provision of fluids, and the state of a person’s bedroom. The action taken by the registered manager was recorded in each case, and there were no further concerns raised in each case. One complaint made direct to the Commission for Social Care Inspection about the attitude of staff, and the general décor of the home, was also referred to the home to investigate. The appointed investigator provided feedback to both the complainant and the CSCI about the outcome of their investigation within the timescales set by the company. Staff said that they would report any matters of concern affecting people who live at the home, straight away. They knew that they could not keep secrets Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 18 where people’s welfare and safety was in question. The registered manager has reported one matter to both the local authority ‘safeguarding adults’ team and the Commission for Social Care Inspection. This concerned the alleged poor conduct of a member of staff. The registered manager took proper action to protect people who live at the home whilst this matter was being investigated, and she was commended on her prompt response to the matter. Staff have been provided with a chart which shows what action they should take if they believe that abuse has occurred. This will help to make sure that unnecessary delays are avoided. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. People live in a generally well maintained and pleasant environment which is being improved upon for their benefit and comfort. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: Although the home accommodates up to sixty eight people, it is separated into smaller areas, which have their own sitting rooms and bathing facilities. This helps to make the environment seem more homely. Some areas of the home have been redecorated, which makes them more pleasant for people. Some bedrooms have new furniture, and the company has provided some additional specialist beds for people who need to spend a lot of time in bed. The home has also used recently acquired government grant money to build a new conservatory in the wing providing dementia care. The conservatory, which is soon to be completed, overlooks the garden area which is being tidied up by staff for people’s enjoyment. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 20 The dementia unit has increased in size since the home was last inspected. Twenty two people can now be accommodated in this wing. A shower facility has been provided, and a specialised bath which was cracked, has now been replaced with a new one. Some of the communal corridors in the main part of the home are in the process of being treated for dampness, and further decoration will take place once completed. This will help to make the environment more pleasant for people. There were two leaks to the tanks above the ceiling in two areas of the home. The registered manager has confirmed that these works have now been completed. There was no call bell in one sitting area at the home. Although staff were near at hand, should people want attention when they were not in the room, they would have to wait, or shout for staff attention, if they needed assistance. Staff said that they are supplied with protective equipment such as gloves and aprons so that the risk from cross infection is minimised. They also receive training on infection control. The laundry is appropriately equipped, and special equipment is provided so that any soiled linen can be kept separate. The home was generally clean and tidy, and free from offensive odours. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience good quality outcomes in this area. The recruitment and training programme helps to make sure that the staff who work at the home have the knowledge and skills to provide care to people. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The staffing arrangements have been changed since the last site visit. Additional general assistants are now provided to carry out tasks such as bed making, and organising trays for mealtimes, so that care staff have more time to concentrate on providing care. Also, a ‘floating’ member of staff has been provided, who works between two units, wherever they are most needed. People surveyed thought that staff were either always or usually available when they were needed by them. One person said that the staff are ‘competent’ and that they ‘feel safe’. Visitor said that they could always find staff when needed. They also found the staff competent, and very welcoming. All of those surveyed thought that their relatives were cared for by staff who had the right skills. Staff receive a range of statutory training. An appointed member of staff, who makes sure that training does not fall behind, oversees the programme. This means that people are cared for by staff who have up to date skills and knowledge about how to give good, safe care. In addition to statutory training, staff also undertake additional training to improve their understanding of people’s needs and conditions. For instance, a number of staff have completed Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 22 dementia awareness training. Trained staff also get opportunities to update their skills. For instance, one is due to attend care planning training, whilst others have completed medication training. Care staff are encouraged to complete National Vocational Qualifications in care, and there is a rolling programme in place so that all staff have the opportunity to work towards this. This will help to achieve a well qualified workforce who understand what good care is. The recruitment records identified that staff are recruited properly so that people are protected from unsuitable workers. Newly recruited staff complete a period of induction when they begin to work at the home, so that they know how the home runs, and how the home’s policies and procedures can support the home’s objectives in the delivery of care. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience good quality outcomes in this area. The manager runs the home in a professional way, taking into account the interests of the people who live there. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The manager is registered with the Commission for Social Care Inspection. She has received an award from Mimosa Healthcare this year for being the most improved manager in 2006. People, their visitors and staff agreed that they see the manager regularly. One member of staff who has worked at the home for some time said that it is ‘a lot better now’. Family members surveyed agreed that they are always given sufficient information from the home to help them and their relatives make important decisions. The registered manager is currently looking at ways in which the people who live at the home, and who visit them, have more say in the way that it is run. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 24 She now has meetings every six weeks as part of the quality programme at the home. There is a quarterly newsletter, which helps people keep in touch with what is happening at their home. She also sends out satisfaction surveys to people who live at the home, their relatives, and others with an interest in it, such as doctors and district nurses. She looks at this information and publishes the results, so that people know that their views are taken seriously. She carries out audits of the home, including accidents, kitchen practice, medication and care plans. This helps to make sure that people get the service that they deserve and expect, and expected standards do not slip. People’s personal allowances can be looked after by the home if this is their choice. There was a clear audit trail kept of money kept on people’s behalf. The administrator said that staff would assist people with their finances if they chose to look after their own cash. However, where the home looks after their personal allowances, there is always someone at the home with access to it, in case they should want it at short notice. The information provided by the registered manager before the site visit identified that the home is generally kept maintained, and there is a fire safety risk assessment in place. The registered manager said that some checks which were due, such as the Portable Appliance Tests, which had not been carried out since October 2005, and the Legionella check, are planned. The maintenance man deals with in-house repairs, safety checks and decorations. Where equipment such as bed safety rails have been provided, there are systems in place to make sure that they are checked regularly. However, one set of bed rails seen was too low down the bed according to the safety guidance displayed at the home. The registered manager arranged for all the bed rails to be checked and corrected accordingly. However, staff who check this equipment must be clear about the safety guidance so that people can be assured that they will be fitted safely in the future. This will help to protect the safety of the people who need this equipment. Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 25 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 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 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 3 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 2 Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A 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 2 Standard OP10 OP38 Regulation 12 13 Requirement Timescale for action 10/10/07 To maintain people’s dignity, their care needs must not be discussed publicly. Staff responsible for checking 31/10/07 bed safety rails must be provided with additional training so that people can be assured that the equipment is fitted safely. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations People’s care plans should always contain information about their personal needs, wishes and aspirations so that these are clearly understood and acted upon so that their personal health and safety and psychological needs are met. To make sure that the chance of avoidable errors are kept to a minimum, the medication audit should be reviewed, to make sure that shortfalls in practice are identified and acted upon. To maintain people’s dignity, equipment supplied to them DS0000070004.V343811.R01.S.doc Version 5.2 Page 27 2 OP9 3 OP10 Moorlands Care Home 4 5 OP12 OP15 must be kept clean, and maintained to an acceptable standard. Thought should be given as to how the communal areas can be made more interesting, to further meet people’s social and recreational needs. To further improve the meals service for people: The chef should be given more information and training about how to prepare fortified meals. • Pureed meals should be kept in separate portions, so that the meal looks more appetising. • People should be provided with a choice of condiments to accompany their meals. • Staff should be reminded of the relevance of the colour coded meals trays, so that they know who they need to support at mealtimes. • The dining arrangements in the dementia unit should be reviewed so that mealtimes are better organised, and become more of a social occasion. Consideration should be given to the provision of a call bell system in the communal sitting area which does not currently have this facility, so that people are able to call for help when staff are not present. • 6 OP19 Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Moorlands Care Home DS0000070004.V343811.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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