Care Home: Moorlands Residential Care Home

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What the care home does well The home has up to date information available to give to people who may be interested in living at the home. Contracts that describe the terms and conditions for living at the home are given to people. People have their needs assessed before they move into the home so that the home is confident that they can meet those needs before an admission is agreed. The manager told us "We carry out a thorough pre-admission assessment on all prospective residents to ensure that their needs can be met. All prospective residents are encouraged to visit the home prior to making a decision and indeed are invited to spend a day with us to familiarise themselves fully with what we offer. We DS0000000811.V370201.R01.S.doc Version 5.2 Page 6do find that this works well especially where relatives are apprehensive about how their relative will take to residential care." Everyone has a care plan that is well written and shows that people and their relatives have been involved in writing the plan. These care plans are reviewed every month. These reviews involve the person whose care plan it is, their relatives (wherever possible) and a carer. "I do a monthly review with (the deputy manager) and I know I can say anything." The records we saw showed that health care needs are met and people have confirmed this to be true. One relative told us "The home has always put my mother`s care needs and her feelings first. They encourage my mother to do things for herself yet they have always been there when my mother needs help or assistance." The manager has systems in place to manage medication properly and the privacy and dignity of people living at the home is respected. Visitors are made welcome in the home and a range of individual and group activities are offered to the people who live there. People can make choices about how they live their lives. One relative added these comments to their survey "The home provides a caring, loving environment enabling residents to feel part of a large family group. The staff put a great deal of effort into celebrating seasonal events and birthdays making residents feel very special. There are always lots of activities going on and everyone is encouraged to take part and make their own contribution. Beloved pets are also welcome, which is so important for some." The people working in the home know how to respond to complaints and they have been trained in what to do if they think someone is at risk of abuse. "Yes I know what procedure to follow if I need to complain about the authority or care they are given. The management are always available to answer any queries I may have." There has been money spent on the building to improve access for wheelchairs and to improve health and safety. For example the installation of door guards and better infection control measures, liquid soap and paper towels are being put in to communal toilets and washrooms for people to use and a new washing machine and dryer has been bought for the laundry. In general there are enough staff on duty to meet the needs of the people who live at the home however, we were told "It can get busy when everything seems to happen at once but normally we are fine." And "Care needs are always met but I feel sometimes more time could be allocated to sit and talk to residents." One person who lives at the home told us "There are many, many gaps when staff are always too busy." Staff are recruited properly and are trained to do their jobs. "There is a lot of training at Moorlands which at times can be a little too much, but I understand it needs to be done and does improve the standard of work." What has improved since the last inspection? The information about the home has been updated and people have been given copies of their contracts, which make it clear about the terms and conditions of residency. The care staff have received training in how to protect adults from abuse. This will help them to recognise and respond in the right way if they think that someone in the home is being abused. Improvements are being made to the environment of the home and these should continue to ensure that it remains in a state of good repair. Good infection control measures are being introduced but staff must be reminded about their individual responsibilities in managing the control of infection. The management arrangements have seen some improvement in that the deputy manager now has more hours allocated to do management tasks for example care plans, staff supervision and rotas. The home has started to introduce quality-monitoring systems to help them make sure that the home is achieving its objectives. The care staff are receiving regular fire training so that they know what to do in an emergency and they also receive regular supervision sessions that provides them with the opportunity to discuss their progress. Updated risk assessments have been completed and are placed onto peoples` care plans. What the care home could do better: A menu listing the different options, that are available as alternatives to the main menu, should be produced for people to see. People who wish to follow a weight reducing diet should be helped to do so if it is appropriate. One person who lived at the home thought that there was a "Lack of interest in those of us who want to diet and loose weight." Redecoration and maintenance work should continue to ensure the home continues to improve and remains looking good. Care staff should be reminded that bars of soap should not be left in communal bathing areas and should be returned to individual bedrooms following bathing routines. There must be sufficient staff on duty at a weekend to respond to any spillages that could result in slips, falls or the spread of infection.The registered manager should make sure that their management responsibilities for the domiciliary care agency does not conflict with their management role in the care home. The registered manager should continue to develop the quality assurance system and make sure that they include a range of other stakeholders. For example relatives, people who use the service, care managers etc. CARE HOMES FOR OLDER PEOPLE Moorlands Residential Care Home Moorlands 57/61 Stanhope Road Darlington Durham DL3 7AP Lead Inspector Jean Pegg Key Unannounced Inspection 9th August 2008 10:50 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 DS0000000811.V370201.