Care Home: Moorside Hall

What the care home does well The Management Team at Moorside Hall takes on board new ideas and advice offered during inspections in order to actively improve the quality of the service on offer. Moorside Hall is a relatively small home and as such is able to ensure people are kept informed about issues that affect the home and them as individuals. The management and staff are friendly and create a pleasant environment. The staff receive appropriate training in order to benefit the service on offer. The providers take seriously any concerns/complaints made and take action to rectify. What has improved since the last inspection? The care plans for the individual residents have been updated using a different format and this makes it easy to find the relevant information ensuring peoples needs are met. They include a medical history, which is a good practice enabling people`s medical needs and conditions to be understood and acted upon. What the care home could do better: The surveys completed by staff and some of the families of the residents reflected that there is a need for more activities appropriate for people with dementia.A number of staff employed at the home stated that there are times when the home is short staffed. They further added that this is usually due to Bank staff letting the home down. When these issues were discussed with Mr Murray, one of the providers, he immediately said "we will look into these concerns and have them addressed." CARE HOMES FOR OLDER PEOPLE Moorside Hall Wyresdale Road Lancaster Lancashire LA1 3DY Lead Inspector Jenny Dunkeld Unannounced Inspection 13.15 17 March 2008 th 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 Moorside Hall DS0000009681.V347046.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. Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Moorside Hall Address Wyresdale Road Lancaster Lancashire LA1 3DY 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) 01524 69901 01524 68176 Mrs Kathryn Lesley Regan Mr Robert John Murray vacant post Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (6) of places Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service is registered to accommodate a maximum of 22 service users in the category DE (Dementia). The service may accommodate 6 named service users in the category of OP (older persons 65 and over) within the overall maximum number of 22 14th December 2006 Date of last inspection Brief Description of the Service: Moorside Hall is a care home registered with the Commission for Social Care Inspection to accommodate up to 22 people with a dementia, it can accommodate 6 named people who are aged over 65 years within the overall total of 22. Set in its own grounds, and close to Lancaster City Centre, the home consists of mainly single bedrooms with en-suite facilities with a toilet and a hand-wash basin. There is a large conservatory with a dining room and a lounge adjacent to it. There is also a small lounge on the first floor. The first floor is accessible by a passenger lift. Mr Murray is one of the proprietors of Moorside Hall and also employs a care manager. Prior to admission, residents care needs are assessed and individual care plans are implemented. Access to health care services such as General Practitioners or District Nurses is arranged as required, as is the services of visiting professional such as Dentists, and Chiropodists. The current fees at the home range from £380 to £495 per week depending upon the needs of the individual. Moorside Hall DS0000009681.V347046.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. This home has been inspected against the National Minimum Standards for older people introduced in April 2002. This inspection lasted for 3.5 hour during the day on 17/03/08 This inspection was unannounced in that neither the residents, staff nor management team were aware that it was to take place that day. The site visit is part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The site visit involved; • • • • • Observations of care practices Talked with the residents Interviews with the staff, the care manager and one of the providers. Examination of records that are required to be maintained including plans of care. A tour of the premises Before the visit took place, the service providers were asked to complete an AQAA (Annual Quality Assurance Assessment) this document is required to be completed annually and reflects how the services are provided. The term ‘We’ used in this report refers to the Commission for Social Care Inspection. In the report there are references to the “tracking process”, this is a method whereby the inspector focuses on a small group of residents during the site visit. All records relating to these individuals are examined. Residents are invited to discuss their experiences of the home with the inspector. A response to surveys was requested from residents, relatives, staff and visiting professionals. The comments contained in the completed surveys from professionals included: “The service cares well physically and mentally for the residents respecting their dignity.” Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 6 “They liaise well with medical and nursing staff.” “Excellent establishment. Staff friendly, helpful and professional.” The comments contained in the completed surveys from staff included: “Sometimes we are short staffed as Bank Staff let us down” “This service tends to the needs of the residents very well” “Moorside Hall are very good at giving the staff the training they need.” What the service does well: What has improved since the last inspection? What they could do better: The surveys completed by staff and some of the families of the residents reflected that there is a need for more activities appropriate for people with dementia. Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 7 A number of staff employed at the home stated that there are times when the home is short staffed. They further added that this is usually due to Bank staff letting the home down. When these issues were discussed with Mr Murray, one of the providers, he immediately said “we will look into these concerns and have them addressed.” 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. Moorside Hall DS0000009681.V347046.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 Moorside Hall DS0000009681.V347046.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): Standard 3 This service does not offer intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good arrangements for the needs of potential residents to be assessed prior to them taking up residency at Moorside Hall thereby ensuring the service is able to meet their needs. EVIDENCE: Pre-admission assessments were looked at and were completed satisfactorily; they include all aspects of physical, social and psychological care, making sure that the prospective resident’s needs are identified and that the home can provide the care that is needed. Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 10 These assessments are done by a the homes care manager and agreed by the resident and/or their family. All residents are assessed by the same tool, thus promoting equality of assessment and care provision. From the initial assessment care plans are develped to ensure people receive a service that meets their individual needs. The written information about the home is thorough and would enable relatives to know whether this was the right home for there loved one. People are encouraged to visit the home before making a decision as to whether they would like a trial stay. Moorside Hall DS0000009681.V347046.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): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements to meet the health, personal and social care needs of the residents are outlined in the individual’s care plan. This results in people feeling content in the home. EVIDENCE: The management has recently developed a new system for recording information about the individual and their needs. This includes health care, personal and social care. The care plans for three people were viewed as part of the tracking process. Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 12 All files contained the following: - Social Services “Core Assessment” in addition to a full assessment by the home prior to the persons admission to Moorside Hall. - An in-depth care plan reflecting all needs and how these are to be met. Including how to manage/prevent behaviours that challenge. - Risk assessments as appropriate to the individual. - A record of residents meetings and issues raised. - Moving and handling needs - Dietary needs - Record of activities that the person has participated in Each resident also has a “My life story” book that the resident and their relatives have contributed to, this tells of the person’s life, past and present. On file for some residents is a document “when I die” this is a diverse document that outlines the persons wishes upon death and is appropriate for all cultures, sexes and religions. It ensures the person’s wishes are known and are then carried out according to their religious needs and wishes. The residents said they are ‘Well looked after’ ‘and ‘the staff are all very nice. The staff spoken with were aware of the individual care plans and of people’s needs. We noticed that some residents had dried food on their clothing, it is important to enable people to maintain their dignity and ensure they appear, as they would have chosen to appear prior to their dementia. People who are prescribed medication have signed a ‘Medical Declaration’ form outlining whether they wish to self medicate or have the staff administer their prescribed medication to them. This recognises people’s rights to be independent within a risk assessment framework. Medication is administered and stored correctly. Medication Administration Record sheets are signed at the time of administration therefore ensuring medication is not administered incorrectly. The following comments were made by a visiting GP: Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 13 “The service cares well physically and mentally for the residents respecting their dignity. Liaise well with medical and nursing staff. Excellent establishment. Staff friendly, helpful and professional.” Moorside Hall DS0000009681.V347046.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): Standards 12, 13, 14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. This service is constantly looking to increase the activities on offer thereby ensuring people have a fulfilling lifestyle. People benefit from a balanced diet. EVIDENCE: The manager outlined the activities provided such as knitting, tai chi, visiting entertainers and sing-along are regularly provided. Each resident’s activities programme is recorded on his or her file. We looked at 3 files as part of the ‘Tracking process’. For some people there were regular visits by family and/or taken out by family. People who did not have family taking them out, had a less active social life. Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 15 The majority of surveys completed by staff and families of the residents outlined the need for more activities. Comments included: ‘We need more entertainment and activities for the residents’ and ‘There are not always enough activities’ Staff and residents made the following suggestions for activities during this inspection: ‘Outings to the park in Summer and have an ice-cream’ Taxi ride to Morecambe down the promenade, to look at the scenery and reminisce.’ Cheese and wine evening and invite the families of the residents’ This was discussed with one of the service providers and he agreed to look into this. There was evidence that people choosing to go to church were enabled to do so. Indeed one lady went to a church meeting during this inspection. The care manager explained they are developing photo albums of significant events in the individuals’ life to use as a discussion point. We looked at examples of these. It was apparent from viewing the individual activity records that families are welcomed in the home. Indeed on the day of this inspection one man explained how he visited his relative regularly and he is always made welcome and offered refreshment. He was full of praise for the staff and their kindness. Stating ‘It’s lovely here, all the staff are lovely’ The dietary needs of each resident are recorded on their file. The menus reflect choice and a healthy balanced diet was on offer. All meals are home made with cakes and puddings being popular. The residents stated that the food was good. Comments included: ‘We get good meals’ and ‘The food is so good I am putting on weight’ A four weekly menu is in operation and offer a choice of meals. Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides a safe environment where the people are well protected from abuse. EVIDENCE: The homes complaints procedure ensures people’s diverse needs are met, in that it is in picture and large print format. The management have developed a complaints file, which includes a procedure entitled “ Managing Complaints”. This procedure requires that an acknowledgement letter be sent to the complainant. The complaints record reflects that complaints are taken seriously and acted upon. The solution/outcome is recorded. This positive attitude towards complaints is indicative of the professional management style and ensures people feel free to raise small issues to prevent them from becoming major ones. Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 17 However over the recent weeks there have been a number of complaints made to the Commission for Social Care Inspection the majority of which were anonymous. The provider has looked into them and has satisfied the Commission for Social Care Inspection with the actions he has taken to investigate the concerns raised. The management take very seriously all allegations of abuse and take appropriate steps to protect people from abuse. We looked at the home’s complaints record. Some of the residents had complained about the quality of the TV picture. Appropriate action had been taken and recorded. Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 18 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): Standards 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The resident’s benefit from living in a safe environment that is well maintained EVIDENCE: Moorside Hall is a detached building set in it is own grounds with a garden that is secure for people to walk in. There are 18 single bedrooms and 2 twin bedded rooms. All bedrooms have en suite facilities. Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 19 The home has been well carpeted and decorated offering a pleasant environment to live in. Central heating radiators have been fitted with low heat surface covers to Prevent residents from burning themselves against very hot radiators. Hot water outlets have a thermostatically controlled valve on them to prevent people being scalded. Bedroom doors have an appropriate lock with the resident having the key to their own room, unless a risk assessment dictates otherwise. All bedroom doors have the occupants photograph on the door to make it easier for the residents to find their own room. It was noted that the lounge carpet was in need of cleaning as it has become grubby looking in the areas most walked on. The home was generally clean and odour free. The curtains in a number of rooms are in need of re hanging as hooks have come out from part of them and detract from the homely appearance of the home. Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 20 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): Standards 27, 28, 29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents’ benefit from a well recruited and trained staff team. EVIDENCE: Staff training is seen as an imoortant factor in caring for vulnerable people, the home has a staff training room in the basement of the home. The staff training records that were examined showed that induction and training and the mandatory health and safety training programmes were in in place. Other training included Dementia Awareness First Aid Medication Awareness Risk Assessment Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 21 12 staff have achieved a National Vocational Qualification level 2 in care and 2 are currently taking the training for this award. 5 staff have achieved a National Vocational Qualification level 3 in care and 3 are taking this training. This means the home will have 98 of the staff with an National Vocational Qualification. This reflects the importance the providers place in ensuring the staff are appropriately trained to carry out their role effectively. The information provided in staff files confirmed the registered provider of Moorside Hall operates a thorough recruitment procedure so as to ensure the safety and well being of residents accommodated there. In all staff files viewed, a full employment history had been obtained and in discussion, the care manager confirmed that any gaps in a candidate’s employment history would be investigated. In addition, two written references and a satisfactory Criminal Records Bureau clearance were available on the files examined. A completed survey received from a visiting GP included the following comment: ‘Care staff meet the needs of the residents.’ A number of staff stated in their surveys: ‘ We sometimes do not have enough staff as Bank staff let us down.’ And ‘When I first started at Moorside they were very helpful in doing the training I needed. There are not always enough staff.’ The provider stated he will look into this issue to ensure the staffing level meets the needs of the residents. Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 22 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): Standards 31, 33, 35 and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The management at Moorside Hall demonstrate they are open and honest. They ensure people’s finances are safe guarded. EVIDENCE: The service provider, care manager and the staff ensure that the home keeps the residents and their families informed at all times about the running of the Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 23 home and the services on offer and welcome comments as to how they can improve the service. Formal consumer surveys are carried out yearly to ensure people are content in the care they receive. The management team of the home have all achieved the National Vocational Qualification Registered Managers Award, ensuring they are aware of their role in managing a care home. The care manager of the home has a very ‘hands on’ approach to her work and closely monitors daily care practices and standards. In discussion, staff confirmed that Mrs Holroyd (Care Manager) and Mr Murray (Service provider) were approachable managers who welcomed new ideas and suggestions. Residents are supported to manage their own financial affairs for as long at they are able or wish to do so. However for the majority of the current residents this is not possible, therefore third party advice such as from a relative or advocate is sought. Where the home has to be involved in handling any resident’s money, this is recorded in detail e.g. the amount credited/debited, the reason for the debit, the balance and this record is signed and witnessed at each transaction. The home does not currently look after any resident’s money. Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 24 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 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 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 3 Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18(1)(a) Requirement The service provider must ensure there are adequate numbers of staff to meet the needs of the residents at all times Timescale for action 30/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP12 OP7 Good Practice Recommendations The service provider should ensure people have activities they wish to participate in and record when people refuse People receiving services should be assisted to ensure their dignity is upheld, including enabling them to change clothing after a meal if necessary Moorside Hall DS0000009681.V347046.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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. 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