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. DS0000000811.V370201.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moorlands Residential Care Home Address Moorlands 57/61 Stanhope Road Darlington Durham DL3 7AP 01325 487413 01325 487413 moorlands911@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr David Hodgson Smith Mrs Michelle Smith Mrs Michelle Smith Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places DS0000000811.V370201.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 only - Code PC 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, maximum number of places: 19 The maximum number of service users who can be accommodated is: 19 24th August 2007 2. Date of last inspection Brief Description of the Service: Moorlands Residential Care Home provides personal care and accommodation for up to 19 older people - in 17 single bedrooms and 1 double bedroom. 8 bedrooms have en-suite facilities. Moorlands was originally 3 large (now converted) terraced town houses. It is pleasantly situated, overlooking a park and within walking distance of Darlington town centre. Bedrooms and communal spaces are arranged over 4 floors, with a passenger lift providing access to most areas. However, 2 bedrooms are only accessible by stairs so are only suitable for people who are more independently mobile. Communal space in the home includes 2 lounges, a dining room and a patio / garden area to the rear of the property. Communal toilets, two bathrooms and a shower room are located throughout the home. At the time of this inspection it costs £404 per week to live at Moorlands. Additional charges are made for things like hairdressing and clothing. Please speak to the manager about what is included in the fees. DS0000000811.V370201.R01.S.doc Version 5.2 Page 5 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. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This inspection visit was started on Saturday 9 August from 10:50 am until 3pm and 13 August from 2:30pm until 7pm. An ‘expert by experience’ assisted with the inspection on 9 August. An ‘expert by experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The comments made by the ‘expert by experience’ will be included in this report. As well as visiting the home and looking at documents and records and observing what happens during the day, we sent surveys to the people who use the service, their relatives and care managers and the people who work in the service. We also asked the registered manager to complete a self-assessment document called an annual quality assurance assessment (AQAA). This self-assessment document provides us with information about how well the manager believes the service is doing. We will refer to this document in the report. We will also refer to the responses we received back from the people who returned surveys, which are 5 people who work in the service, 3 relatives and 8 people who use the service. All of this information is used to help us reach a conclusion about how well the service is doing. What the service does well: The home has up to date information available to give to people who may be interested in living at the home. Contracts that describe the terms and conditions for living at the home are given to people. People have their needs assessed before they move into the home so that the home is confident that they can meet those needs before an admission is agreed. The manager told us “We carry out a thorough pre-admission assessment on all prospective residents to ensure that their needs can be met. All prospective residents are encouraged to visit the home prior to making a decision and indeed are invited to spend a day with us to familiarise themselves fully with what we offer. We DS0000000811.V370201.R01.S.doc Version 5.2 Page 6 do find that this works well especially where relatives are apprehensive about how their relative will take to residential care.” Everyone has a care plan that is well written and shows that people and their relatives have been involved in writing the plan. These care plans are reviewed every month. These reviews involve the person whose care plan it is, their relatives (wherever possible) and a carer. “I do a monthly review with (the deputy manager) and I know I can say anything.” The records we saw showed that health care needs are met and people have confirmed this to be true. One relative told us “The home has always put my mother’s care needs and her feelings first. They encourage my mother to do things for herself yet they have always been there when my mother needs help or assistance.” The manager has systems in place to manage medication properly and the privacy and dignity of people living at the home is respected. Visitors are made welcome in the home and a range of individual and group activities are offered to the people who live there. People can make choices about how they live their lives. One relative added these comments to their survey “The home provides a caring, loving environment enabling residents to feel part of a large family group. The staff put a great deal of effort into celebrating seasonal events and birthdays making residents feel very special. There are always lots of activities going on and everyone is encouraged to take part and make their own contribution. Beloved pets are also welcome, which is so important for some.” The people working in the home know how to respond to complaints and they have been trained in what to do if they think someone is at risk of abuse. “Yes I know what procedure to follow if I need to complain about the authority or care they are given. The management are always available to answer any queries I may have.” There has been money spent on the building to improve access for wheelchairs and to improve health and safety. For example the installation of door guards and better infection control measures, liquid soap and paper towels are being put in to communal toilets and washrooms for people to use and a new washing machine and dryer has been bought for the laundry. In general there are enough staff on duty to meet the needs of the people who live at the home however, we were told “It can get busy when everything seems to happen at once but normally we are fine.” And “Care needs are always met but I feel sometimes more time could be allocated to sit and talk to residents.” One person who lives at the home told us “There are many, many gaps when staff are always too busy.” Staff are recruited properly and are trained to do their jobs. “There is a lot of training at Moorlands which at times can be a little too much, but I understand it needs to be done and does improve the standard of work.” DS0000000811.V370201.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: A menu listing the different options, that are available as alternatives to the main menu, should be produced for people to see. People who wish to follow a weight reducing diet should be helped to do so if it is appropriate. One person who lived at the home thought that there was a “Lack of interest in those of us who want to diet and loose weight.” Redecoration and maintenance work should continue to ensure the home continues to improve and remains looking good. Care staff should be reminded that bars of soap should not be left in communal bathing areas and should be returned to individual bedrooms following bathing routines. There must be sufficient staff on duty at a weekend to respond to any spillages that could result in slips, falls or the spread of infection. DS0000000811.V370201.R01.S.doc Version 5.2 Page 8 The registered manager should make sure that their management responsibilities for the domiciliary care agency does not conflict with their management role in the care home. The registered manager should continue to develop the quality assurance system and make sure that they include a range of other stakeholders. For example relatives, people who use the service, care managers etc. 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. DS0000000811.V370201.R01.S.doc Version 5.2 Page 9 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 DS0000000811.V370201.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Information about the home has been updated and people living at the home have signed contracts that describe their terms and conditions of residency. People have their needs assessed before they move into the home so that the home is confident that they can meet those needs before an admission is agreed. EVIDENCE: We were given a copy of the updated statement of purpose and service users’ guide. The updated document provides a range of different information that should help people decide if the home is right for them. In our survey we asked people who use the service “Did you receive enough information about this home before you moved in so you could decide if it was the right place for DS0000000811.V370201.R01.S.doc Version 5.2 Page 11 you?” Seven people said, “Yes”. One told us “I don’t remember as it has been eight years since I moved in.” The updated service users’ guide includes a copy of the updated terms and conditions that form part of the contract between the home and the person receiving the service. It describes what is and is not covered by the fees, when they should be paid and who should pay them etc. We saw signed copies of these contracts in files held by the home. We asked the people who live at the home “Have you received a contract?” Six people said “Yes” and one person could not remember. We looked at three files, for people who use the service, in detail. The ones we saw showed that a pre-admission form and checklist had been completed by the home and that these forms had been signed and dated. In the AQAA the manager told us “We carry out a thorough pre-admission assessment on all prospective residents to ensure that their needs can be met. All prospective residents are encouraged to visit the home prior to making a decision and indeed are invited to spend a day with us to familiarise themselves fully with what we offer. We do find that this works well especially where relatives are apprehensive about how their relative will take to residential care.” The staff we spoke to talked about the support they had been given by some of the specialist nurses to help them deal with some service users who have learning disabilities and mental health problems. DS0000000811.V370201.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Well-written care plans that are reviewed every month by the person concerned, their carer and relatives are in place. Records show that health care needs are met. Improvements have been made to the management of medication and privacy and dignity is respected. EVIDENCE: We looked three care plans, for people who use the service. All of the care plans were well structured and contained things like recent photographs, bedroom numbers and the name individuals prefer to be known by. There was a record kept of all the significant people and their contact details and any special arrangements for individuals were also identified for example, personal hairdressing arrangements, spiritual needs and funeral arrangements. A detailed and informative life and social history had been recorded to help DS0000000811.V370201.R01.S.doc Version 5.2 Page 13 carers understand what is important to the people they care for. The care plans we looked at, were quite detailed and well written including social preferences for example wanting bedside lamp on at bedtime, different clothing preferences etc. Monthly care plan reviews are held that involve both relatives and the people who live at the home. These review records are structured and well-written showing that all interested people are involved in the review and decision making process. One person told us “I do a monthly review with (the deputy manager) and I know I can say anything.” Records are kept of any GP visits and changes made to medication. District nurse visits are also identified along with investigations, outpatient appointments, hospital admissions, chiropody, vision and dental appointments. Weight charts are kept and completed every two weeks. We noticed that where weight losses were recorded that a dietary plan was put into place to support that person. However, one person who returned a survey to us said that there was “a lack of interest in those of us who want to diet and loose weight.” We also asked people “Do you receive the medical support you need?” Four people said “always” and three said “usually.” On our first visit we carried out a medication audit. This audit showed that there was a more accurate record of medication that was held in ‘blister packs’ than medication that was held in boxes and given out on a “when needed basis.” On our second visit the manager showed us what she had put into place to improve the accuracy of recording for medication that is not needed on a regular basis. The home has an internal audit system in place and only staff that are trained in the “Safe Handling of Medicines” administer medication to the people who live at the home. We did not see anyone behaving in a disrespectful manner during our visit. We asked the people who live at the home “Do the staff listen and act on what you say?” Six people said “Yes” and one person said “Usually”, we were told different things by different people for example “They always do” and “Sometimes they do, sometimes they don’t” and another person told us “They do not give you a chance to say what you want to say.” We noticed that there was a telephone available for people to use. One relative confirmed this by saying “the staff are always there when I phone to ask how my mother is, they always get my mother to the phone so we can talk to each other.” The home has a system in place to ensure that people receive their own clothes back from the laundry so that they are not wearing other people’s clothes. One relative told us “The home has always put my mother’s care needs and her feelings first. They encourage my mother to do things for herself yet they have always been there when my mother needs help or assistance.” DS0000000811.V370201.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Visitors are made welcome in the home and a range of individual and group activities are offered to the people who live there. People can make choices about how they live their lives. EVIDENCE: During both our visits we noticed that visitors were made welcome in the home. One lady was on her way out to lunch with her family when we visited. We also saw birthday cards on display in bedrooms and in the main lounge of the home. The person whose birthday it was, was going out for a meal with the manager to celebrate that night. Another person had recently had a party in the home to celebrate reaching 100 years. One lady in the home recognised the ‘expert by experience’ (who was helping with the inspection) from Growing Old in Darlington (GOLD) group that they both attend. We saw a mobility scooter under cover in the back yard. This vehicle belonged to one of the people who is active in the community. We were told about the bingo games that are held in the home and how instead of prizes people win tokens DS0000000811.V370201.R01.S.doc Version 5.2 Page 15 that they trade in for extra treats for example a manicure or a trip out somewhere special. This seemed to be popular with the people who lived at the home The home holds ‘resident meetings’ and we were shown the minutes of these meetings. We saw that the meetings were used to inform people about such things as staffing changes, room changes and menu changes. Updates on garden work and notice of forth coming entertainment were also covered. The manager told us in the AQAA “As well as our existing activities coordinator, we have employed a part time activities assistant who helps out with all activities, this has improved the provision of one to one sessions such as playing dominoes or reading, going out or just sitting in the garden talking.” Based on what we saw on our first visit, the expert by experience said that she would have liked to see more ‘stimulation’ taking place in the home. We asked the people who use the service “Are there activities arranged by the home that you can take part in?” five said “always” two said “usually” and one said “sometimes.” As we walked around the building we saw evidence of people being encouraged to personalise their rooms. No two rooms looked the same. Some people had bought their own furniture and paid to have the room redecorated to their taste. We were told that one person had a telephone installed in their room. We also noticed that one person living at the home had brought their two cats in, to live with them. The home also has another cat and a dog that some people enjoyed stroking. Individual preferences and choices are written as part of care plan. One relative told us “They support the individuals to have as much independence as possible to live the life they chose to, but they are always on hand to help people if they need assistance.” The first time we visited we noticed that lasagne was being served for lunch. Those people who did not want it were offered plain mince and vegetables or anything else if they did not want that. The chef told us that they always had things like sausages, bacon, egg, quiche, cold meats etc that could be provided as an alternative. One person who lives at the home told us, “If I don’t like what is on offer I get offered something else.” We witnessed one person refusing all offers for lunch and a drink. The care staff did encourage them to take something but they did not force the issue when politely refused. The expert by experience joined the people who lived at the home for lunch. The expert noticed that the majority of people ate independently. The expert by experience noticed a member of staff who was assisting one person to eat; the expert noticed that this was at the persons own pace not the carers. The care staff made sure that people were assisted to clean away any dropped food from clothes etc before they left the dining room. The expert said that “good size portions were given and the meal was nicely presented.” A choice of juice was offered at lunchtime and tea was served later in the lounge. The dining room tables had nice bright tablecloths and the room overlook the new patio area that was complete with fishpond and fountain. The chef confirmed DS0000000811.V370201.R01.S.doc Version 5.2 Page 16 that they provided fortified diets and low fat diets to those who needed them. A 10-week menu is used for the home that has been approved of by the people who live at the home. Alternatives are not identified on the menu but were offered. Fruit and scones are offered with the mid morning and afternoon breaks. One person who lived at the home thought that there was a “Lack of interest in those of us who want to diet and loose weight.” One relative added these comments to their survey “The home provides a caring, loving environment enabling residents to feel part of a large family group. The staff put a great deal of effort into celebrating seasonal events and birthdays making residents feel very special. There are always lots of activities going on and everyone is encouraged to take part and make their own contribution. Beloved pets are also welcome, which is so important for some.” DS0000000811.V370201.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 & 18 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Complaints are responded to and people working at the home have received training in how to keep people safe from harm or abuse. EVIDENCE: We asked the people who live at the home “Do you now how to make a complaint?” eight people said “Yes” and went on to name the manager and deputy as people they would talk to. The relatives (who returned surveys to us) confirmed that they knew how and who to complain to. One person added “Yes I know what procedure to follow if I need to complain about the authority or care they are given. The management are always available to answer any queries I may have.” The care staff were also confident about knowing what to do if someone complained. “I would go to see a senior staff member and tell them.” And “If we can’t sort it out we have a complaints procedure.” We were shown the complaints file and also some compliments that had been received from family members and some from local colleges who had placed students at the home. We noticed that the local authority had investigated a complaint made by a person living at the home but that this had been resolved to everyone’s satisfaction. The Commission for Social Care Inspection have not received any complaints about this service since the last inspection. DS0000000811.V370201.R01.S.doc Version 5.2 Page 18 Staff have been provided with training in how to protect adults from harm. The manager talked us through a current example where staff were working with other agencies to protect individuals in the home. There have been no adult protection alerts raised since the last inspection visit. DS0000000811.V370201.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 & 26 People who use the service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Improvements have been noticed in both the environment and the control of infection measures used within the home. EVIDENCE: On our first visit we walked around the building. We found that the passenger lift was working as it should be, however the expert by experience did pass comment that the stairs we used to descend would benefit from having yellow strips fitted across each step instead of black as it was difficult to see where the stair tread was. This would be helpful for those people who may have poor eyesight. We tested the water on the top floor and found it to be slightly cooler than it should be. The manager confirmed that they did experience problems DS0000000811.V370201.R01.S.doc Version 5.2 Page 20 with the hot water but were investigating the cause. The carer we spoke to said that it often happened after use in the morning. We noticed that some specialist bathing equipment was being stored in a bathroom and were told that this had been purchased by an individual who lived at the home and that they were responsible for its maintenance. The sink had been removed from this bathroom. The pipe had been closed off but was still fixed to the wall. The bathroom was clean but showing signs of age and was in need of redecoration. There were thermometers in all of the bath and shower rooms we saw. This means that care staff are able to test the temperature of the water to make sure that it is suitable for people to bathe safely. We noticed that door guards were being installed so that doors could be left open safely and would close automatically should a fire occur. Doorways had also been widened to enable wheelchairs to pass through without problem. The rooms we saw were clean and some had been re-decorated. Each room had its own character and felt lived in. Some rooms had en-suite facilities. We checked that the nurse call system was working; however we did notice that there was a cord missing from the shower room. We also noticed that, in the downstairs lounge, a pressure cushion was being used that was torn and as such not fit for purpose. This was withdrawn from use immediately. The home has received a grant that has been used to improve the outside area to include paving, raised flowerbeds a pond, fountain and a seating area for people to use. Paper towels and liquid soap had been placed in the bathroom and we were told that this was happening in all communal areas as an improved infection control measure. There was an incident that made us aware of the fact that the home did not have a cleaner on duty over the weekend. When we asked who was responsible for cleaning any spillages we were told that, “care staff do it when they have time.” The incident was dealt with during our visit. In one of the shower rooms we noticed lots of different bars of soap left in the sink area. This is not good infection control practice and should stop. The laundry has had a new washer and dryer installed and other improved infection control measures have been put into place, to make sure that personal laundry is managed appropriately. There were some odours present in parts of the home; however, these odours were not evident on every visit. One relative and one person who lived at the home complained about odours, which they thought were caused by the animals in the home. DS0000000811.V370201.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 & 30 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. In general there are sufficient staff in duty to meet the needs of the people who live at the home. Staff are recruited in a proper manner and are trained to do their job. EVIDENCE: The rotas show that for nineteen people there are at least three care staff on duty throughout the day and two staff that work through the night. On our first visit we noticed three care staff on duty plus catering staff but no domestic. We were told that the domestic staff do not work weekends. The registered providers were also on the premises for both of our visits. We asked staff “Are there enough staff to meet the individual needs of all people who use the service.” Everyone who responded said that there was “usually” enough staff. These are some of the comments that they made. “There is enough staff I feel, on each shift unless somebody telephones in ill and that shift is unable to get covered.” And “It can get busy when everything seems to happen at once but normally we are fine.” And “Care needs are always met but I feel sometimes more time could be allocated to sit and talk to residents.” We asked the people who live at the home “Are there enough staff available when you need them?” three said “always” three said “usually” and two said DS0000000811.V370201.R01.S.doc Version 5.2 Page 22 “sometimes” One person told us “There are many, many gaps when staff are always too busy.” We were told that 60 of the care staff have a National Vocational Qualification in Care. A further 20 of staff are working towards gaining their National Vocational Qualification in Care. The deputy manager is also working towards the Registered Managers Award. We checked three staff recruitment records and saw evidence of a good recruitment procedure being followed. References were taken up and criminal record bureau checks were carried out before people were allowed to work at the home. The manager has also kept clear records of the interview process. The manager told us that they have been awarded the “two ticks award” for employment opportunities; they explained, “The disability award is the two ticks award through job centre plus which means we are committed to employing disabled people, we have an annual review to make sure we are still compliant.” The manager was able to show evidence of a variety of training events that staff have had access to. Training had been provided both as in-house events through ‘off the shelf’ packages, and through external providers. For example specialist health care staff for specific conditions, South Durham and Darlington Nutrition Services have provided “Focus on Food” training. A range of other training including First Aid and National Vocational Qualifications has been provided via commercial training providers. We asked staff “Did your induction cover everything you needed to know to do the job when you started? Three said “very well” and two said “mostly” One person said “I had an induction on each shift I did (7 am - 3 pm and 3 pm – 9 pm), so I knew what my job role would entail.” We also asked “Are you being given training which is relevant to your role; helps you understand and meet individual needs and keeps you up to date?” everyone said “yes”. These are some of the additional comments that were made. “There is a lot of training at Moorlands which at times can be a little too much, but I understand it needs to be done and does improve the standard of work.” And “I feel that all the training we do at Moorlands is beneficial to the work that we do. I always find the training informative and knowledgeable.” DS0000000811.V370201.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, 36 & 38 People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. There have been a number of improvements made to the management arrangements for the home. EVIDENCE: In previous inspection reports, concerns have been expressed about the registered manager for the home being unable to manage the home effectively because of their added responsibility as registered manager for the domiciliary care agency. Since the last visit, the home has increased the hours spent by the deputy manager, on management tasks, and is supporting this person DS0000000811.V370201.R01.S.doc Version 5.2 Page 24 through their Registered Managers Award. The deputy has taken over some of the manager’s workload and improvements have been noticed as a result of this action. The deputy manager has also been given her own office to work from free from distractions. This arrangement will be monitored during future inspections. Some staff suggested that communication could be improved by the use of a communications book. “This is the one thing that I think needs to be improved, at the last staff meeting a suggestion of a communication book was mentioned and I think this will help.” We were given copies of the new annual development plan and room audits that are now carried out. These documents were very clear to follow and it could be seen that where problems had been identified in the room audits that work had been added to the annual plan. Progress against this work was monitored monthly and reasons for not completing work was identified as were dates when work had been completed. The home has also started to collect data from questionnaires completed by staff. We checked the financial accounts of three people who ask the home to hold money for them. The records were generally well kept and no errors were identified. We did notice that for some entries only one signature had been used to confirm the transaction when good practice suggests that two signatures should be recorded. The manager acknowledged this. Staff supervision records were seen. Detailed records of these supervisions sessions are kept and the plan for staff supervision was up to date. We noticed that the notes kept, showed that the values and principles of the home are reinforced during these sessions. We checked a number of records showing maintenance checks that had been carried out at the home since the last inspection visit. All were in date. The Fire Officer last visited in July 2007 and the Environmental Health Officer had visited in January 2008. The home has been awarded four stars for the ‘Tees Valley Hygiene Award’. The home has purchased portable appliance checking equipment and all new items receive a visual check. We expressed concerns about the fact that no Regulation 37 notification reports had been received by the Commission in recent months. These reports are a regulatory requirement. The manager acknowledged the concern and now sends the reports in when they are needed. Work had also been undertaken to meet the requirements and recommendations made at the previous inspection. DS0000000811.V370201.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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 2 X X X X X X 2 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 2 X 3 X 3 3 X 3 DS0000000811.V370201.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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 OP15 Good Practice Recommendations An alternative menu should be produced that can be shown to people so that they know what different options are available if they do not like the main meals on offer in the home. People who wish to follow a weight reducing diet should be helped to do so if it is appropriate. Redecoration and maintenance work should continue to ensure the home remains looking in a state of good repair. Care staff should be reminded that bars of soap should not be left in communal bathing areas and should be returned to individual bedrooms following bathing routines. At weekends there should be sufficient staff on duty to ensure that cleaning duties are attended to immediately to prevent the spread of infection or the risk of slips or falls for example spillages of bodily fluids. At weekends there should be sufficient staff on duty to ensure that cleaning duties are attended to immediately to DS0000000811.V370201.R01.S.doc Version 5.2 Page 27 2. 3. 4. 5. OP15 OP19 OP26 OP26 6. OP27 7. OP31 8. OP33 prevent the spread of infection or the risk of slips or falls for example spillages of bodily fluids. The registered manager should continue to look at ways that ensure that the management of the care home does not deteriorate because of their registered manager responsibility for the domiciliary care agency. The registered manager should continue to develop the quality assurance system by involving a range of other stakeholders. DS0000000811.V370201.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 DS0000000811.V370201.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. Re-publishing this information is in breach of the terms of use of that website. 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